CAJ | 학술논문

目的：探讨动脉粥样硬化所致下肢动脉狭窄或闭塞血管腔内治疗的临床可行性及应用价值。方法2009年1月至2013年12月我科收治经CT血管造影(CTA)和数字减影血管造影(DSA)证实为动脉粥样硬化性下肢动脉狭窄或闭塞患者36例(42条患肢)，将行经皮腔内球囊扩张血管成形术(PTA)或/和支架植入术治疗。按照Fontaine分型治疗后临床症状改善1级或1级以上为临床成功，PTA后血管残余狭窄小于30%为技术成功。通过术后临床症状改善和CTA/MRA随访来评价治疗效果。结果 PTA技术成功率为95.2%(40/42)，1条技术不成功，1例术后合并动脉血栓，无血管夹层形成。39条肢体症状改善明显，2条无明显改善，踝肱指数从(0.50±0.11)至(0.82±0.15)。术后随访6个月Fontaine分型提高1、2、3级的患者分别为23例、13例和4例(40条患肢)。随访3~15个月，1条股动脉在12个月再次闭塞，1条胫后动脉术后8月再次闭塞，通畅率为92.8%。结论动脉粥样硬化所致下肢动脉狭窄或闭塞腔内介入治疗是安全，有效的，其有助于改善下肢血运，提高通畅率，改善患者生存质量，提高中长期保肢率。
목적：탐토동맥죽양경화소치하지동맥협착혹폐새혈관강내치료적림상가행성급응용개치。방법2009년1월지2013년12월아과수치경CT혈관조영(CTA)화수자감영혈관조영(DSA)증실위동맥죽양경화성하지동맥협착혹폐새환자36례(42조환지)，장행경피강내구낭확장혈관성형술(PTA)혹/화지가식입술치료。안조Fontaine분형치료후림상증상개선1급혹1급이상위림상성공，PTA후혈관잔여협착소우30%위기술성공。통과술후림상증상개선화CTA/MRA수방래평개치료효과。결과 PTA기술성공솔위95.2%(40/42)，1조기술불성공，1례술후합병동맥혈전，무혈관협층형성。39조지체증상개선명현，2조무명현개선，과굉지수종(0.50±0.11)지(0.82±0.15)。술후수방6개월Fontaine분형제고1、2、3급적환자분별위23례、13례화4례(40조환지)。수방3~15개월，1조고동맥재12개월재차폐새，1조경후동맥술후8월재차폐새，통창솔위92.8%。결론동맥죽양경화소치하지동맥협착혹폐새강내개입치료시안전，유효적，기유조우개선하지혈운，제고통창솔，개선환자생존질량，제고중장기보지솔。
Objective To assess the clinical value of endovascular interventional treatment for lower limb ar-tery stenosis or occlusion due to atherosclerosis. Methods Thirty-six lower limb artery stenosis or occlusion cases (42 limbs) proved by CTA/DSA between Jan. 2009 and Dec. 2013 from the hospital were collected and given treatment of percutaneous transluminal angioplasty (PTA) or/and stent implantation. According to Fontaine classification, clinical suc-cess was identified when patients`clinical symptoms were improved by one or more grade, and residual stenosis<30%were defined as technical success. The treatment' efficacy was evaluated through the improvement of clinical symptoms and manifestation of CTA/MRA follow-up. Results The PTA technical success rate was 95.2%(40/42), with one failed and one with postoperative combined arterial thrombosis and no dissection. Clinical symptoms were improved signifi-cantly in 39 limbs while not obvious in 2 limbs, ankle-brachial index (ABI) increased from (0.50±0.11) to (0.82±0.15). After 6 months of follow-up, there were respectively 23, 13, and 4 cases (40 limbs) of Fontaine grade 1, 2 and 3 improvements. After 3~15 months of follow-up, there were one femoral artery occlusion at the 12th month and one posterior tibial artery reocclusion at the postoperative 8th month, the total patency rate was 92.8%. Conclusion Endovascular interventional treatment is safe and effective for lower limb artery stenosis or occlusion. The treatment could improve lower limb blood supply, patency rate, life quality, and the long-term rate of limb salvage.