Interventional Treatment Of Chronic Obstructive Disease Of The Iliofemoral Artery

Objective:To investigate intervention strategies and clinial efficay of treatment of chronic obstructive disease of the iliofemoral artery.Methods:18 cases of chronic iliofemoral arterial stenosis and occlusion was selected from December 2006 to December 2008 at our hospital.among these, male is 15 cases,female 3 cases;the age ranges from 46 to 78,average 64.5 years old;the average course of disease is more than 8 months(from early onset to treatment time).All the patients showed symptoms of chronic lower limb ischemia. The patients are divided into A group(PTA) and B group(PTA and stent) according to the operation form.The vascular ultrasound,Ankle-brachial index(ABI), three-dimensional CT angiography(CTA) and Fontaine classification in the pre-operation,the digital subtraction angiography technique(DSA) inspection in the operation are routinely carried out,and ABI,vascular ultrasound and the increasing degree of Fontaine are the index in the follow-up visit which last 24 months.The counting and measurement data obtained in this study were analyzed statistically by the paired t test and X~2 test.Statistical analysis is carried out by software SPSS 11.0.Results:Fontaine clinical classification is carried out in accordance with the clinical symptoms and intermittent claudication distance,among these,Ⅰ-type is 0 cases(without clinical symptoms);Ⅱa type 5 cases(intermittent claudication distance≥200m),Ⅱb-type 9 cases(intermittent claudication distance＜200 m);Ⅲtype 4 cases(rest pain);Ⅳtype 0 cases(tissue necrosis,gangrene do). Ankle-brachial index(ABI) in the pre-treatment is 0.57±0.14.Among 18 cases,4 cases are associated with coronary heart disease,14 cases with high blood pressure,11 cases with hyperlipidemia,5 cases with diabetes,6 cases with ischemic brain lesions,1 cases with rheumatic heart disease.18 patients 21 vascular lesions is sick in the total 18 cases,during which the number of common iliac artery occlusion is 0,the number of external iliac artery occlusion is 0,the number of iliac artery stenosis is 12,the number of external iliac artery stenosis is 3 with narrow length of 2～8cm,the number of stock main artery occlusion is 1 with the length of 2cm,the number of limited stenosis or segmental stenosis which occur in many parts in the stock shallow artery is 4 with full-length of 4～12cm,the number of stenosis from stock main artery to stock shallow artery is 1 with the length of 8cm.7 vessel lines are carried out by PTA,14 vessel line by PTA and vascular stent implantation with a total of 16 stent implantation.Stents were successfully placed in the iliac/femoral artery,with the technical success rate of 100%.Stent diameter is 5～10 mm and its length is 6～10cm.Success in the treatment of 18 cases,the clinical symptoms and signs were significantly improved.One cases were minor complications which is cured by symptomatic treatment.Clinical follow-up 1～24 months,18,18,16,13 and 8 patients are followed up in the after-operation 1,3,6,12 and 24 months respectively,a total opening rates were 100%(21/21),100% (21/21),95%(18/19),87%(13/15),80%(8/10).In this study,in the after-operation 6 months in 16 patients(18/19),ABI index vary from 0.56±0.14 in the pre-operation to 0.92±0.09 in the after-operation, as shown that ABI index in the after-operation is superior to that in the per-operation(P＜0.05).The increasing degree of Fontaine is as follows:a month after the operation,17 cases reachⅠ-type,and 1 case reachⅡa;six month after that,there are still 9 cases reachingⅠ,6 cases withⅡa,and 1 case withⅡb.twelve month later,5 cases get toⅠ,6 cases get toⅡa,and 2 cases get toⅡb.twenty-four month later,there are 3 cases reachingⅠ,2 cases reachingⅡa,and 3 cases reaching toⅡb.Conclusion:Chronic obstructive iliofemoral artery opening treatment of traumatic lesions is characterized by small injure,good effect,quick restore,few complications and repeated applications,and there is a good clinical value.