Retrospective study of peripheral arterial disease and ankle brachial index in femoro - popliteal segment visual assessment and analysis.

Bacground: Peripheral arterial disease is the most common disease of arterial vessels in this anatomical region. Symptoms may range from intermittent claudication to pain even at rest. The claudication is expressed by the occurrence of pain in the affected limb in physical effort and resolves at rest. Pain, usually appears distally from the narrow or clogged area of the vessel. When atherosclerotic changes affect the superficial femoral artery and/or popliteal artery, pain commonly occurs in the calf region of the affected limb. Aim: Analysis of frequency and type of vessel changes in femoro - popliteal anatomical region and correlations of the disease with ankle brachial index. Patients and methods: The study includes 400 patients (250 men and 150 women aged between 60 and 75. All patients under investigation exhibit one or more symptoms of PAD and their complaints date for at least 2 years. All CT studies included in the study are performed on 256 slice CT with automatic injection system. Standard angiographic system is used for performing digital subtraction angiograms in the study. Standard straight and curved, diagnostic catheters and guides were used, according to the desired access and anatomical features of the patient. Angiographic injection system. The mean age of patients was 65.21. Standard deviation of 4.1, corrected standard error 0.059. Median = 65. According to the WHO, the patients collected in this study fall into the age of "elderly people". Results: 71% of surveyed patients have thrombotic changes in the femoral anatomic segment. Engagement of the superficial femoral artery is visualized in about 80% of cases with this anatomical localization. Followed by popliteal artery 68% and the deep femoral artery 32%. 13% of those surveyed for PAD have lesions type D, proven by CT and DSA in femoro- popliteal segment. 20.5% have C-type lesions in the anatomic region. Type B lesions are observed in 22% of patients suffering from PAD. 21% of patients have Type A lesions. Inversion of the values of unilateral or bilateral involvement is visible. Type A and B lesions are predominate in unilateral engagement of arterial vessels, whereas C and D lesions are more frequent in bilateral disease. It is noteworthy that ABI is less than 0.5 at 100% of patients with lesions of type D in femoro popliteal segment. α = 0.02 - there is a statistically significant relationship. Dependence is average V2 = 0.374. 68.29% of the studied patients with ABI values below 0.5 have type C lesions. α = 0.01 - there is a statistically significant relationship. Dependence is poorly expressed V2 = 0.201. 47.72% of the studied patients with ABI values between 0.7-0.5 have type B lesions. α = 0.35 - we accept H0. 71.42% of the studied patients with ABI value above 0.7 have type A lesions. α = 0.741 - there is no statistically significant relationship.

研究背景：外周动脉疾病(Peripheral Arterial Disease, PAD)是该解剖区域最常见的动脉血管病变。其临床表现谱系宽泛，从间歇性跛行直至静息痛不等。间歇性跛行表现为受累肢体在体力活动时出现疼痛，休息后疼痛可缓解，疼痛通常位于血管狭窄或闭塞区域的远端。当动脉粥样硬化病变累及股浅动脉和/或腘动脉时，疼痛常发生于患肢小腿区域。
研究目的：分析股腘解剖区域血管病变的发生率与类型，并探讨该疾病与踝肱指数(Ankle Brachial Index, ABI)的相关性。
患者与方法：本研究纳入400例患者（250例男性，150例女性，年龄区间为60~75岁）。所有纳入研究的患者均存在一项或多项PAD相关症状，且症状持续至少2年。本研究涉及的所有CT检查均采用256层CT扫描仪及自动注射系统完成。数字减影血管造影(Digital Subtraction Angiography, DSA)采用标准血管造影系统进行操作。根据患者的手术入路需求及个体解剖特征，选用标准直头、弯头诊断导管及导丝完成操作。本研究使用血管造影注射系统。患者的平均年龄为65.21岁，标准差为4.1，校正标准误为0.059，年龄中位数为65。根据世界卫生组织(World Health Organization, WHO)的分类标准，本研究纳入的患者均属于「老年人」范畴。
研究结果：71%的受访患者在股动脉解剖节段存在血栓性病变。其中约80%的病例可见股浅动脉受累，其次为腘动脉（68%）及股深动脉（32%）。13%的PAD受访患者在股腘节段存在D型病变，该病变类型经CT及DSA检查证实。20.5%的患者存在C型病变，22%的PAD患者存在B型病变，21%的患者存在A型病变。单侧与双侧血管受累的病变类型分布呈现反转特征：A型与B型病变多见于单侧动脉血管受累病例，而C型与D型病变则更常见于双侧血管病变病例。值得注意的是，所有股腘节段D型病变患者的ABI值均低于0.5（α=0.02，存在统计学显著相关性，相关性程度中等，V2=0.374）。68.29%的ABI值低于0.5的研究对象存在C型病变（α=0.01，存在统计学显著相关性，相关性程度较弱，V2=0.201）。47.72%的ABI值介于0.5~0.7之间的研究对象存在B型病变（α=0.35，接受原假设H0）。71.42%的ABI值高于0.7的研究对象存在A型病变（α=0.741，无统计学显著相关性）。