Parsons R E, Suggs W D, Lee J J, Sanchez L A, Lyon R T, Veith F J
Divisions of Vascular Surgery and Interventional Radiology, Department of Surgery, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, New York, NY 10467, USA.
J Vasc Surg. 1998 Dec;28(6):1066-71. doi: 10.1016/s0741-5214(98)70033-3.
Results of percutaneous transluminal angioplasty (PTA) in selected cases have been reported to be equal or superior to those of arterial bypass graft surgery, with a lower morbidity and mortality. We performed PTA of stenotic or occlusive lesions in patients with limb-threatening ischemia, hoping to improve our overall success and decrease morbidity in this group of patients. The results of PTA in the limb-salvage setting was evaluated.
From 1992 to 1995, 307 PTAs were performed in 257 patients. One hundred sixty-one (63%) patients had diabetes mellitus, and 32 (12%) patients had renal failure. All patients were evaluated by means of pulse volume recordings and ankle brachial indices at 1 and 6 weeks after PTA and at 3 month intervals thereafter. Seventeen patients (9%) were lost to follow-up. The continued success or failure of PTA was defined by means of noninvasive vascular laboratory criteria, patency by means of pulse examination, the need for subsequent bypass grafting across the index lesion, and limb salvage.
The 1-year patency rates for external iliac PTAs (56%) were significantly lower (P <.05) than those for common iliac PTAs (87%). Infrainguinal PTAs at the femoral, popliteal, and tibial level had 1-year patency rates of less than 15%.
Common iliac artery PTA is justified in most cases in which it is feasible. However, when PTAs are performed below the inguinal ligament, the results are markedly worse. One-year patency rates of PTA in this group of patients with threatened limbs are inferior to the patency rates of arterial bypass grafts, even when these bypasses are performed with a prosthetic material. PTA should not be considered as a primary treatment modality for patients with infrainguinal arterial occlusive disease who also have limb-threatening ischemia, except in unusual circumstances.
据报道，经皮腔内血管成形术（PTA）在部分病例中的效果等同于或优于动脉搭桥手术，且发病率和死亡率更低。我们对有肢体威胁性缺血的患者进行了狭窄或闭塞性病变的PTA，希望提高这组患者的总体成功率并降低发病率。评估了PTA在保肢方面的效果。
1992年至1995年，对257例患者进行了307次PTA。161例（63%）患者患有糖尿病，32例（12%）患者患有肾衰竭。所有患者在PTA后1周和6周以及此后每隔3个月通过脉搏容积记录和踝肱指数进行评估。17例（9%）患者失访。PTA的持续成功或失败通过非侵入性血管实验室标准、通过脉搏检查的通畅情况、是否需要在病变部位进行后续搭桥手术以及保肢情况来定义。
髂外动脉PTA的1年通畅率（56%）显著低于（P<.05）髂总动脉PTA（87%）。股动脉、腘动脉和胫动脉水平的股下PTA的1年通畅率低于15%。
在大多数可行的情况下，髂总动脉PTA是合理的。然而，当在腹股沟韧带以下进行PTA时，结果明显更差。这组有肢体威胁的患者中PTA的1年通畅率低于动脉搭桥手术的通畅率，即使这些搭桥手术使用了人工材料。对于同时患有肢体威胁性缺血的股下动脉闭塞性疾病患者，除非在特殊情况下，PTA不应被视为主要治疗方式。
