经足底弓腔内成形术治疗踝下动脉闭塞性疾病

摘要

目的：评价经足底弓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2012年10月～2014年1月，对12例（14条患肢）踝下动脉闭塞性病变，采用足底弓腔内成形技术，顺行或逆行成功通过病变，对闭塞段行球囊扩张治疗。观察术后6个月的疼痛视觉模拟评分（VAS），足背或胫后动脉搏动评分，踝肱指数（ABI），患肢侧足背经皮氧分压（TcPO2）和溃疡愈合情况。结果9例（11条患肢）技术成功，除1例术后2个月死于脑血管意外外，其余8例（10条患肢）随访6个月，缺血症状无复发，VAS、ABI、TcPO2分别从术前的5．68±1．09，0．60±0．04，（25．71±5．25） mm Hg，改善至术后6个月的0．44±0．27，0．87±0．05，（35．90±5．28）mm Hg（P＜0．05），动脉搏动评分明显提高（P＝0．004）。溃疡均愈合，未出现相邻神经、血管损伤等严重并发症。1例技术不成功者因疼痛无缓解，感染未控制，行小腿截肢术。结论经足底弓腔内成形对治疗踝下动脉闭塞性病变具有良好前景，但长期效果有待进一步研究。%Objective To assess the feasibility and efficiency of pedal-plantar loop technique in the treatment of below-the-ankle arterial occlusion . Methods A retrospective analysis was undertaken on 12 cases ( 14 legs ) of below-the-ankle arterial occlusion.The pedal-plantar loop angioplasty was performed in all the cases .Balloon angioplasty was performed after traversing through the arterial obstruction sites using antegrade or retrograde technique .After 6 months of the surgery , the results of visual analogue scale , dorsal or plantar arterial pulse volume scores , ankle brachial index , TcPO2 , and healing of the ulcer were compared to preoperative measures. Results Technical success was achieved in 9 cases (11 legs).During follow-up, 1 patient died of cerebrovascular events 2 months after the therapy .The other 8 cases (10 legs) were followed up for 6 months and no one had recurrent ischemic symptoms . The results of visual analogue scale , ankle brachial index, and TcPO2 before the surgery were (5.68 ±1.09) points, 0.60 ±0.04, and (25.71 ±5.25) mm Hg, which were improved to (0.44 ±0.27) points, 0.87 ±0.05, and (35.90 ±5.28) mm Hg (P<0.05).Dorsal or plantar arterial pulse volume scores were also enhanced markedly (P=0.004).Complete ulcer healing was observed in 8 limbs.No related complication was observed in other patients after the surgery .One technical unsuccessful patient who suffered infection and severe rest pain was given leg amputation . Conclusion Pedal-plantar loop technique is an effective therapy for below-the-ankle arterial occlusion while long term follow-up data need to be collected .