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目的探讨BOLUS(团注)步进减影技术在干细胞治疗糖尿病足下肢动脉硬化闭塞症的临床应用价值。方法 12例患者,健侧(单侧)或较轻侧(双侧)股动脉Seldinger经皮穿刺,在透视下将导管送至髂总动脉上或单侧靶血管,双下肢近端作为步进造影起始位、足背作为步进造影终止位行BOLUS步进减影技术造影,显示双或单下肢动脉全程影像;膝上狭窄采取经皮血管球囊扩张成形术;膝下采取腘动脉球囊封堵术及远端干细胞置入术。结果 BOLUS造影成功显示下肢动脉硬化闭塞症10例,造影不成功2例,其中右侧髂总动脉完全闭塞及股动脉闭塞各1例。股动脉狭窄及球囊扩张3例。阻断腘动脉后干细胞置入10例,于闭塞段取栓后行球囊扩张及未阻断腘动脉直接置入干细胞1例,腹主动脉下端直接注入干细胞1例。12例患者中11例效果较为显著,疼痛、麻木感明显缓解,皮温及ABI指数均较术前显著升高,两者间差异具有统计学意义(P<0.01)。下肢溃疡4例不同程度好转。结论 BOLUS步进减影技术是目前观察下肢动脉血管解剖和形态改变的最先进的检查技术,注射一次对比剂可长段显示血管,减少造影次数及剂量,减轻造影剂对患者的毒性反应。腘动脉球囊封堵及远端干细胞置入可延长干细胞在远端血管内的停留时间,保证干细胞治疗糖尿病足下肢动脉硬化的治疗效果。
Objective To investigate the clinical value of BOLUS stepping subtraction imaging in the treatment of diabetic foot lower extremity arteriosclerosis obliterans by stem cells. Methods Seldinger percutaneous (unilateral) or femoral artery (bilateral) femoral artery was percutaneously punctured in 12 patients. The catheter was sent to the common iliac artery or unilateral target vessel under fluoroscopy. The proximal ends of both lower extremities were taken as stepping Angiography starting position, dorsal foot as a step-by-step endoscopic imaging BOLUS step subtraction imaging, showing double or single lower extremity arterial whole image; narrow stenosis to percutaneous balloon angioplasty; knee to take popliteal artery balloon Blockage and distal stem cell implantation. Results BOLUS angiography successfully demonstrated lower extremity arteriosclerosis obliterans in 10 cases, angiography unsuccessful in 2 cases, including the right common iliac artery occlusion and femoral artery occlusion in 1 case. Femoral artery stenosis and balloon dilation in 3 cases. After blocking the popliteal artery, stem cells were implanted in 10 cases. In the occlusion section, balloon dilatation and non-occlusion of the popliteal artery were performed. One case was injected directly into the stem and one case was injected directly into the lower abdominal aorta. Among the 12 patients, the effect was significant in 11 cases. The pain and numbness relieved obviously. The skin temperature and ABI index increased significantly compared with those before operation. The difference was statistically significant (P <0.01). Lower extremity ulcer in 4 patients improved to varying degrees. Conclusions BOLUS stepping subtraction technique is the most advanced examination technique to observe the anatomy and morphological changes of lower extremity arteries at present. Once a contrast medium is injected, BOLUS can display blood vessels, reduce the times and doses of contrast and reduce the toxicity of contrast medium to patients.腘 Artery balloon occlusion and implantation of distal stem cells can prolong the residence time of stem cells in the distal blood vessels to ensure the therapeutic effect of stem cells on arteriosclerosis of lower extremities of diabetic foot.