KẾT QUẢ ĐIỀU TRỊ BỆNH ĐỘNG MẠCH CHI DƯỚI MẠN TÍNH GIAI ĐOẠN IV THEO FONTAINE BẰNG CAN THIỆP NỘI MẠCH TẦNG DƯỚI GỐI

Abstract

Backgroud: Peripheral Artery Disease (PAD) is a common disease in the elderly, progressing silently and recurring many times. Stage IV PAD according to Fontaine is the late, most severe stage of lower limb vascular disease, causing disability and leading amputation rate, reducing the patient's quality of life. Objectives: To determine the initial and short-term results of treatment for endovascular intervention of Infrapopliteal PAD at clinical stage IV of Fontaine classification. Subjects and methods: A retrospective descriptive study was conducted on patients with Infrapopliteal PAD at clinical stage IV of the Fontaine classification who underwent endovascular intervention at Cardiovascular and Thoracic Center, Viet Duc University Hospital from January 2022 to April 2023. Results: A total of 53 limbs at Fontaine stage IV from 51 patients (age 76.6 ± 14.5 years) underwent endovascular intervention at the below-the-knee levels, with a male/female ratio of 22/29. The main risk factors were smoking 31.3%, hypertension 74.0%, diabetes 51% with Rutherford classification 5 and 6 rates being 83% and 17%. The proportion of complex lesions TASC II C accounted for 72%, TASC II D accounted for 5.7%. The ankle brachial index (ABI) before and after intervention was 0.20 ± 0,08 and 0.72 ± 0.38, respectively (p < 0.05), intervention time was 32.0 ± 7.4 (from 25 - 51) minutes. The ratio of the number of arteries below the knee to be intervened includes one vessel 18.9%, two vessels 43.4%, three vessels 37.7%. Among the intervened vessels, the anterior tibial artery accounted for 38.8%, the posterior tibial artery for 31.9%, and the peroneal artery for 29.3%. The number of legs treated at the thigh level accounted for 43.4%, the below knee level accounted for 100%. The rate of Fontaine stage 1 month after intervention was IIa (68%), IIb (28%), III (4%) and the wound healing rate was 92%. The rate of complications after intervention included 3.9% upper leg amputation, 23.5% toe amputation, 2.0% limb infection after intervention, 5.9% post-intervention restenosis and 7.8% of hematomas at the puncture site, no patients died or had kidney failure after intervention. Conclusion: Endovascular intervention for infrapopliteal arteries proves to be a safe and effective procedure for treating symptomatic PAD. Nevertheless, a larger sample size and further studies are required for confirmation.