Clinical Comparison Of Different Surgical Procedures For Critical Limb Ischemia

Objective:To analyze the clinical effects of percutaneous mechanical thrombectomy(PMT)/ + percutaneous transluminal angioplasty(PTA),catheter directed thrombolysis(CDT)/+PTA,simple PTA and artery thrombectomy/+PTA in critical limb ischemia(CLI),we compared the four motheds of surgical treatments in critical limb ischemia(CLI)and discussed the indications of different surgical methods.Methods:We review the clinical data about PMT,CDT,PTA(balloon dilatation and stenting)and artery thrombectomy for critical limb ischemia.The data were come from the Tianjin Medical University General Hospital during Jan 2013 to Nov 2015.All the cases were divided into 4 groups,including group of PMT/+PTA,group of CDT/+PTA,group of simple PTA and group of artery thrombectomy/+PTA.Four groups of patients with limb artery surgery success rate,intraoperative and postoperative complications,postoperative ABI value,primary patency rate of 3 months,restenosis rate of 3 months,the second intervention rate,amputation rate of 6 months and clinical efficiency of 6 months are analyzed with single factor.Results:The total 346 limbs were treated by operation.The ABI values before and after operation of the four groups were compared respectively.There was significant difference in each group's statistics(P<0.05).The operative and postoperative complications of four groups were compared.There were statistically significant differences in bleeding or hematoma,lymphatic fistula,incision infection,fat liquefaction,arterial dissection and acute arterial thrombosis or embolism complications in the four groups(P<0.05).The incidence of complications of hemorrhage and hematoma in group of PMT/+PTA was the smallest,6.25%.The largest proportion of bleeding and hematoma complications occurred in group of CDT/+PTA,which was 23.26%.The proportion of arterial dissection in group of simple PTA was the largest,accounting for 8.25%.There were no statistically significant differences in the four groups in the surgical complications of pseudoaneurysm,arteriovenous fistula,target vessel rupture or perforation and compartment syndrome(P>0.05).The primary patency rate of 3 months after operation in the four groups was significantly different among the four groups(P<0.05).The primary patency rate of 3 months in group of PMT/+PTA was the highest,93.75%.In group of simple PTA,the primary patency rate of 3 months after operation was the lowest,which was 68.45%.There was significant difference in restenosis rate and the second intervention rate among four groups(P<0.05).The restenosis rate of 3 months and the second intervention rate in group of PMT/+PTA was the lowest,6.25%.The restenosis rate 3 months and the second intervention rate in group of simple PTA was the highest,31.55% and 29.61% respectively.The clinical efficiency of 6 months in group of PMT/+PTA was the highest,87.50%.There weren't significant differences in the success rate of primary operation and amputation rate of 6 months among four groups(P>0.05).Conclusion:1.Percutaneous mechanical thrombectomy,catheter directed thrombolysis,angioplasty and artery thrombectomy can provide treatment conditions for further intracavitary angioplasty,which is beneficial to the improvement of the curative effect of critical limb ischemia.Volume reduction therapy can be used as the initial treatment for CLI.2.Percutaneous mechanical thrombectomy can quickly remove thrombus and some vulnerable plaques under minimally invasive condition.It is the first choice for volume reduction therapy.3.The onset time of CDT is slow,and the risk of bleeding of vital organs is high.It is suitable for patients with poor outflow tract.4.Artery thrombectomy is suitable for simple arterial embolization.Initial treatment for patients with acute thrombosis secondary to arteriosclerosis obliterans is not effective.It is necessary to combine arterial intimal stripping and angioplasty in order to improve the therapeutic effect.5.As a traditional means of endovascular treatment,PTA is more effective than simple PTA therapy after initial volume reduction therapy.