老年女性动脉硬化闭塞症的特点及腔内治疗效果评价

Characteristics of arteriosclerosis obliterans in elderly women and assessment of endovascular treatment

摘要:

目的 探讨老年女性动脉硬化闭塞症患者的特点及腔内治疗的预后情况。方法 回顾性总结2015年3月至2016年3月山西大医院血管外科收治的106例下肢动脉硬化闭塞症老年患者的临床资料。其中男性54例,年龄60～89(68.3±13.4)岁；女性52例,年龄59～90(77.3±7.7)岁。全部患者接受下肢动脉腔内治疗,比较男性与女性之间的一般资料及术后随访情况,总结分析女性患者患病因素及腔内治疗效果评价。采用SPSS 22.0统计学软件进行分析。计数资料比较采用χ²检验。 结果 全部患者进行腔内手术并随访,手术成功率99.1%(1例男性多节段病变未开通),随访率94.3%。与男性患者相比,老年女性的发病年龄更大,吸烟者少,合并高血压患者多,且股动脉以远病变患者比例更大,病变程度更重(均P＜0.05)。围手术期严重并发症4例(3.85%),其中2例心肌梗死均为女性。随访期内死亡3例(男性2例,女性1例),截肢5例(男性3例,女性2例),并发心脑血管事件11例(男性2例,女性9例),支架内再狭窄17例(男性13例,女性4例)。比较两性患者的随访数据,结果显示,腔内治疗后老年女性患者再栓塞率低于男性(χ²=5.085,P=0.024),但并发心脑血管事件发生率显著高于男性(χ²=5.271,P=0.022)。结论 老年女性下肢动脉硬化患者平均发病年龄更大,且多合并高血压病,但吸烟者明显少于男性,病变程度更重。腔内治疗后老年女性患者再栓塞率低于男性,但并发心脑血管事件发生率明显升高。

Abstract:

Objective To investigate the characteristics and prognosis of arteriosclerosis obliterans in the elderly women. Methods A retrospective analysis was performed of 106 elderly patients (54 males and 52 females) from March 2015 to March 2016 with arteriosclerosis obliterans. The 54 male patients were 60-89 (68.3±13.4) years old, and 52 female patients 59-90 (77.3±7.7) years old. All the patients received endovascular treatment of lower extremity arteries. The two gender groups were compared in terms of the general data and postoperative follow-up, and the female patients were analyzed for the prevalence factors and efficacy of endovascular treatment. SPSS statistics 22.0 was used for data analysis, and Chi-square test for comparison of enumeration data. Results All patients underwent endoluminal surgery and were followed up, with a success rate of 99.1% (failed recanalization in 1 male patient with multi-segment lesions) and a follow-up rate of 94.3%. The female group were significantly advanced in age (P<0.05), with fewer smokers (P<0.05), more complicated with hypertension (P<0.05), greater proportion with distant femoral lesions (P<0.05) and more severe lesions (P<0.05). Perioperative complications occurred in 4 serious patients (3.85%), 2 of whom were female and had myocardial infarction. During the follow-up, in-stent restenosis occurred in 17 patients (13 males and 4 females) and, 3 (2 males and 1 female) died, 5 (3 males and 2 females) amputated. Cardiovascular and cerebrovascular events were reported in 11 patients (2 males and 9 females). Conclusion Compared with the males, the elderly females have a higher average age of onset of lower extremity arteriosclerosis, a higher proportion of concomitant hypertension, a significant smaller number of smokers, and more severe lesions. The elderly females show a lower rate of re-embolism after endovascular treatment than the males, but the incidence of concurrent cardiovascular and cerebrovascular events is significantly higher.