血管成形术治疗下肢动脉硬化闭塞的预后因素分析

摘要

目的：分析血管腔内成形术（percutaneous transluminal angioplasty ，PTA）治疗下肢动脉硬化闭塞症（arterio‐sclerosis obliterans ，ASO）的临床效果及影响预后的相关因素。方法回顾性分析2012年1月～2014年6月收治的55例下肢动脉硬化闭塞症患者的临床资料。本组患者平均年龄69．5岁，男性36例，女性19例，临床症状包括间歇性跛行3例，静息痛22例，肢体溃疡或坏死30例；单侧肢体病变33例，双下肢病变22例；D‐二聚体增高42例（D‐Ⅱ＞550ug／L），其中伴有糖尿病患者18例，房颤患者15例，高脂血症患者31例；全部患者接受下肢动脉腔内治疗，单纯球囊成形术11例，同时行球囊成形术和支架植入术44例，无围手术期死亡。结果全组55例患者术后随访1～30个月，随访期内复发31例，复发率56．4％，平均生存时间17．2个月，中位生存时间18个月，6个月生存率95．0％，1年生存率85．0％，2年生存率20．0％；单因素分析结果显示病变肢体数目、治疗方法、糖尿病、房颤及高脂血症病史是与 ASO 血管腔内治疗后再狭窄的相关因素；Cox 风险回归分析显示病变肢体数目、糖尿病、高脂血症是影响 ASO 患者行 PTA 治疗预后的独立危险因素，而治疗方法是影响预后的保护因素（ P ＜0．05）。结论病变肢体数目、糖尿病、高脂血症是影响 ASO 患者行PTA 治疗预后的独立危险因素，而治疗方法是影响预后的保护因素，有利于客观评判疗效和生存预期，并提供有效的介入治疗策略。%Objective To analyze the outcome and risk factors of endovascular revascularization of arteriosclerosis oblite‐rans patients .Methods From January 2012 to June 2014 ,55 patients (36 men and 19 women) underwent endovascular revascularization due to lower limb ischemia .3 patients had severe intermittent claudication ,22 patients had rest pain ,30 patients had ulcer or gangrene .11 patients had diabetes mellitus glycuresis ,14 patients had atrial fibrillation ,and 35 pa‐tients had hyperlipemia .Results 11 patients underwent angioplasty ,while the rest 44 patients underwent angioplasty plus primary stent implantation .Perioperative mortality within the first 30 d was 0 .Follow‐up duration were 1 to 30 months . During the follow‐up duration ,31 patients had recurred ,the recurred rate was 56 .4% .The average survival time of the patients’ limbs was 17 .2 months ,and the median time was 18 .0 months .The primary patency rate at 6 ,12 and 24 months were 95% ,85% and 20% .The result of singlevariate Cox model analysis showed that the number of the lesion limbs ,the therapeutic schedule ,the diabetes mellitus glycuresis ,the atrial fibrillation and hyperlipemia were prognosis factors .Multivariate Cox model analysis showed that the number of the lesion limbs ,the diabetes mellitus glycuresis ,and hyperlipemia were the independent prognostic factors .Conclusion The number of the lesion limbs ,the diabetes mellitus glycuresis ,and hyperlipemia influence the prognosis of ASO with percutaneous transluminal angioplasty .