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目的评价内膜下成形技术治疗糖尿病患者踝下动脉闭塞性病变的可行性和安全性。方法内膜下成形术用于治疗37例伴有严重下肢缺血症状,足背动脉和(或)足底动脉闭塞性病变的糖尿病患者。所有患者均不适合血管腔内成形术或外科血管旁路移植术治疗。57条患肢中,31条(54.4%)有组织缺损,51条(89.5%)肢体表现为静息痛。患者的临床症状,足背动脉或者足底动脉的搏动评分和踝-臂指数(ABI)在行内膜下成形技术前后进行比较。随访过程中评估伤口愈合、截肢和靶血管的再狭窄情况。Kaplan-Meier生存曲线用于评价接受治疗患者的肢体挽救率、生存率和免截肢率。结果 57条患肢共66处踝下动脉病变中的55处(83.3%)成功行内膜下成形技术治疗。平均动脉搏动评分和ABI从术前的0.33±0.54和0.31±0.19分别改善为术后的2.04±1.05和0.80±0.14(P<0.01)。术后30 d内1例患者(2.7%)死亡,5例(13.5%)患者发生包括出血,血栓形成或者血管痉挛等轻微并发症。12个月随访时,Kaplan-Meier评分显示肢体挽救率为94.6%,免截肢率为89.2%,生存率为97.3%。结论足背动脉和(或)足底动脉的内膜下成形技术对于具有严重下肢缺血症状而不适合外科血管旁路移植手术治疗的糖尿病患者的肢体挽救率是有效的。
Objective To evaluate the feasibility and safety of subintimal forming in the treatment of ankle artery occlusive disease in diabetic patients. Methods Endarterectomy was used to treat 37 patients with diabetes mellitus with severe lower extremity ischemia, dorsalis pedis artery and / or plantar artery occlusive disease. All patients are unsuitable for endovascular or surgical bypass grafting. Of the 57 limbs, 31 (54.4%) had tissue defects and 51 (89.5%) showed resting pain. The clinical symptoms of the patients, the beating score of the dorsalis pedis artery or the plantar artery, and the ankle-brachial index (ABI) were compared before and after the intima-forming technique. Assessment of wound healing, amputation and target vessel restenosis during follow-up. Kaplan-Meier survival curves were used to evaluate the rate of limb salvage, survival, and amputation-free rate in patients undergoing treatment. Results Fifty-five (83.3%) of 66 ankle artery lesions in 57 limbs were successfully treated with subintimal angioplasty. Mean arterial pulse score and ABI improved from 0.33 ± 0.54 and 0.31 ± 0.19 before surgery to 2.04 ± 1.05 and 0.80 ± 0.14 (P <0.01) after surgery respectively. One patient (2.7%) died within 30 days after surgery and 5 minor complications (13.5%) occurred including bleeding, thrombosis or vasospasm. At 12-month follow-up, the Kaplan-Meier score showed a rate of 94.6% for limb salvage, 89.2% for amputation, and 97.3% for survival. Conclusions Intima-forming techniques of the dorsalis pedis and / or the plantar artery are effective in saving the limb salvage rate of diabetic patients who have severe lower limb ischemic symptoms and are not suitable for surgical bypass grafting.