[1]徐燕军,赵俊功,魏黎明,等.逆行腔内血管成形术与常规顺行成形术治疗膝下动脉闭塞性病变临床研究[J].介入放射学杂志,2015,(07):575-581.
 XU Yan- jun,ZHAO Jun- gong,WEI Li- ming,et al.Retrograde endovascular angioplasty and conventional anterograde endovascular angioplasty for the treatment of below- the- knee arterial occlusion diseases: a comparative study[J].journal interventional radiology,2015,(07):575-581.
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逆行腔内血管成形术与常规顺行成形术治疗膝下动脉闭塞性病变临床研究()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2015年07期
页码:
575-581
栏目:
血管介入
出版日期:
2015-07-25

文章信息/Info

Title:
Retrograde endovascular angioplasty and conventional anterograde endovascular angioplasty for the treatment of below- the- knee arterial occlusion diseases: a comparative study
作者:
徐燕军 赵俊功 魏黎明 朱悦琦 鲁海涛 张蓓蕾 朱海云 程永德
Author(s):
XU Yan- jun ZHAO Jun- gong WEI Li- ming ZHU Yue- qi LU Hai- tao ZHANG Pei- lei ZHU Hai- yun CHENG Yong- de
Department of Diagnostic and Interventional Radiology, Affiliated Sixth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200233, China
关键词:
【关键词】 膝下动脉闭塞性病变 足底动脉弓 血管成形术
文献标志码:
A
摘要:
【摘要】 目的 探讨经足背-足底(TDP)或足底-足背(TPD)动脉环逆行腔内血管成形术与常规顺行血管成形术治疗膝下动脉闭塞性病变的临床疗效。方法 回顾性分析2009年10月至2011年7月接受常规顺行血管成形术的96例膝下动脉闭塞性病变患者112条患肢,其中27条顺行手术失败患肢接受经TDP或TPD动脉环逆行腔内血管成形术。根据手术前踝-臂指数(ABI)、基于冠状动脉造影的心肌梗死溶栓(TIMI)后血流评分(TIMI评分)及足背或足底动脉搏动评分,评价比较顺行血管成形术治疗成功组(常规组,71例患者85条患肢)和经TDP或TPD动脉环逆行腔内血管成形术治疗成功组(逆行组,20例患者22条患肢)术后肢体挽救率及靶血管通畅率。结果 逆行组和常规组手术成功率分别为75.9%和74%(P>0.05),ABI分别由术前0.55±0.21和0.56±0.14改善为术后0.93±0.19和0.89±0.18(P>0.05);逆行组和常规组TIMI评分分别由术前0.1±0.5和0.8±0.8改善为术后2.5±0.6和1.8±0.8(P<0.000 1),逆行组患者远侧足部组织获得更好血流灌注。逆行组和常规组术后12、24个月靶血管一期通畅率分别为63.6%(14/22)、45.5%(10/22)和52.9%(45/85)、37.6%(32/85)(P>0.05)。术后24个月Kaplan- Meier 生存分析曲线评价显示逆行组和常规组肢体挽救率分别为95.5%和96.5%(P>0.05)。结论 与常规顺行血管成形术相比,经TDP或TPD动脉环逆行腔内血管成形术治疗膝下动脉闭塞性病变可获得更好的即刻血流改善情况以及相似的ABI改善情况、一期通畅率及肢体挽救率,可作为顺行血管成形术失败后的有效替补治疗方法。

参考文献/References:

[1] Faglia E, Clerici G, Caminiti M, et al. Mortality after major amputation in diabetic patients with critical limb ischemia who did and did not undergo previous peripheral revascularization Data of a cohort study of 564 consecutive diabetic patients[J]. J Diab Complicat, 2010, 24: 265- 269.
[2] Faglia E, Dalla Paola L, Clerici G, et al. Peripheral angioplasty as the first- choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003[J]. Eur J Vasc Endovasc Surg, 2005, 29: 620- 627.
[3] Park SW, Kim JS, Yun IJ, et al. Clinical outcomes of endovascular treatments for critical limb ischemia with chronic total occlusive lesions limited to below- the- knee arteries[J]. Acta radiol, 2013, 54: 785- 789.
[4] Lo RC, Darling J, Bensley RP, et al. Outcomes following infrapopliteal angioplasty for critical limb ischemia[J]. J Vasc Surg, 2013, 57: 1455- 1463.
[5] Scheinert D, Katsanos K, Zeller T, et al. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus- eluting stent in patients with ischemic peripheral arterial disease: 1- year results from the Achilles trial[J]. J Am Coll Cardiol, 2012, 60: 2290- 2295.
[6] 朱悦琦, 赵俊功, 李明华, 等. 经足背-足底或足底-足背动脉环逆行腔内成形术治疗糖尿病踝下动脉闭塞性病变的临床研究[J]. 介入放射学杂志, 2011, 20: 185- 190.
[7] Fusaro M, Dalla PL, Brigato C, et al. Plantar to dorsalis pedis artery subintimal angioplasty in a patient with critical foot ischemia: a novel technique in the armamentarium of the peripheral interventionist[J]. J Cardiovasc Med (Hagerstown), 2007, 8: 977- 980.
[8] Zhu YQ, Zhao JG, Li MH, et al. Retrograde transdorsal- to- plantar or transplantar- to- dorsal intraluminal re- entry following unsuccessful subintimal angioplasty for below- the- ankle arterial occlusion[J]. J Endovasc Ther, 2010, 17: 712- 721.
[9] Manzi M, Fusaro M, Ceccacci T, et al. Clinical results of below- the knee intervention using pedal- plantar loop technique for the revascularization of foot arteries[J]. J Cardiovasc Surg (Torino), 2009, 50: 331- 337.
[10] Chomel S, Douek P, Moulin P, et al. Contrast- enhanced MR angiography of the foot: anatomy and clinical application in patients with diabetes[J]. AJR Am J Roentgenol, 2004, 182: 1435- 1442.
[11] Manzi M, Cester G, Palena LM, et al. Vascular imaging of the foot: the first step toward endovascular recanalization[J]. Radiographics, 2011, 31: 1623- 1636.
[12] Palena LM, Brocco E, Manzi M. The clinical utility of below- the- ankle angioplasty using "transmetatarsal artery access" in complex cases of CLI[J]. Catheter Cardiovasc Interv, 2014, 83: 123- 129.
[13] Palena LM, Manzi M. Extreme below- the- knee interventions: retrograde transmetatarsal or transplantar arch access for foot salvage in challenging cases of critical limb ischemia[J]. J Endovasc Ther, 2012, 19: 805- 811.
[14] Gibson CM, Cannon CP, Murphy SA, et al. Relationship of the TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to long- term outcomes after thrombolytic administration in acute myocardial infarction[J]. Circulation, 2002, 105: 1909- 1913.
[15]吴正阳, 朱悦琦, 谭华桥, 等. 经足底动脉弓成形术与常规腔内或内膜下成形术治疗糖尿病踝下病变的对比研究[J]. 介入放射学杂志, 2012, 21: 625- 629.
[16] Gardner AW, Parker DE, Montgomery PS, et al. Diabetic women are poor responders to exercise rehabilitation in the treatment of claudication[J]. J Vasc Surg, 2014, 59: 1036- 1043.
[17] Liu J, Wu Y, Li Z, et al. Endovascular treatment for intermittent claudication in patients with peripheral arterial disease: a systematic review[J]. Ann Vasc Surg, 2014, 28: 977- 982.
[18] Giugliano G, Perrino C, Schiano V, et al. Endovascular treatment of lower extremity arteries is associated with an improved outcome in diabetic patients affected by intermittent claudication[J]. BMC Surg, 2012, 12 Suppl 1: S19.

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备注/Memo

备注/Memo:
(收稿日期:2014-11-03)
(本文编辑:边 佶)
更新日期/Last Update: 2015-07-22