| Objective: The diabetic lower extremity angiopathy has became one of the main causes of non-traumatic amputation.By analyzing the related cases of diabetic lower extremity angiopathy treated by interventional therapy in the Department of Endocrinology of the fourth Hospital of Hebei Medical University,to understand the epidemiology of diabetic lower extremity angiopathy,and to explore the related risk factors of diabetic lower extremity angiopathy.At the same time,the long-term curative effect and risk factors of restenosis after interventional therapy for diabetic lower extremity angiopathy were studied to provide the basis for clinical prevention and treatment.Methods: The inpatients with diabetic lower extremity angiopathy were elected from the Department of Endocrinology of the fourth Hospital of Hebei Medical University from August 2007 to March 2014 as the study object.After regular follow-up,the clinical records of the patients which were collected were carried out,analysed,collected and researched.Results: 1 The clinical basic data analysisOf the 166 patients in this study,101 patients(60.8%)were male and 65 patients(39.2%)were female.The mean age was 66.3 ±11.5 years old,and only 1 case was less than 50 years old.The average duration of diabetes was 120(159)months,and the course of diabetes was long in patients with lower extremity angiopathy.Patients with hypertension accounted for 63.86%.Patients with cardiovascular disease accounted for 45.78%.Patients with cerebrovascular diseases accounted for 39.16%.And diabetic lower extremity angiopathy complicated with hypertension and cardiovascular and cerebrovascular complications.2 Related influencing factors of diabetic lower extremity angiopathyRisk factors for diabetic lower extremity angiopathy include HGB(P=0.001),TG(P=0.018),ALB(P=0.000),LPa(P=0.030),PT(P=0.001),and APTT(P=0.005).By binary logistic regression analysis,HGB and LPa were independent factors in the diagnosis of diabetic lower extremity angiopathy.HGB(P=0.004,OR=0.973)was the protective factor,and LPa(P=0.048,OR=1.002)was the risk factor.The more severe the occlusion,the higher the level of LPa and the lower the content of HGB.3 Interventional operation 3.1 Distribution and occlusive position of affected limbsThere were 191 limbs in 166 patients,and 104 limbs of them were placed into stents,accounting for 54.45%.There were 103 left limbs,accounting for 62.05%.And there were 88 right limbs,accounting for 37.95%,(25 patients had bilateral limbs undergoing interventional surgery).And most of the affected limbs were left limbs.There were only 6 affected limbs(3.14%)with iliac artery lesion,52 limbs(27.2%)with femoral and popliteal artery lesion,68 limbs(35.6%)with inferior genicular artery lesion,and 8 limbs(4.12%)with iliac artery and femoral popliteal artery lesion,53 limbs(27.75%)with femoral and popliteal artery and inferior genicular artery lesion,2 limbs(1.02%)complicated with iliac artery and inferior genicular artery lesion,2 limbs(1.02%)complicated with iliac artery,inferior genicular arterywith and femoral popliteal artery lesion.Most of the lesions occurred in the inferior genicular artery.3.2 Surgical effectOne week after operation,the pulsatility of the dorsal artery of the feet was enhanced,the resting pain was relieved,the walking distance was increased.And the ABI was significantly increased as compared with the pre-operation group(0.30 ±0.15)and the first week after operation(0.85 ±0.20).3.3 Operative complicationsThere were 12 patients with operative-related complications(7.2%),including arterial thrombosis,post-operative cerebral infarction,stress gastric ulcer,acute renal insufficiency,acute myocardial infarction,heart failure,and pseudoaneurysm.Postoperative bleeding,pulmonary infection and respiratory failure occurred in 3 of them,and the perioperative mortality was 1.5%.4 Follow-up results 4.1 The survival aspectOf the 166 patients,31 patients were lost to follow-up during the follow-up period,and 51 patients of the 135 patients who were followed up were dead.The main causes were postoperative complications,cardiovascular disease,cerebrovascular disease,renal failure,diabetic ketoacidosis,pulmonary infection,and respiratory failure,and so on.Cardiovascular death which accounted for 33.3% of the causes was the main case.Twenty-there patients died more than 5 years after operation,the 5-year survival rate was 45.1%.4.2 Limb salvage conditionsDuring the follow-up,there were 4 limbs which were cutted off above the ankle joint of the 80 patients(80 limbs),and 95% of the patients avoided amputation.4.3 Unobstructed reconstruction of blood vesselsForty patients(40 limbs)of the 80 patients(80 limbs)experienced recurrence or aggravation of ischemic symptoms after operation.The patency rate of blood vessels in one year,two years,three years and five years were 89%,80%,62% and 52%.The incidence of restenosis increased with the duration of intervention.4.4 The analysis of risk factors associated with recurrence of ischemic symptomsThe patients who survived in the follow-up were divided into two groups: recurrence group and non-recurrence group.The results of multivariate binary logistic regression analysis showed that the severity of occlusion was statistically significant for recurrence of ischemic symptoms,and the more severe the vascular occlusion of lower limbs was,the more severe the occlusions of lower extremities were.The more likely symptoms to recur,the higher the incidence of postoperative restenosis.Conclusion:1.The patients with diabetic lower extremity angiopathy were mostly male,most of whom were over 50 years old.The course of diabetes was long and often complicated with hypertension and cardio-cerebrovascular disease.2.The more severe vascular occlusion was in diabetic lower extremities,the higher the level of LPa was and the lower the content of HGB was.3.Cardiovascular disease was the main cause of death in patients with diabetic lower extremity angiopathy.The incidence of restenosis increases with the prolongation of interventional therapy.The more severe vascular occlusion was,the higher the incidence of restenosis was.4.Interventional surgery was effective and safe in the near future,but the prevention of long-term restenosis will still be the most important in clinical practice. |
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