Objective To discuss the application and clinical efficacy of anterograde puncture endovascular management in treating below - knee arteriosclerotic obliteration of lower extremities. Methods During the period from January 2009 to January 2012, a total of 59 patients with below-knee arteriosclerotic obliteration of lower extremities were admitted to authors' hospital to receive percutaneous transluminal angioplasty (PTA). The clinical data were retrospectively analyzed. All the patients were followed up for 3 — 24 months. The preoperative and postoperative Fontaine staging and ankle - brachial index (ABI) were determined, and the results were analyzed. Results The technical success rate of this series was 81.4% (48/ 59). Fontaine stage II group was composed of 27 patients. The technical success rate in this group was 92.6% (25/27). The clinical symptoms were improved in 20 patients, with a remission rate of 80.0% (20/ 25). Fontaine stage HI group was composed of 18 patients. The technical success rate and the remission rate in this group were 83.3% (15/18) and 86.7% (13/15) respectively. Fontaine stage LV group had 14 patients, and the technical success rate and the remission rate in this group were 57.1% (8/14) and 50.0% (4/8) respectively. The technical success rate of Fontaine stage II group was significantly higher than those of Fontaine stage HI group as well as of Fontaine stage LV group (P < 0.03). The clinical remission rate of Fontaine stage II group and Fontaine stage HI group was significantly higher than that of Fontaine stage IV group( P <0.05).After the treatment,the ankle-brachial index increased from preoperative(0.36±0.15)tornpostoperative (0.79 ± 0.16), the difference was statistically significant (P < 0.01). Follow-up rate for patients gaining technical success was 85.4% (41/48). Recurrence at 3, 6, 12 and 24 months after the treatm was seen in 2, 3, 6 and 4 cases respectively. During the follow-up period, amputation had to be carried out in 4 cases, with an amputation rate of 6.8% (4/59). The amputation level was above-knee (n = 1) or below-knee (n = 1), and metatarsal surgical amputation was performed in two cases. Conclusion For the treatment of below-knee arteriosclerotic obliteration of lower extremities, endovascular angioplasty is safe and effective. The clinical symptoms can be well improved with satisfactory short-term and mid-term effectiveness although long-term effectiveness needs to be further evaluated.(J Intervent Radiol, 2013, 22: 154-158)%目的 探讨并评估顺行穿刺腔内治疗在膝下动脉硬化闭塞症中的应用价值及疗效.方法 回顾性分析2009年1月至2012年1月接受腔内血管成形术(PTA)治疗的下肢动脉硬化闭塞症患者59例,随访3个月至2年.对术前及术后的Fontaine分期,踝肱指数(ABI)等资料进行分析比较.结果 本组手术技术成功率为81.4％ (48/59),FontaineⅡ期组27例,成功率为92.6％(25/27),其中20例临床症状得到改善,缓解率为80.0％(20/25)；Ⅲ期组为83.3％(15/18)和86.7％(13/15)及Ⅳ期组57.1％(8/14),其中4例(4/8)症状改善.Ⅱ期技术成功率明显高于Ⅲ期及Ⅳ期组(P＜0.03)；Ⅱ期及Ⅲ期组的临床症状缓解率高于Ⅳ期组,(P＜0.05).ABI由术前的0.36±0.15提升至术后的0.79±0.16,差异有统计学意义(P＜0.01).技术成功患者的随访率为85.4％(41/48),术后第3、6、12和24个月分别有2例、3例、6例和4例复发；期间行截肢(足)手术4例,截肢率6.8％ (4/59).截肢平面在膝关节以上1例,膝下平面截肢1例,2例行跖骨截除.结论 膝下动脉硬化闭塞症患者的血管腔内治疗安全、有效,能改善患者的临床症状.近期及中期疗效较满意,远期疗效的评估有待进一步随访.
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