股浅动脉狭窄及闭塞的介入治疗现状

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1、股浅动脉狭窄/闭塞的治疗现状BASIL(BypassvsAngioplastyinSevereIschemiaoftheLeg)--multicenter,randomisedcontrolledtrialBypasssurgeryvsballoonangioplasty27UKhospitals5.5y(1999-2004)452patients:severelimbischemiaduetoinfra-inguinaldisease,269men,183women,meanage75228surgery:1/3SFA-PA(AK),1/3

2、SFA-PA,1/3cruralarteries224angioplasty(36%transluminal,50%subintimal,14%mixed)162(80%)SFA,126(62%)includemoredistalvesselsPrimaryendpoint:amputationordeath40%DM,>1/3smokersFollow:449(99%)-1y336(74%)-2y216(48%)-3y99(22%)-4y37(8%)-5yAdamDJ:Bypassversusangioplastyinsevereische

3、miaoftheleg(BASIL):Multicentre,randomisedcontrolledtrial.TheLancet,Dec3-Dec9，2005；366，1925-1934BalloonangioplastybypasssurgeryN=224n=228M:F128:96141:87Age(<70/70-79/>80)30%/46%/24%35%/39%/26%Rt/Ltleg46%/54%43%/57%Smokingstatusnever21%18%current32%40%not>1y46%42%DMnotknown58

4、%58%insulin-dep17%17%non-insulin-dep25%25%Angina19%18%PreviousMI20%15%Previousstroke/TIA18%25%Painatrest92%90%Tissueloss75%73%HT63%59%Baselinecharacteristicsoftrialpatients.248(55%)ptshadnotreachedtheprimaryendpoint(ie,werealivewiththeirtriallegintact)38(8%)werealivewiththe

5、irtriallegamputated36(8%)haddiedsubsequenttohavingtheirtriallegamputated130(29%)haddiedwithoutamputationAttheendoffollow-up:DuringsamehospitalFollowingdischargefromstayas1stinterventionhospitalafter1stinterventionAngioplastySurgeryAngioplastySurgeryN=237n=197n=230n=186Morta

6、lity71100Morbidityangina4412MI61322Stroke1320hematoma16(2)19(9)1(0)5(0)woundinfection18452529chestinfection41032Urineinfection8726falseaneurysm0(0)2(1)0(0)0(0)venousthromboembolism1020Furtherinterventionsangioplasty3110surgery212130amputation201732graftre-exploration0500emb

7、olectomy1210thrombectomy0301wounddebridement3611Mortality,morbidity,andre-interventionwithin30daysafter1stinterventionAngioplastyallocatedin224pts:216underwentattemptedangioplasty43(20%):immediatetechnicalfailure12months:50%resultedinclinicalfailureSurgeryallocatedin228pts:

8、195underwentattemptedsurgery12months:56%werealivewiththetriallegintactRe-intervent