目的评价血管小体靶向性股下血管内血运重建治疗糖尿病肢体缺血的创面愈合和肢体保存率。方法回顾性分析102例(男60例,女42例;平均年龄,72±11年),FontaineIV缺血(踝臂指数,ABI:0.16±0.06)。根据血管体概念进行了47次血管成形术(直接血运重建,DR),虽然55没有纳入血管体概念(间接血运重建,IR)。血管成形术的疗效通过在临床随访期间每3个月进行一次ABI的术后测定来评估,以评估缺血性伤口的愈合情况。在整个研究中记录截肢和死亡事件。结果102例患者均成功行血运重建,无并发症发生。在平均18±11个月的随访期间,术后平均ABI改善为0.84±0.10。DR组术后6个月和12个月的愈合率分别为85.1%和93.5%,分别,而保肢率分别为100%和93.5%,分别。IR组术后6个月和12个月的治愈率分别为60%和76.4%,分别,保肢率为90.1%,85.5%,分别。结论在危重型糖尿病足缺血患者中,以血管小体为基础的膝下血管成形术具有较好的创面愈合和较高的保肢率。对缺血血管体间接灌注的患者应进行血运重建。获得可接受的保肢率。
Objective To evaluate the rates of wound healing and limb preservation following
angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia. Methods We performed a retrospective analysis of data gathered from 102 infrapopliteal angioplasty cases (60 males and 42 females; mean age, 72 ± 11 years) with Fontaine IV ischemia (ankle-brachial index, ABI: 0.16 ± 0.06). Forty-seven angioplasties were performed based on the
angiosome concept (direct revascularization, DR), while 55 did not incorporate the
angiosome concept (indirect revascularization, IR). The curative effects of angioplasty were assessed by postoperative determinations of ABI performed every 3 months during clinical follow-up visits conducted to assess healing of the ischemic wound. Amputation and death events were recorded throughout the study. Results All 102 patients were successfully revascularized without complications, and during a mean follow-up period of 18 ± 11 months, the mean postoperative ABI improved to 0.84 ± 0.10. The postoperative 6 and 12 month healing rates in the DR group were 85.1% and 93.5%, respectively, while the limb-salvage rates were 100% and 93.5%, respectively. The postoperative 6 and 12 month healing rates in the IR group were 60% and 76.4%, respectively, while the limb-salvage rates were 90.1%, and 85.5%, respectively. Conclusion
Angiosome-based Infrapopliteal angioplasty was associated with better wound healing and higher rates of limb salvage in cases of critical diabetic foot ischemia. Revascularization should be provided to patients who have undergone indirect perfusion of the ischemic
angiosome, as acceptable rates of limb salvage are obtained.