PURPOSE:To evaluate the primary success and short-term patency associated with a new 4-F sheath-compatible self-expanding nitinol stent after failed conventional angioplasty of distal popliteal and infrapopliteal lesions in severe lifestyle-limiting claudication (LLC) and chronic critical limb ischemia (CLI). MATERIALS AND METHODS:Between May 2003 and July 2005, 35 patients with Rutherford category 3-5 disease (16 patients with CLI, 19 patients with LLC) underwent percutaneous transluminal angioplasty (PTA) and stent implantation. Indications for stent placement were residual stenosis, flow-limiting dissections, or elastic recoil after PTA. Before and after the intervention and during the 6-month follow-up, clinical investigation, color-flow and duplex Doppler ultrasonography, and digital subtraction angiography were performed. Technical success, primary patency at 6 months, clinical improvement as defined by Rutherford with clinical and hemodynamic measures, and complications were evaluated. RESULTS:A total of 22 patients underwent distal popliteal artery stent placement and 13 underwent tibioperoneal artery stent placement. Stent implantation was successfully performed in all patients. After stent placement, the primary cumulative patency rate for the study group at 6 months was 82%. The mean resting ankle-brachial index at baseline was 0.50 +/- 0.16 and significantly increased to 0.90 +/- 0.17 at 12-24 hours after intervention and 0.82 +/- 0.24 at latest follow-up (P < .001 for both). The sustained clinical improvement rate was 80% at the 6-month follow-up. The 6-month limb salvage rate regarding major amputation was 100%. The rate of major complications was 17%. CONCLUSIONS:Infrapopliteal application of the new nitinol stent is a safe, feasible, and effective method with good short-term patency rate in the treatment of severe LLC and chronic CLI.

译文

目的:评估在严重的生活方式限制性lau行(LLC)和慢性危重肢体的远侧pop和in下病变的常规血管成形术失败后,与新型4-F鞘相容性自扩张镍钛合金支架相关的主要成功和短期通畅性缺血(CLI)。
材料与方法:2003年5月至2005年7月,对35例卢瑟福3-5型疾病患者(16例CLI患者,19例LLC患者)进行了经皮腔内血管成形术(PTA)和支架植入术。支架置入的指征是残余狭窄,限流夹层或PTA后的弹性后座力。在干预前后,以及在6个月的随访期间,进行了临床研究,彩色流和双工多普勒超声检查以及数字减影血管造影。评估了技术成功率,6个月时的通畅性,卢瑟福定义的临床改善以及临床和血液动力学指标以及并发症。
结果:总共22例患者接受了pop骨远端动脉支架置入术,其中13例接受了胫腓骨动脉支架置入术。所有患者均成功进行了支架植入。放置支架后,研究组在6个月时的主要累积通畅率为82%。基线时平均静息踝臂指数为0.50 /-0.16,干预后12-24小时显着增加至0.90 /-0.17,最新随访时为0.82 /-0.24(两者均P <.001)。在六个月的随访中,持续的临床改善率为80%。大截肢的6个月肢体抢救率为100%。主要并发症发生率为17%。
结论:新的镍钛合金支架在眼下应用是治疗严重LLC和慢性CLI的一种安全,可行,有效的方法,具有良好的短期通畅率。

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