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目的评价经足背-足底(transdorsal-to-plantar,TDP)或经足底-足背(transplantar-to-dorsal,TPD)动脉环逆行腔内成形技术,治疗踝下动脉闭塞性病变的可行性和疗效。方法 8例踝下闭塞性病变患者共8条患肢,行传统腔内成形技术失败后接受TDP或者TPD逆行腔内成形技术治疗。所有患者临床症状,足背或者足底动脉搏动评分和踝-臂指数(ABI)术前术后均行比较。随访内容包括疼痛缓解,伤口愈合,肢体挽救及靶血管的再狭窄。结果经TDP或者TPD逆行腔内成形技术在8例患者中的5例(62.5%)获得成功。足部疼痛明显改善,动脉搏动评分和ABI指数从术前的0.60±0.55和0.32±0.20分别上升至术后的2.40±0.55和0.75±0.12(P<0.01)。12个月随访结束时,视觉疼痛评分从术前的7.40±1.14改善至2.20±1.48(P=0.002)。2例难愈性溃疡患者术后1例完全愈合,1例明显缩小。所有手术成功患者均未接受截肢。随访磁共振血管成像(MRA)显示1条靶血管再狭窄。结论经TDP和TPD动脉环逆行腔内成形技术治疗常规腔内成形术失败的糖尿病足部缺血患者是可行和有效的。
Objective To evaluate the feasibility of treating ankle artery occlusive disease via transdorsal-to-plantar (TDP) or retrograde transluminal angioplasty using a transplanted-to-dorsal (TPD) Sex and efficacy. Methods Eight patients with ankle obstructive lesions were treated with TDP or TPD retrograde endoluminoplasty after the failure of traditional endoluminoplasty. All patients had clinical symptoms, dorsal or plantar artery beat scores, and ankle-brachial index (ABI) preoperatively and postoperatively. Follow-up included pain relief, wound healing, limb salvage, and restenosis of target vessels. Results TDP or TPD retrograde endoluminoplasty was successful in 5 of 8 patients (62.5%). Foot pain was significantly improved. Arterial pulse and ABI index increased from 0.60 ± 0.55 and 0.32 ± 0.20 preoperatively to 2.40 ± 0.55 and 0.75 ± 0.12 (P <0.01) postoperatively, respectively. At the end of the 12-month follow-up, the visual acuity score improved from 7.40 ± 1.14 preoperatively to 2.20 ± 1.48 (P = 0.002). Two cases of refractory ulcer patients completely healed in one case, one case was significantly reduced. All patients with successful surgery did not receive amputation. Follow-up Magnetic resonance angiography (MRA) showed one target vessel restenosis. Conclusion TDP and TPD arterial ring retrograde transluminal angioplasty in the treatment of diabetic foot ischemic patients who have failed conventional endoplasty is feasible and effective.