Nazzal M, Kaidi A, Thanh P
Department of Surgery, University of Iowa Hospital and Clinical, Iowa City 52242, USA.
J Cardiovasc Surg (Torino). 1998 Apr;39(2):131-5.
Thirty-three patients (34 limbs) with peripheral vascular occlusive disease were treated with Nd Yag laser assisted angioplasty over a three-year period (1989-1991).
Sixteen males and 17 females were included in the study. The mean age of all patients was 70.29 (44-86) years. Twenty-two (66.7%) patients were smokers, 21 (63.6%) had coronary artery disease and 14 (42.4%) had diabetes mellitus. Thirty-three patients (100%) had disabling intermittent claudication, 20 patients (60.6%) had rest pain, 2 patients (6.1%) had ulcers and 10 patients (30.3%) had gangrenous changes. Thirty-nine vessels were treated; 34 (87.2%) superficial femoral arteries, 4 (10.3%) popliteal arteries and 1 external iliac artery. Eleven (28.2%) vessels were totally occluded and the remaining 28 (71.8%) vessels had high grade stenosis of more than 90%. The mean preoperative ABI Index was 0.23+/-12.
The preoperative angiogram showed poor out-flow in 24 (70.6%) extremities, 1 patent distal vessel in 7 extremities (20.6%) and at least 2 vessels in 3 extremities (8.8%). The patients were followed up for a period of 9.9 months (20 days-30 months). The procedure could not be done in 2 extremities. All the remaining 32 extremities had patent vessels at the end of the procedure. Fifteen (48.4%) patients stated that they improved but remained symptomatic. Twelve (38.7%) were completely asymptomatic, 3 (9.7%) patients had no change in their symptoms and 2 patients worsened at the end of the follow-up period. The mean postoperative ABI was 0.78. Bleeding from the puncture site requiring closure was the most common complication of the procedure in 6 patients (19.4%). Angioplasty in 5 of these patients was done by the open technique. Other complications included hematoma in 3 (9.7%) patients and one case (3%) of artery perforation. Among those who remained asymptomatic at the end of the follow-up period the mean change in ABI was 0.625+/-0.19, those who improved but remained symptomatic the mean ABI change was 0.43+/-0.25 while those whose symptoms did not change or worsened the mean ABI change was 0.12+/-0.13. The ABI change in the first two groups was significantly higher than the last one (p<0.006 and p<0.001 respectively). There was no significant difference in the outcome of LABA between stenosed and occluded vessels. Smoking was significantly higher in the symptomatic patients (7/20) compared to those who were asymptomatic 5/12, p<0.02. Diabetes mellitus, cardiovascular disease and the preoperative ABI were not significant variables in the outcome of angioplasty.
In conclusion, Nd Yag laser assisted angioplasty is a safe procedure. It could relieve symptoms in 87.1% of cases. Change in the ABI and smoking are predictive of the success of the procedure.
在1989年至1991年的三年时间里，对33例（34条肢体）外周血管闭塞性疾病患者进行了钕钇铝石榴石激光辅助血管成形术治疗。
本研究纳入16例男性和17例女性。所有患者的平均年龄为70.29（44 - 86）岁。22例（66.7%）患者吸烟，21例（63.6%）患有冠状动脉疾病，14例（42.4%）患有糖尿病。33例患者（100%）有致残性间歇性跛行，20例（60.6%）有静息痛，2例（6.1%）有溃疡，10例（30.3%）有坏疽改变。共治疗39条血管；34条（87.2%）为股浅动脉，4条（10.3%）为腘动脉，1条为髂外动脉。11条（28.2%）血管完全闭塞，其余28条（71.8%）血管有超过90%的高度狭窄。术前平均踝肱指数（ABI）为0.23±0.12。
术前血管造影显示，24条肢体（70.6%）流出道不佳，7条肢体（20.6%）有1条远端血管通畅，3条肢体（8.8%）有至少2条血管通畅。对患者进行了9.9个月（20天至30个月）的随访。2条肢体无法进行该手术。其余32条肢体在手术结束时血管均通畅。15例（48.4%）患者表示病情有所改善但仍有症状。12例（38.7%）完全无症状，3例（9.7%）患者症状无变化，2例患者在随访期末病情恶化。术后平均ABI为0.78。穿刺部位出血需要缝合是该手术最常见的并发症，共6例（19.4%）。其中5例患者通过开放技术进行了血管成形术。其他并发症包括3例（9.7%）患者出现血肿，1例（3%）动脉穿孔。在随访期末无症状的患者中，ABI的平均变化为0.625±0.19，病情改善但仍有症状的患者ABI平均变化为0.43±0.25，而症状无变化或恶化的患者ABI平均变化为0.12±0.13。前两组的ABI变化显著高于最后一组（分别为p<0.006和p<0.001）。狭窄血管和闭塞血管的激光辅助血管成形术结果无显著差异。有症状患者中的吸烟者比例（7/20）显著高于无症状患者（5/12），p<0.02。糖尿病、心血管疾病和术前ABI在血管成形术结果中不是显著变量。
总之，钕钇铝石榴石激光辅助血管成形术是一种安全的手术。它能在87.1%的病例中缓解症状。ABI的变化和吸烟情况可预测手术的成功与否。
