| Background and AimThe diabetic foot is one of the familiar complications which threaten diabetics'health seriously, it has high Mutilation rate and amputation rate, significant to reduce the sufferer's living quality and positive prevention and treatment of various chronic complications of diabetic can raise the sufferer's survival rate. At the United States, there is 6.5% of diabetic foot patients need amputation annually, 15 times above the number of non-diabetic [1]. The statistic data of china shows [2], the number of diabetic foot patients takes up 1.7% of the diabetic and the rate of legs amputation reach up to 17.3%. The treatment of the diabetic foot give priority to surgical bypass graft and medical interventional therapy. The rate of re-amputation after surgical bypass graft is pretty high, it was reported that the rate of amputation in 6 months postoperatively is 40% and 20% amputation patient will die in 1 year after the operation. The 5 years patency rate of surgical bypass graft is 85%-90% and the 10 years patency rate is 75%-80%[3]. Interventional therapy contains Short Balloon Angioplasty(SBA) and stent implantation, the restenosis rate of SBA is 27.8%-35% in 1 years[4-5], the restenosis rate of stent implantation is 37%[6]. How to raise the treatment effect of the diabetic foot are becoming more and more attracting people's eyes in international Interventional therapy domain. In recently years, Long Balloon Angioplasty(LBA) is used, initial research show that probably raise the patency rate of affected limb and reduce the rate of restenosis rate.To studying the curative effectiveness and restenosis rate of Long Balloon Angioplasty, To prevention the occurrence of restenosis through the observation of dynamic changes of coagulative and fibronolysis system before the operation and after the operation in treatment of the diabetic foot.MethodFrom July 2006 to August 2007, 40 the diabetic foot patients were proved by means of angiography to have at least one culprit branch with diameter stenosis of 75%-99%, divided into Short Balloon Angioplasty team(n=20) and Long Balloon Angioplasty team(n=20) randomly, to carried out SBA and LBA respectively. Follow up the clinical curative effect before and 6 month after operation and the observe items include: rest pain, skin temperature, skin color, pulsation of dorsal artery, walk distance, ankle-brachial pressure index, Transcutaneous Oxygen Pressure, Limb Doppler. restenosis rate, success rate and patency rate. Draw femoral vein blood sample at 3 time points: pre-operation, post-operation instantly, 24 hours after the operation, exam the content of t-PA, PAI-1, FPA in enzyme linked immunosorbent assay.Result1. After 6 months of operation, effective rate of rest pain relief experimental group is better than control group (60.69% vs 90.48%, P < 0.01), skin temperature in two group are changed significantly(60.87% vs 86.96%, P <0.05), skin color were significant differences between two groups(60.00% vs 85.71%, P < 0.05), effective rate of pulsation of artery were significant differences between (70.83% vs 86.96%, P < 0.05).2.After 6 months of operation experimental group is better than control group, walk distance was significantly improved(720±86.31m vs 1380±103.68m, P < 0.01), ankle-brachial pressure index while compare to control group with the experimental group were significant differences between(0.72±0.27 vs 0.88±0.13, P < 0.05), Transcutaneous Oxygen Pressure compare to control group with the experimental group were significant differences between(35.04±9.56mmHg vs 38.23±6.06mmHg, P < 0.05). Limb Doppler shows, experimental group is preceding at the blood speed of pulsation of dorsal artery were significant differences between(11.69±0.89cm/s vs 13.31±8.28cm/s, P < 0.05),the experimental group's blood speed of tibial artery is better than the control group's significantly (24.61±2.13cm/s vs 26.38±1.03cm/s, P <0.01). fibular artery were no significant differences between two group (19.81±1.05cm/s vs 20.38±1.03cm/s, P > 0.05).3.The restenosis rate of control group was 7(28%) compare to LBA was 4(16%) to recheck Angiography, it has significant differences between two group ( P < 0.05).4.success rate and patency rate. The clinical success rate of control group was 25(92.59%), comparatively experimental group was 25(96.15%), were no significant differences between two group(P > 0.05). The patency rate of experimental group has lasted to 23(92.00%) till postoperative 6 months, comparatively control group was 20(80.00%), it has significant differences between two group ( P < 0.05). 5.the activation of t-PA experimental group was obvious recovered at 24h (31.01±0.89ng/ml vs 33.30±3.20ng/ml, P < 0.05), the activation of PAI-1 experimental group was obvious recovered at 24h (47.68±2.52ng/ml vs 44.53±0.75ng/ml, P < 0.01), the activation of FPA experimental group was obvious recovered at 24h (3.55±0.10μg/ml vs 3.32±0.14μg/ml, P < 0.05). the content of t-PA of 24h-postoperative experimental group increase, were significantly( P <0.05). the content of PAI-1 of 24h-postoperative experimental group goes down notably, were significantly(P < 0.01). FPA of 24h-postoperative experimental group was recovered and nearly the level of pre-operation (P <0.01).Conclusion1.LBA significant improves the clinical effects.2.LBA decreases the occurrence of thrombus event, reduce the restenosis rate, raises the rate of patency.3.LBA effectively accelerates the recovery of blood plasma fibrinolys activity, reduce the coagulative activity.
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