关键词: 下肢动脉硬化闭塞症, 置管溶栓, 多种腔内介入术, 动脉硬化指标

Abstract:

Objective To investigate the application of catheter-directed thrombolysis combined with various endovascular interventions in improving arteriosclerotic indices in patients with lower limb arteriosclerosis obliterans. Methods A total of 125 patients with lower limb arteriosclerosis obliterans admitted to the hospital between December 2021 and December 2024 were randomly assigned， using a random number table method， into a control group （n = 63， with 3 lost to follow-up， resulting in 60 evaluable cases） and an observation group （n = 62， with 2 lost to follow-up， resulting in 60 evaluable cases）. The control group received endovascular interventional therapy alone， whereas the observation group underwent catheter-directed thrombolysis prior to the same endovascular intervention. Both groups were followed up for 6 months post-intervention. Outcomes assessed included clinical efficacy at 6 months after treatment， Walking Impairment Questionnaire （WIQ） scores， Berg Balance Scale （BBS） scores， Visual Analogue Scale （VAS） scores， Rutherford classification， hemodynamic indices， arteriosclerosis index， nerve conduction velocity in the lower limbs， serological markers （measured before treatment and 6 months post-treatment）， and incidence of complications during follow-up. These outcomes were compared between the two groups. Results Six months after treatment， the total clinical effective rate in the observation group （93.33%） was significantly higher than that in the control group （78.33%） （P < 0.05）. Compared with pre-treatment levels， both groups showed improvements in walking distance， walking speed， and stair-climbing ability， with greater gains observed in the observation group （P < 0.05）. The Berg Balance Scale （BBS） scores increased in both groups， with a more pronounced improvement in the observation group （P < 0.05）. Additionally， the proportion of patients with Visual Analog Scale （VAS） scores and Rutherford classification exceeding grade 3 decreased， with a lower proportion in the observation group （P < 0.05）. The arterial lumen diameter increased in both groups， while blood flow volume and peak velocity improved more significantly in the observation group， along with a greater increase in ankle-brachial index （ABI） （P < 0.05）. Carotid intima-media thickness （IMT） decreased in both groups， with a greater reduction in the observation group； pulse wave velocity （PWV） slowed， and both motor and sensory nerve conduction velocities increased， with more favorable changes in the observation group （P < 0.05）. Serum levels of vascular endothelial growth factor （VEGF） increased in both groups， particularly in the observation group， while levels of endothelin-1 （ET-1）， high-sensitivity C-reactive protein （hs-CRP）， and tumor necrosis factor-α （TNF-α） decreased， with more marked reductions in the observation group （P < 0.05）. During the follow-up period， the overall complication rate in the observation group （3.33%） was significantly lower than that in the control group （15.00%） （P < 0.05）. Conclusions Endovascular interventional therapy following catheter-directed thrombolysis can stabilize hemodynamic parameters in patients with lower limb arteriosclerosis obliterans， modulate atherosclerotic markers， accelerate lower limb nerve conduction velocity， improve vascular endothelial function， reduce systemic inflammatory factor levels， enhance walking capacity and motor function， alleviate patient pain， and mitigate the degree of lower limb arterial ischemia. This combined approach demonstrates significant therapeutic efficacy and reduces the incidence of complications.

Key words: arteriosclerosis obliterans of lower limbs, catheter thrombolysis, various endovascular interventions, atherosclerosis index