The Clinical Analysis Of Management Of Lower-extremity Arteriosclerosis Obliterans In Elderly Patients

Objective:To investigate the algorithm for management of lower-extremity arteriosclerosis obliterans in elderly patients.Methods:The clinical data of 160 cases with lower-extremity arteriosclerosis obliterans being treated in vascular surgery of our hospital from January 2010 to June 2014 was analyzed.The main symptoms of patients include numbness, weakness, intermittent claudication, rest pain, ulcer and gangrene.All patients received color doppler ultrasound examination before admition,and then received CTA examination.For the lesion still not clear,additional DSA examination performed.In total 160 patients,130 was underwent percutaneous transluminal angioglasty(PTA) and stenting,4 underwent bypass surgery,7 underwent hybrid surgery,1 underwent the venous arterialization.16 patients took the expectant treatment because all sorts of reasons.2 underwent amputation.Results:One hundred and twenty seven cases were successfully treated and the technical success rate was 97.7%(127/130).One hundred and eight cases who accepted endovascular treatment were followed up for 1-54 months with the average of 20.40±7.22 months.The ankle brachial index(ABI) of affected extremities increased from 0.49 ±0.26(before operation) to 0.78±0.23(after operation),P <0.01.The primary patency rate was 86.5%(90/104)、79.5%(58/73)and 66.7%(26/39),and the secondary patency rate was 90.4%(94/104)、87.6%(64/73)and 79.5%(31/39)at 6、12 and 24 months after surgery,respectively.Five cases who accepted the hybrid surgery were followed up for 6-43 months with the average of 17±12.36 months,the symptoms of the patients were relieved without major complications.The ankle brachial index(ABI) of affected extremities increased from 0.38 ±0.30(before operation) to 0.62±0.14(after operation),P <0.05.Four cases who accepted the bypass surgery were followed up for 6-48 months with the average of 34.5±19.82 months,the result carried out meeting the criterion of cure,so as the patient who accepted the venous arterialization.The ankle brachial index(ABI) of affected extremities increased from 0.50 ±0.09(before operation) to 0.84±0.14(after operation),P <0.05.Five cases who accepted expectant treatment were followed up for 1-48 months with the average of 9.0±16.69 months,the clinical symptoms vanished or significantly improved after treatment..Two cases failed to endovascular treatment and all of them converted to amputation.Conclusion:Though DSA is till the “gold standard"examination,the color doppler ultrasound examination and CTA play important roles for the diagnosis and definite diagnosis of ASO.The interventional therapy, which has the advantages of safe, minimally invasive and easy to operate, is a feasible treatment choice for ASO patients..