| Arterial occlusive diseases of the lower extremity is the stenosis or occlusion of the lower extremity artery caused by a variety of reasons, and it may cause ischemia of the lower extremity. It is a degenerative disease of the large and median artery, and mainly caused by atherosclerosis. It is characterized by the formation of intimal plaques consisting of lipid accumulations, smooth-muscle and inflammatory cells, connective tissue fibers, and calcium deposits. It is similar in clinic case but we can not still know the reasons. Apt sicken factor of the diseases is including diabetes, lipid accumulation decompensation, smoking, high blood pressure, plasma fibrinogen rising etc. according to the survey of epidemiology. In the early onset of the disease, it is difficult to be found out, with only slightly cool limb, numbness, discomfort and intermittent claudication, the lack of specific symptoms, easy to misdiagnosis and be missed diagnosis. The emergence of clinic intermittent claudication always mean there is already a serious ischemia, the classical cures are surgical treatments and conservative pharmacotherapy, multiple research testified that the former is a more effective treatment. Early atherosclerosis can be given oral or intravenous drug treatments, it is effective generally. But with the growth of age, even if formal treatment is unable to prevent the development of the diseases completely, drug treatment is always ineffective, and often need surgical treatments. The current surgical treatment is the bypass with prosthese or autogenous veins. But not every patients can tolerate surgery, how to improve the blood circulation of the limbs, relieve pain, reduce amputations and death incident become a serious problem. In the last 40 years, as the developments of interventional technique and apparatus, many researchers are trying to find treatments that can improve the quality of life and prolong survival time with a minimally invasion. Now the intervention methods for its simple operation, less trauma, fewer complications and higher success rate had become an important treatment in the treatment of peripheral arterial occlusive diseases.Objective: Comparing the treatment group and surgical intervention group before and after operation ankle brachial index and the changes in the two groups after one week, one month, six months and one year of follow-up ABI, observation of two methods for the treatment of lower extremity ischemia of the clinical effect on The disease intervention therapy in the treatment of the role and advantages.Methods: The clinical data of 139 cases with arterial occlusive diseases who were treated in the first clinical hospital of the Jilin university and the Changhai hospital of the second military medical college from November 2005 to March 2008 is analyzed retrospectively. The cases were classified to two groups: interventional group and surgical group. The first group contain 78 cases, 59 males, 19 females, aged 51～88 years, with an average age of 64.52±6.98. The second group contain 61 cases, 49 males, 12 females, aged 50～76 years, with an average age of 61.32±5.87. Use the German Angiostar and AIXOM Arits dTA digital angiography machine and the two groups were treated respectively by endovascular treatment and operation treatment. To check ankle branchial index of lower limbs in different period through the special Doppler in order to confirm Interventional Therapy result. And to analyze and judge therapy result according to result changing statistics a week, a month, a half year and a year before and after operation. To follow up 1～24 months, 76 cases (97.43%) were followed up in the first group, and 58 cases (95.08%) in the second goup. Recording the ankle/brachial index (ABI) of the two groups before operation and one week, one month, six months, one year after operation, and take it into statistical analysis.Results: 76 cases is successful by Endovascular treatment, opening rate is 97.4%, and it is higher than the current reports. Two cases of the iliac artery oclussion were not opened, so the next day operated aorto-femoral bypass. The first two days after the treatment of one case, the distal blood circulation has not marked improvement, so it received the second treatment, after 5 days the third treatment the distal blood circulation improved significantly. In one case, there was thrombosis in the artery, opened again and gave thrombolytic therapy, the symptoms improved finally. In one case, after two days thrombolytic therapy, there was bone compartment syndrome, so open the impartment, the patient recovered after two months. Among the remaining cases, there were not serious postoperative complications and no deaths. No matter what kind of treatments, the symptoms were significantly improved. In 78 cases comparing the ABI between pre-operation and a week, a month, six months and a year after operation, there are significant differences statistically (P<0.01). 61 cases of surgical treatment success, opening rate is 100%. One case died from renal failure in third day after surgery. One case died from respiratory failure in the in fifth day after surgery, and one case died from myocardial infarction. The symptoms were also significantly improved. Among the 61 cases, comparing the ABI between pre-operation and a week, a month, six months and a year after operation, there are significant differences statistically (p<0.01). Comparing ABI of two groups of cases accepted different treatment after a week, a month, a half year and a year, there is not a significant difference (P>0.05).Conclusion: Through analyzing the treatment of 139 cases, we can find that, the patients with clinical symptoms improved significantly, and endovascular treatment is an effective treatment for the arterial occlusive diseases of the lower extremity. Endovascular treatment is not better than the surgical treatment, but because it is minimally invasive, reused, and has fewer postoperative complications, does not exclude the surgical treatment, it will be more widely used in the arterial occlusive diseases of the lower extremity.1. Surgical indications become wider relatively, it is a treatment with lower mortality, fewer complications and no serious complications after operation.2. Choosing the right indications for endovascular treatment, it can gain the similar effect with surgical treatment, and can save time for the second trearment.3. Endovascular treatment is compatible with surgical treatment, and can be used for pre-surgical treatment, can be used after surgical treatment as an implementation, and can even be combined with surgical treatment.4. With the development of equipments and apparatus inner antrum, endovascular treatment will become the main method for peripheral arterial occlusive diseases. |
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