오금하동맥 폐색 환자에서 경피적 경혈관 풍선 혈관성형술: 임상적 결과 및 영향인자 = Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

다국어 초록 (Multilingual Abstract)

Purpose: To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis.
Materials and Methods: A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage.
Results: Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003).
Conclusion: PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

국문 초록 (Abstract)

목적: 오금하동맥의 협착 또는 폐색이 있는 환자에서 시행한 경피적 경혈관 풍선 혈관성형술(PTA)의 유용성에 대해 알아보고, PTA 결과에 영향을 미치는 인자에 대해 연구하고자 한다.
대상과 방법: 오금하동맥의 협착 또는 폐색이 발생하여 PTA를 받았던 55명의 환자, 60 하지를 대상으로 하였다. 시술 전 동맥 경화성 위험인자, 임상 증상, TASC 분류, 혈관 석회화와 시술 전과 후의 정상적 혈류를 가지는 오금하동맥의 수를 평가하였고, 시술 후 증상 개선율과 하지 보존율을 추적하였다.
결과: 기술적인 성공은 53/60 하지(88.3%), 81/93개 혈관(87.1%)에서 있었고, TASC 분류(p = 0.038)와 혈관 석회화(p = 0.002)가 심할수록 실패 확률이 높았다. 시술 후 26/55 하지(47%)에서 증상 호전이 있었고, 42/55 하지(76%)에서 하지를 보존하였다. 당뇨병 환자(17/43, 40%)에 비해 비당뇨병 환자(9/12, 75%)에서 증상 개선율이 높았다(p = 0.024). TASC 분류와 혈관 석회화가 심할수록 증상 개선율과 하지 보존율이 낮았고, PTA 후의 정상적 혈류를 보이는 오금하동맥의 수가 많을수록 증상 개선율(p ＜ 0.001)과 하지 보존율(p = 0.003)이 높았다.
결론: 만성 중증 하지 허혈 환자에서 PTA는 일차적 치료로서 충분한 유용성을 가진다. 또한 시술 전 PTA에 영향을 미칠 수 있는 인자에 대한 충분한 고려가 필요하며, 시술시 가능한 많은 병변에 재개통술이 이루어져야 한다.

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