CAJ | 학술논문

目的：探讨经足背－足底（TDP）或足底－足背（TPD）动脉环逆行腔内血管成形术与常规顺行血管成形术治疗膝下动脉闭塞性病变的临床疗效。方法回顾性分析2009年10月至2011年7月接受常规顺行血管成形术的96例膝下动脉闭塞性病变患者112条患肢，其中27条顺行手术失败患肢接受经TDP或TPD动脉环逆行腔内血管成形术。根据手术前踝－臂指数（ABI）、基于冠状动脉造影的心肌梗死溶栓（TIMI）后血流评分（TIMI评分）及足背或足底动脉搏动评分评价比较常规顺行血管成形术治疗成功组（常规组，71例患者85条患肢）和经TDP或TPD动脉环逆行腔内血管成形术治疗成功组（逆行组，20例患者22条患肢）术后肢体挽救率及靶血管通畅率。结果逆行组和常规组手术成功率分别为75．9%和74%（P＞0．05），ABI分别由术前0．55±0．21和0．56±0．14升至术后0．93±0．19和0．89±0．18（P＞0．05）；逆行组和常规组TIMI评分分别由术前0．1±0．5和0．8±0．8升至术后2．5±0．6和1．8±0．8（P<0．0001），逆行组患者远侧足部组织获得更好血流灌注。逆行组和常规组术后12、24个月靶血管一期通畅率分别为63．6%（14/22）、45．5%（10/22）和52．9%（45/85）、37．6%（32/85）（P＞0．05）。术后24个月Kaplan-Meier 生存分析曲线评价显示逆行组和常规组肢体挽救率分别为95．5%和96．5%（P＞0．05）。结论与常规顺行血管成形术相比，经TDP或TPD动脉环逆行腔内血管成形术治疗膝下动脉闭塞性病变可获得更好的即刻血流改善情况以及相似的ABI改善情况、一期通畅率及肢体挽救率，可作为顺行血管成形术失败后的有效替补治疗方法。
목적：탐토경족배－족저（TDP）혹족저－족배（TPD）동맥배역행강내혈관성형술여상규순행혈관성형술치료슬하동맥폐새성병변적림상료효。방법회고성분석2009년10월지2011년7월접수상규순행혈관성형술적96례슬하동맥폐새성병변환자112조환지，기중27조순행수술실패환지접수경TDP혹TPD동맥배역행강내혈관성형술。근거수술전과－비지수（ABI）、기우관상동맥조영적심기경사용전（TIMI）후혈류평분（TIMI평분）급족배혹족저동맥박동평분평개비교상규순행혈관성형술치료성공조（상규조，71례환자85조환지）화경TDP혹TPD동맥배역행강내혈관성형술치료성공조（역행조，20례환자22조환지）술후지체만구솔급파혈관통창솔。결과역행조화상규조수술성공솔분별위75．9%화74%（P＞0．05），ABI분별유술전0．55±0．21화0．56±0．14승지술후0．93±0．19화0．89±0．18（P＞0．05）；역행조화상규조TIMI평분분별유술전0．1±0．5화0．8±0．8승지술후2．5±0．6화1．8±0．8（P<0．0001），역행조환자원측족부조직획득경호혈류관주。역행조화상규조술후12、24개월파혈관일기통창솔분별위63．6%（14/22）、45．5%（10/22）화52．9%（45/85）、37．6%（32/85）（P＞0．05）。술후24개월Kaplan-Meier 생존분석곡선평개현시역행조화상규조지체만구솔분별위95．5%화96．5%（P＞0．05）。결론여상규순행혈관성형술상비，경TDP혹TPD동맥배역행강내혈관성형술치료슬하동맥폐새성병변가획득경호적즉각혈류개선정황이급상사적ABI개선정황、일기통창솔급지체만구솔，가작위순행혈관성형술실패후적유효체보치료방법。
Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P<0.000 1). In the retrograde group, the blood flow perfusion of the distal foot tissue was improved. The primary target vessel patency rate at 12 months and 24 months after the treatment in the retrograde group and the routine group were 63.6% (14/22), 45.5%(10/22) and 52.9%(45/85), 37.6%(32/85) respectively (P>0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.