血管内手术治疗下肢血栓闭塞性脉管炎(比尔格氏病)的短期疗效。

Postgraduate medicine Pub Date : 2024-06-01 Epub Date: 2024-06-28 DOI:10.1080/00325481.2024.2373678
Guofu Zheng, Hailiang Xie, Minggui Lai, Xiaochun Liu
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摘要

目的:虽然血栓溶解性闭塞症(TAO)被公认已有一个多世纪的历史,但目前还没有最佳的治疗方法。本报告旨在比较导管引导溶栓(CDT)、经皮腔内血管成形术(PTA)和CDT+PTA治疗TAO疾病的短期疗效:方法:将2012年至2022年期间在赣州市人民医院接受治疗的TAO患者纳入回顾性研究。根据病历信息,血管内治疗包括 CDT、PTA 或 CDT+PTA。比较了接受血管内手术的TAO患者的一年随访结果。主要结果是肢体主要不良事件(MALE),次要结果是技术成功率、并发症、术后一周的ABI和轻微截肢:从2012年到2022年,69名TAO患者接受了血管内手术。其中,22 名患者接受了 CDT,21 名患者接受了 PTA,26 名患者接受了 PTA+CDT。一年的随访结果显示,三组患者的无男性疾病生存率存在显著差异,尤其是 CDT 组和 PTA+CDT 组(无男性疾病生存率的危险比(HR)为 0.173,95% CI [0.050-0.599],P = 0.006)。三组的技术成功率分别为 63.6%、90.5% 和 92.3%。三组患者术后一周的 ABI 存在差异:结论:血管内手术在短期内对 TAO 有效。结论:血管内手术在短期内对TAO是有效的,但单独使用CDT的疗效并不理想;将CDT与PTA结合使用可获得最理想的血管内治疗效果;而PTA的疗效介于这两种手术之间。
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Short-term efficacy of endovascular procedures for lower extremity thromboangiitis obliterans (Buerger's disease).

Purpose: Although thrombolysis obliterans (TAO) has been recognized for more than a century, there is no optimal treatment for this disease. The aim of this report was to compare the short-term efficacies of catheter-directed thrombolysis (CDT), percutaneous transluminal angioplasty (PTA) and CDT+PTA in treating TAO disease.

Method: Consecutive patients with TAO treated at Ganzhou People's Hospital between 2012 and 2022 were included in this retrospective study. According to the information provided in the medical records, endovascular procedures included CDT, PTA or CDT+PTA. One-year follow-up outcomes of the patients with TAO who underwent endovascular procedures were compared. The primary outcome was major adverse limb event (MALE) and the secondary outcomes were the technical success, complications, ABI at 1 week after surgery and minor amputation.

Results: Sixty-nine patients with TAO were assessed for inclusion in our single-center study from 2012 to 2022 and received endovascular procedures. Among them, 22 patients underwent CDT, 21 patients underwent PTA, and 26 patients underwent PTA+CDT. The one-year follow-up revealed significant differences in the MALE-free survival rates among the three groups, particularly between the CDT group and the PTA+CDT group (the hazard ratio (HR) for MALE-free survival was 0.173, 95% CI [0.050-0.599], p = 0.006). The technical success rates of the three groups were 63.6%, 90.5%, and 92.3%, respectively. There were differences in the ABI at one week after surgery among the three groups.

Conclusions: Endovascular procedures are effective for TAO in the short term. The effectiveness of CDT alone is suboptimal; combining CDT with PTA achieves the most favorable endovascular treatment outcome; while the effectiveness of PTA falls in between these two procedures.

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