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罗新, 黄可, 黄斌, 等. 下肢慢性肢体威胁性缺血合并糖尿病的单中心治疗体会[J]. 四川大学学报(医学版), 2022, 53(6): 988-992. DOI: 10.12182/20221160506
引用本文: 罗新, 黄可, 黄斌, 等. 下肢慢性肢体威胁性缺血合并糖尿病的单中心治疗体会[J]. 四川大学学报(医学版), 2022, 53(6): 988-992. DOI: 10.12182/20221160506
LUO Xin, HUANG Ke, HUANG Bin, et al. Single-Center Experience of Treating Chronic Limb-Threatening Ischemia of Lower Limbs Combined with Diabetes[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(6): 988-992. DOI: 10.12182/20221160506
Citation: LUO Xin, HUANG Ke, HUANG Bin, et al. Single-Center Experience of Treating Chronic Limb-Threatening Ischemia of Lower Limbs Combined with Diabetes[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(6): 988-992. DOI: 10.12182/20221160506

下肢慢性肢体威胁性缺血合并糖尿病的单中心治疗体会

Single-Center Experience of Treating Chronic Limb-Threatening Ischemia of Lower Limbs Combined with Diabetes

  • 摘要:
      目的  总结我院近5年针对下肢慢性肢体威胁性缺血合并糖尿病治疗的单中心经验及治疗体会。
      方法  回顾性分析2017年3月–2021年6月于我院诊断为下肢慢性肢体威胁性缺血合并糖尿病的病例,收集患者的基线信息、手术情况及随访结果。主要结局指标为术后1年目标动脉通畅率,次要结局指标为术后1年再干预率及术后1年截肢率。
      结果  共纳入89名下肢慢性肢体威胁性缺血合并糖尿病的患者。85例(95.51%)接受经皮腔内血管成形术,其中7例手术失败,手术成功率91.76%(78/85)。3例接受人工血管股-腘动脉搭桥术,1例接受人工血管髂-股动脉搭桥,手术成功率100%(4/4)。78例行介入手术的患者中位随访时间为33个月。术后1年内2例病例死亡,术后1年生存率97.44%(76/78)。术后1年内再干预率为19.23%(15/78),1年目标血管通畅率(不包括死亡)为85.53%(65/76),1年截肢率为3.85%(3/78)。行旁路治疗患者中,随访时长13~48个月,随访期间未观察到人工血管血栓形成及再次闭塞,人工血管保持通畅。
      结论  腔内血管成形术具有较为理想的术后血管通畅率,且手术创伤小,围术期风险低,在局麻下即可完成,可作为慢性肢体威胁性缺血患者的首选治疗方式;旁路手术远期通畅率好,但围术期风险较高,手术创伤较大,可作为介入治疗失败的备选方案。

     

    Abstract:
      Objective  To summarize our hospital’s single-center experience of and reflections on the treatment of chronic limb-threatening ischemia (CLTI) of lower limbs combined with diabetes in the past 5 years.
      Methods  We retrospectively analyzed cases of lower limb CLTI combined with diabetes diagnosed at our hospital from March 2017 to June 2021. The baseline data, surgical information, and follow-up results of the patients were collected. The primary outcome indicator was the patency rate of lower limb target artery within 1 year post-op, and the secondary indicators were the reoperation rate within 1 year post-op and the amputation rate within 1 year post-op.
      Results  A total of 89 patients with lower limb CLTI combined with diabetes were included in the study. A total of 85 patients underwent percutaneous transluminal angioplasty and the operation of 7 patients ended in failure, with the operation success rate reaching 91.76% (78/85). Three patients underwent femoral popliteal artery bypass grafting with artificial blood vessels and one patient underwent iliac femoral artery bypass grafting with artificial blood vessels, with the success rate of the operations reachign 100% (4/4). Among 78 patients who successfully underwent percutaneous transluminal angioplasty, the median follow-up time was 33 months (13, 64). Two patients died within one year after operation, with the post-op one-year survival rate being 97.44% (76/78). The post-op 1-year reoperation rate was 19.23% (15/78), the 1-year target vascular patency rate (deaths not included) was 85.53% (65/76), and the 1-year amputation rate was 3.85% (3/78). Among the patients who underwent bypass surgery, the follow-up period was 13-48 months. No thrombosis in or re-occlusion of the artificial blood vessels were observed during the follow-up period, and the artificial blood vessels remained unoccluded.
      Conclusion  Transluminal angioplasty has a relatively ideal rate of postoperative vascular patency. In addition, it is a minimally invasive procedure involving low perioperative risks and is performed under local anesthesia. Therefore, it can be used as the preferred treatment for patients with CLTI. On the other hand, bypass surgery has good long-term patency rate, but it involves higher perioperative risks and the procedure is more invasive. Therefore, bypass surgery can be used as an alternative when transluminal angioplasty ends in failure.

     

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