单纯球囊扩张与联合药物涂层支架置入治疗膝下动脉闭塞性疾病的效果比较

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摘要目的对比分析单纯球囊扩张与联合药物涂层支架置入治疗膝下动脉闭塞性病变的效果。方法回顾性分析2013年3月～2015年10月首都医科大学宣武医院收治的126例（139条肢体）行腔内治疗的膝下动脉闭塞性疾病患者的临床资料。所有病变均先行球囊扩张治疗，其中32条肢体在膝下动脉内增加了药物涂层支架置入治疗，术后观察患者症状的改善，踝肱指数的变化，血管超声下的影像学改变，保肢率以及近期通畅率等。结果 8例（10条肢体）手术失败，成功者踝肱指数（ABI）由术前的（0.39±0.13）提高至术后3 d的（0.82±0.16）（P < 0.05）。总体的膝下动脉血流通畅率在术后6个月为83.5%（101/121），术后12个月为69.5%（57/82），其中单纯行球囊扩张术的通畅率分别为83.3%（75/90）和71.0%（44/62），行支架置入术的通畅率分别为83.9%（26/31）和65.0%（13/20），单纯行球囊扩张与行支架置入术后的疗效比较，差异无统计学意义（P > 0.05）。结论伴有药物涂层支架置入的腔内介入治疗与单纯球囊扩张均可应用于治疗膝下动脉闭塞性疾病，两者的短期疗效是相近的。在治疗膝下动脉病变过程中若有严重的影响血流的并发症时还应考虑行支架置入，以改善患肢血运，避免并发症，提高保肢率。

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	吴中俭谷涌泉▲ 齐立行郭连瑞崔世军李建新杨盛家佟铸

关键词 ：腔内介入治疗, 膝下动脉, 支架置入, 球囊扩张

Abstract：Objective To compare and analyze the efficacy of balloon dilatation alone and combination with drug eluting stent implantation in the treatment of infrapopliteal arterial occlusive disease. Methods The clinical data of 126 patients (139 limbs) with infrapopliteal arterial occlusive disease and underwent the endovascular treatment from March to 2013 and October 2015 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. All the cases received balloon dilatation therapy at first, and 32 limbs among them received the drug-eluting stent implantation in infrapopliteal artery. After the surgery, the improvement of symptoms, the change of ankle brachial indexes, changes of vascular ultrasonic images, the limb salvage rate and recent patency rate and so on were observed. Results 8 patients (10 limbs) failed, and the ankle brachial index (ABI) of successful cases increased from before surgery (0.39±0.13) to 3 days after the surgery (0.82±0.16) (P < 0.05). Overall infrapopliteal arterial patency rate 6 months after the operation was 83.5% (101/121), and 12 months after operation was 69.5% (57/82), the patency rates of those with balloon dilatation alone were 83.3% (75/90) and 71.0% (44/62) respectively, the patency rates of those with stent implantation were 83.9% (26/31) and 65.0% (13/20) respectively, there were no statistical difference in efficacy between balloon dilation alone and stent implantation 6 months and 12 months after operation (P > 0.05 ). Conclusion Both endovascular interventional therapy with drug eluting stent implantation and balloon dilatation alone can be used to treat infrapopliteal arterial occlusive disease and they are with similar short-term efficacy. If there are severe complications that affect the blood flow in the treatment of infrapopliteal arterial disease, stent implantation should be considered to improve limb blood flow, avoid the complications and improve the limb salvage rate.

Key words： Endovascular interventional therapy Infrapopliteal artery Stent implantation Balloon dilatation

基金资助:北京市医管局临床技术创新项目（XMLX201610）；
北京市医管局登峰人才项目（DFL20150801）。

通讯作者: ▲通讯作者

引用本文:

吴中俭谷涌泉▲ 齐立行郭连瑞崔世军李建新杨盛家佟铸 . 单纯球囊扩张与联合药物涂层支架置入治疗膝下动脉闭塞性疾病的效果比较[J]. 中国医药导报, 2017, 14(22): 66-68.
WU Zhongjian GU Yongquan▲ QI Lixing GUO Lianrui CUI Shijun LI Jianxin YANG Shengjia TONG Zhu. Comparison the effect of balloon dilatation alone and combination with drug eluting stent implantation in treatment of infrapopliteal arterial occlusive disease. 中国医药导报, 2017, 14(22): 66-68.

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