内膜下成形术治疗糖尿病足部动脉闭塞而引起的缺血

Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic PatientsWith Chronic Critical Limb IschemiaYue-Qi Zhu; Jun-Gong Z

正文

Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic Patients

With Chronic Critical Limb Ischemia

Yue-Qi Zhu; Jun-Gong Zhao;Fang Liu; Jian-Bo Wang; Ying-Sheng Cheng;

Ming-Hua Li;Jue Wang;Jie Li

Departments of Radiology and Endocrinology, The Sixth Affiliated People’s
Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.

Purpose: To assess the feasibility and efficacy of subintimal angioplasty (SA) in

the treatment of below-the-ankle arterial occlusion in diabetic patients with chronic

critical limb ischemia (CLI).
Methods: SA was applied in 37 diabetic patients (24 men; mean age 70.9±8.5 years,

range(52–88) with chronic CLI and occlusive disease of the dorsalis pedis artery

(DPA) and/or plantar artery (PA) but were poor candidates for intraluminal

angioplasty or bypass surgery. Tissue loss was present in 31 (54.4%) of 57 afflicted

limbs, and rest pain was reported in 51 (89.5%) limbs. SA was performed to create

continuous arterial flow to the foot for limb salvage. The clinical symptoms, DPA or

PA pulse volume scores, and ankle brachial index (ABI) were compared before and

after SA. Wound healing, amputation, and restenosis of target vessels were also

evaluated at follow-up. Kaplan-Meier curves wereconstructed to evaluate limb salvage,

survival, and freedom from amputation.
Results: Below-the-ankle SA was performed successfully in 55 (83.3%) of 66 arteries

in 57 limbs. Median pulse volume scores and ABIs were 0.33±.055 and 0.31±.019

before SA and 2.04±1.05 and 0.80±0.14 after SA, respectively (p<0.0001 for both).

The 30-day mortality was 2.7%. Median follow-up was 9.1±6.1 months (range 1–18).

Majorcomplications occurred in 1 (2.7%) patient and minor complications in 3 (8.1%).

Twelve months after SA, Kaplan-Meier analysis showed that the limb salvage rate

was 94.6%, the freedom from amputation was 89.2%, and the survival rate

was 97.3%.
Conclusion: SA of the dorsalis pedis artery and/or plantar artery is a useful

technique for lower limb salvage in diabetic patients with chronic CLI who are not

candidates for bypass surgery.
J Endovasc Ther. 2009;16:604–612

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