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目的评估下肢动脉严重狭窄患者经皮球囊成形术或选择性支架置入术的近中期临床疗效和安全性。方法连续136例下肢严重间歇性跛行或慢性缺血的患者,病因均为动脉粥样硬化,其中髂动脉阻塞81例,股浅动脉阻塞43例,腘动脉阻塞12例,所有病变首先均进行经皮球囊成形术,如果有夹层或残余狭窄>30%,则置入支架。随访1年,在6个月和12个月时评估再狭窄和临床疗效。结果共进行36例经皮球囊成形术和99例选择性支架置入术。术前病变狭窄程度70%～100%(88.6%±7.5%),狭窄长度1.5～18.0 cm[(6.2±2.9)cm],治疗节段2.0～19.0 cm[(7.3±3.2)cm],术后残余狭窄0%～30.0%(8.7%±5.1%)。手术相关的并发症2例。6个月随访发现,再狭窄率在髂动脉、股腘动脉和所有病变分别为7.3%、19.4%和12.3%,球囊成形术组和支架置入术组再狭窄率分别为17.8%比10.2%(P>0.05);12个月随访发现,再狭窄率在髂动脉、股腘动脉和所有病变分别为12.5%、29.9%和19.6%,球囊成形术组和支架置入术组再狭窄率分别为28.9%比16.1%(P>0.05)。但6 min 最大步行距离和踝肱收缩压比球囊成形术组均显著小于支架置入术组(P<0.001)。12个月随访期间发生急性心肌梗死3例和小卒中2例,无死亡病例。结论经皮介入治疗下肢动脉阻塞安全有效。中期疗效显示,选择性支架置入术组的再狭窄率与球囊成形术组相当,但6 min 最大步行距离和踝肱收缩压比优于球囊成形组。
Objective To evaluate the clinical efficacy and safety of percutaneous balloon angioplasty or selective stenting in patients with severe lower extremity arterial stenosis. Methods A total of 136 consecutive patients with severe intermittent claudication or chronic ischemia of the lower extremity were all atherosclerotic. The incidences of iliac artery occlusion in 81 cases, superficial femoral artery occlusion in 43 cases and popliteal artery occlusion in 12 cases were all higher than those in the control group Balloon angioplasty, stenting if there is dissection or residual stenosis> 30%. One year follow-up, restenosis and clinical efficacy were assessed at 6 and 12 months. Results A total of 36 cases of percutaneous balloon angioplasty and 99 cases of selective stenting were performed. Preoperative stenosis ranged from 70% to 100% (88.6% ± 7.5%), stenosis length ranged from 1.5 to 18.0 cm (6.2 ± 2.9) cm, and treatment ranged from 2.0 to 19.0 cm (7.3 ± 3.2) cm Residual stenosis ranged from 0% to 30.0% (8.7% ± 5.1%). Surgery-related complications in 2 cases. At 6-month follow-up, restenosis rates were 7.3%, 19.4%, and 12.3% in the iliac artery, femoropopliteal artery and all lesions, restenosis rates in balloon-angioplasty and stenting were 17.8% vs 10.2% % (P> 0.05). At 12-month follow-up, restenosis rate was 12.5%, 29.9% and 19.6% in the iliac artery, femoral artery and all lesions, respectively. The restenosis rate in balloon angioplasty group and stenting group Rates were 28.9% and 16.1%, respectively (P> 0.05). However, the maximal walking distance at 6 min and the ankle-brachial-systolic-pressure balloon-angioplasty group were significantly smaller than those of the stenting group (P <0.001). During the 12-month follow-up, 3 cases of acute myocardial infarction and 2 cases of minor stroke occurred without any death. Conclusion Percutaneous interventional treatment of lower extremity artery occlusion is safe and effective. The mid-term results showed that the restenosis rate in the selective stenting group was similar to that in the balloon angioplasty group, but the maximum walking distance at 6 min and the ankle-brachial systolic pressure ratio were superior to the balloon-forming group.