重建股深动脉开口治疗股总动脉分叉处受累的下肢动脉严重缺血疗效分析

Efficacy of femoral profundoplasty on severe ischemic lower limbs with atherosclerotic lesions at the bifurcation of the common femoral artery

摘要:

目的 比较股总动脉分叉处存在病变的下肢动脉硬化严重缺血患者行股浅动脉支架植入术(SFAS)及股深动脉成形术(DFAP)的疗效。方法 回顾性分析2012年1月至2016年12月北京积水潭医院血管外科Rutherford 3～5级患者40例,根据手术方式分为SFAS组和DFAP组,每组20例。比较2组患者术前、术后踝肱指数(ABI)和Rutherford分级的改变。随访2年,比较2组患者手术后2年截肢情况、12个月及24个月通畅率。采用SPSS 17.0统计软件对数据进行分析。组间比较采用t检验或χ²检验。结果 2组患者年龄、性别、临床症状、血糖、血脂、高血压、冠心病和受损血管比例差异无统计学意义(P＞0.05)。SFAS组患者术后ABI相比术前差异具有统计学意义[(0.98±0.09) vs(0.51±0.08),t＝-18.450,P＜0.001]。DFAP组患者术后ABI相比术前差异具有统计学意义[(0.70±0.10) vs (0.47±0.07),t＝-8.910,P＜0.001]。SFAS组相比DFAP组术后ABI高[(0.98±0.09) vs (0.70±0.10)]、Rutherford分级降低率高[90%(18/20) vs 60%(12/20)]、1年通畅率[70%(14/20) vs 95%(19/20)]和2年通畅率低[55%(11/20) vs 90%(18/20)],差异有统计学意义(P<0.05)。结论 对于股总动脉分叉处存在病变的下肢动脉硬化严重缺血患者,DFAP和SFAS均可改善患者症状,增加肢体血供,SFAS即刻症状改善优于DFAP,而DFAP的1年及2年通畅率均高于SFAS。

Abstract:

Objective To compare the efficacy of superficial femoral artery stenting (SFAS) and deep femoral artery profundoplasty (DFAP) in patients with atherosclerotic lesions of common femoral artery. Methods A retrospective study was made of 40 patients treated in Beijing Jishuitan Hospital from January 2012 to December 2016 with severe lower limb ischemia (Rutherford stages 3-5). The patients were divided into 2 groups with 20 in each:SFAS group and DFAP group. The changes of ankle brachial index (ABI) and Rutherford stages were assessed before and after operation. Comparison was made in the respects of the amputation rate at 2 years and patency rates at 1 year and 2 years. SPSS statistics 17.0 were used for data analysis, and t test or Chi-square test for comparison. Results No significant differences between 2 groups (P>0.05) was observed in age, gender, clinical symptoms, blood glucose, blood lipids, hypertension, coronary heart disease and damaged blood vessel ratio. The postoperative ABI in both groups was significantly improved [(0.98±0.09) vs (0.51±0.08), t=-18.450, P<0.001] in SFAS group and [(0.70±0.10) vs (0.47±0.07), t=-8.910,P＜0.001] in DFAP group, but compared with DFAP group, SFAP group had higher postoperative ABI[(0.98±0.09) vs (0.70±0.10)], higher Rutherford grade reduction rate [90%(18/20) vs 60%(12/20)], and lower patency rate at 1 year [70%(14/20) vs 95%(19/20)] and 2 years [55%(11/20) vs 90%(18/20)]. The differences were statistically significant (P<0.05). Conclusion Both DFAP and SFAS can relieve symptoms and increase blood supply to limbs in the patients with severe lower limb ischemia from atherosclerotic lesions at the bifurcation of the common femoral artery. The immediate symptom relieve by SFAS is better than by DFAP, and DFAP results in higher patency rate at 1 year and 2 years than SFAS.