CAJ | 학술논문

目的：探讨经皮腔内血管成形术（PTA）治疗无流出道显影的下肢动脉硬化闭塞症（ASO）的临床疗效及价值。方法无流出道显影的下肢ASO患者19例，男11例，女8例，年龄48～79岁，中位年龄66岁。所有患者主要临床症状为患肢静息痛，其中10例（47.6%）伴有不同程度足部溃疡和坏疽。所有患者术前均接受患肢多层螺旋CT血管造影及DSA检查。PTA治疗后随访12个月，观察并记录临床症状和体征变化，于术前和术后1、3、6、12个月分别检测患肢跛行距离、足趾皮温、踝肱指数（ABI）、趾肱指数（TBI），并作CTA 或彩色多普勒超声检查。结果19例患者共38条病变肢体，54支血管为无流出道显影的下肢动脉闭塞病变，分别为胫前动脉25支（46.3%）、胫后动脉18支（33.3%）、腓动脉9支（16.7%）、腘动脉2支（3.7%）；肢体PTA技术成功率为89.6%，单血管PTA技术成功率为85.2%。术后所有开通成功的患肢皮温改善明显，疼痛症状明显缓解或消失。术后1、3、6、12个月患者跛行距离、足趾皮温、ABI、TBI等均较术前有显著改善（P＜0.05）。术后12个月肢体血管再狭窄率为39.5%（15/38），肢体血管通畅率为55.3%（21/38），肢体保全率为81.6%（31/38）。结论 PTA治疗无流出道显影的下肢动脉闭塞病变的近期疗效确切，安全性高；远期再狭窄率虽较高，但能有效控制病情发展并缓解临床症状，有助于提高缺血肢体的保全率。
목적：탐토경피강내혈관성형술（PTA）치료무류출도현영적하지동맥경화폐새증（ASO）적림상료효급개치。방법무류출도현영적하지ASO환자19례，남11례，녀8례，년령48～79세，중위년령66세。소유환자주요림상증상위환지정식통，기중10례（47.6%）반유불동정도족부궤양화배저。소유환자술전균접수환지다층라선CT혈관조영급DSA검사。PTA치료후수방12개월，관찰병기록림상증상화체정변화，우술전화술후1、3、6、12개월분별검측환지파행거리、족지피온、과굉지수（ABI）、지굉지수（TBI），병작CTA 혹채색다보륵초성검사。결과19례환자공38조병변지체，54지혈관위무류출도현영적하지동맥폐새병변，분별위경전동맥25지（46.3%）、경후동맥18지（33.3%）、비동맥9지（16.7%）、객동맥2지（3.7%）；지체PTA기술성공솔위89.6%，단혈관PTA기술성공솔위85.2%。술후소유개통성공적환지피온개선명현，동통증상명현완해혹소실。술후1、3、6、12개월환자파행거리、족지피온、ABI、TBI등균교술전유현저개선（P＜0.05）。술후12개월지체혈관재협착솔위39.5%（15/38），지체혈관통창솔위55.3%（21/38），지체보전솔위81.6%（31/38）。결론 PTA치료무류출도현영적하지동맥폐새병변적근기료효학절，안전성고；원기재협착솔수교고，단능유효공제병정발전병완해림상증상，유조우제고결혈지체적보전솔。
Objective To investigate the clinical efficacy and value of percutaneous transluminal angioplasty (PTA) in treating arteriosclerosis obliterans (ASO) of lower extremity that shows no visualization of its vascular outflow tract. Methods A total of 19 patients with ASO of lower extremities showing no outflow tract visualization were included in this study. The patients included 11 males and 8 females with a median age of 66 years (48-79 years. The main clinical symptom was rest pain of the leg in all patients; 10 cases had different degrees of foot ulcer and gangrene. Preoperative multi-slice CT angiography and DSA examination were performed in all patents. After PTA, the patients were followed up for 12 months, the changes of the clinical symptoms and signs were recorded. The claudication distance, toe skin temperature, ankle-brachial index (ABI), toe-brachial index (TBI), and CT angiography or color Doppler examination were separately performed before and one, 3, 6 and 12 months after PTA. Results In the 19 patients (38 diseased limbs in total), ASO with no visualization of vascular outflow tract was detected in 54 arteries, 3%), posterior tibial artery (n=18, 33.3%), peroneal artery (n=9, 16.7%) and popliteal artery (n=2, 3.7%). The technical success rate of limb PTA was 89.5%, while the technical success rate of single artery PTA was 85.2%. After PTA, the skin temperature of all the diseased limbs that had been successfully treated was obviously improved, the pain was significantly relieved or disappeared. One, 3, 6 and 12 months after PTA, the claudication distance, toe skin temperature, ABI and TBI were strikingly improved when compared with those determined before PTA (P<0.05). Twelve months after PTA the vascular restenosis rate was 39.5% (15/38), the limb vascular patency rate was 55.3% (21/38), and the limb salvage rate was 81.6%(31/38). Conclusion For the treatment of lower extremities arterial obliterans with obstructed outflow tract, PTA is safe and effective in short-term period. Although its long-term restenosis rate is higher, this technique can effectively control the progress of the disease, relieve the clinical symptoms, and help improve the limb salvage rate of ischemic limbs.