Journal of Endovascular Therapy:PTA治疗肘部以下严重手部缺血的系统分析

2021-11-17 “ Clinic門诊新视野”公众号 “ Clinic門诊新视野”公众号

由肘部以下(BTE)动脉闭塞引起的严重手部缺血(CHI)将严重影响患者的生活,甚至需要截肢。

由肘部以下(BTE)动脉闭塞引起的严重手部缺血(CHI)将严重影响患者的生活,甚至需要截肢。患者通常表现为静息痛、溃疡不愈合或手指部进行性坏疽。BTE动脉疾病在糖尿病和慢性肾病患者中很常见。BTE血管通常表现为弥漫性受累,包括尺动脉、桡动脉、掌弓和指血管,很少孤立地受累骨间血管。目前,对于BTE血管疾病所致的CHI患者的治疗尚无共识。近期,El-Karim等[1]评估了经皮腔内血管成形术(PTA)治疗由BTE动脉疾病导致的CHI的疗效,其结果发表于J Endovasc Ther。

研究目的

评估PTA治疗由BTE动脉疾病导致的CHI的安全性和有效性。

研究方法

检索MEDLINE 和 EMBASE系统中评估PTA治疗BTE动脉闭塞疾病的研究。纳入标准有≥4名患者的前瞻性或回顾性研究、至少一条BTE血管接受PTA治疗、有技术成功和并发症相关报告结果。排除标准有由血管炎、结缔组织疾病引起的CHI、手术或腔内血运重建史、病例报道或会议摘要。

研究结果

最终纳入了8项研究,包含了176例BTE血管阻塞性疾病的患者。本组患者中53%为男性,年龄为53~64岁,其中86%合并高血压、68%合并外周血管疾病、63%合并血脂异常、55%合并慢性肾病或ESRD、55%合并糖尿病以及50%合并冠脉疾病。有关CHI的临床表现,51%有静息痛、31%有组织缺失或坏疽、22%有溃疡。所有研究均使用了low-profile球囊(1.5~4 mm)扩张狭窄或CTO病变,另有13例患者接受了斑块旋切术、14例患者接受支架植入术。

平均技术成功率和临床成功率分别为89.3%(范围:82%~100%)和69.9%(范围:19%~100%),平均随访29.7±17.1个月(表1)。短期(30天内)并发症发生率为4.7%,常见并发症包括入路血肿、假性动脉瘤和桡动脉穿孔或再次血栓形成。近20%的患者需要截肢,大多数(96%)为远端指骨或手指截肢,仅2例患者需要进行了腕部截肢。5年一期通畅率为38%,二期通畅率为54%。5年累计死亡率为33.1%。

表1. 研究结果和再狭窄数据

总 结

总结针对BTE动脉阻塞性病变所致的CHI患者,PTA是可行的治疗方法,具有较高的技术成功率和较低的短期并发症发生率。目前,仍需要更多的的长期比较研究来明确腔内治疗与保守治疗或旁路手术的临床益处。

原始出处:

Ghassan Awad EI-Karim, Sean A. Kennedy, et al. Percutaneous Transluminal Angioplasty for Below-the-Eibow Critical hand Ischemia: A Systematic Review. Journal of Endovascular Therapy, 2021.

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    2022-09-27 quxin068
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