Endovascular Treatment In Refractory Arteriosclerosis Obliterans

Objective With the increase of the national standard of living and aging trend of population, the incidence of lower limb arteriosclerosis occlusion disease has increased year by year. The treatment of lower limb artery ischemic caused by ASO is one of the emphasis and difficulty of clinical vascular surgery. In recent years, with the rapid development of clinical endovascular interventional treatment technology and vascular interventional equipment, scope and curative effect of endovascular treatment of lower limb artery disease has the very big enhancement. According to the second edition of the guide----TASC Ⅱ classification standard about the morphological characteristics of peripheral artery disease, We defined the ASOs graded TASC Ⅱ B～D with ankle brachial index of0～0.4as refractory ones to discuss the effect of endovascular treatment in refractory arteriosclerosis obliterans.Methods43cases(49lower limbs) of ASO graded B-D in TASC Ⅱ were admitted in our hospital from January,2007to November,2011and the ankle brachial index(ABI) of these cases were0～0.4before our therapy. We assessed the preoperative treatment, surgical method, postoperative treatment and efficacy of endovascular treatment of these cases.Results The guide wire smoothly through the occluded narrow section of the lesion and successful completion of the endovascular treatment process was defined as success. The total rate of technical success was91.8%(45/49).Compared with the treatment before, average ABI elevation was0.24+0.13(P<0.05). Postoperative review of CTA or MRA showed popliteal artery and over popliteal artery segments were patency and had at least one artery branch enhancement to the feet was defined as anatomical improvement. Intermittent claudication distance compared with preoperative ones got extension, rest pain caused by artery occlusion got reduction, arterial occlusive skin ulcers healed completely or decreased, amputated level got lower was defined as clinical improvement. After therapy, the symptom alleviated completely (anatomical improvement) in36cases, went better (clinical improvement) in4cases, had no obvious improvement in3cases. Amputation rate during follow-up period was5%(2/40), mortality was2.5%(1/40).Conclusions Endovascular treatment is mini-invasive and repetitive. Percutaneous transluminal angioplasty (PTA) and percutaneous transluminal angioplasty and stenting (PTAS) as first surgery method in refractory ASOs has a satisfactory result in short-term cooperating with preoperative and postoperative medication. Meanwhile, Lower extremity arterial occlusion, narrow site and length do not affect the overall technical success rate of the endovascular therapy. However, the long-term patency rate is an inevitable important problem. How to improve the long-term patency rate still needs further exploration and clinical research.