目的 探讨置管溶栓结合多种腔内介入术在改善下肢动脉硬化闭塞症患者动脉硬化指标中的应用。 方法 采用随机数字表法将2021年12月至2024年12月医院收治的下肢动脉硬化闭塞症患者125例分为对照组（63例，失访3例，最终60例）、观察组（62例，失访2例，最终60例）。对照组予以腔内介入治疗，观察组予以置管溶栓后行腔内介入治疗，两组均随访至介入治疗后6个月。比较两组临床疗效（治疗后6个月），行走受损问卷（WIQ）评分、Berg平衡量表（BBS）、视觉模拟评分（VAS）、Rutherford分级、血流动力学指标、动脉硬化指标、下肢神经传导速度、血清学指标（治疗前、治疗后6个月），并发症发生情况（随访期间）。 结果 治疗后6个月，观察组临床总有效率（93.33%）高于对照组（78.33%）（P < 0.05）。治疗后6个月较治疗前，两组行走距离、步行速度、爬梯能力评分均升高，观察组更高（P < 0.05）。治疗后6个月较治疗前，两组BBS评分均升高，观察组更高，VAS评分、Rutherford分级 > 3级的患者占比则均降低，观察组更低（P < 0.05）。治疗后6个月较治疗前，两组动脉血管内径均增厚，观察组更厚，血流量则均增加，观察组更多，血流峰速则加快，观察组更快，踝肱指数（ABI）则升高，观察组更高（P < 0.05）。治疗后6个月较治疗前，两组颈动脉内中膜厚度（IMT）均减小，观察组更小，脉搏波传导速度（PWV）则均减慢，观察组更慢，运动、感觉神经传导速度则加快，观察组更快（P < 0.05）。治疗后6个月较治疗前，两组血清血管内皮生长因子（VEGF）水平均升高，观察组更高，血清内皮素-1（ET-1）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）水平则均降低，观察组更低（P < 0.05）。随访期间，观察组并发症总发生率（3.33%）低于对照组（15.00%）（P < 0.05）。 结论 置管溶栓后行腔内介入治疗可稳定下肢动脉硬化闭塞症患者血流动力学指标，调整其动脉硬化指标，加快下肢神经传导速度，改善患者血管内皮功能，降低机体炎性因子水平，提高患者行走能力、运动功能，减轻患者疼痛感及下肢动脉缺血程度，疗效显著且能降低并发症发生率。

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.