药物涂层球囊血管成形术治疗孤立性腘动脉慢性闭塞的近期效果  

Short-term outcomes of drug-coated balloon angioplasty for isolated chronic occlusion of popliteal artery

作　　者：叶开创[1] 彭智猷[1] 吴小雨 张省[1] 王新[1] 陆信武[1] YE Kaichuang;PENG Zhiyou;WU Xiaoyu;ZHANG Xing;WANG Xin;LU Xinwu(Department of Vascular Surgery,Affiliated Shanghai Ninth People’s Hospital,School of Medicine,Shanghai Jiao Tong University/Vascular Center of Shanghai Jiao Tong University,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院血管外科、上海交通大学血管病诊治中心,200011

出　　处：《介入放射学杂志》2021年第9期874-879,共6页Journal of Interventional Radiology

基　　金：上海市科委医学引导类项目(19411966100)。

摘　　要：目的评价药物涂层球囊(DCB)血管成形术治疗孤立性腘动脉闭塞性病变的近期临床效果。方法回顾性分析2018年1月至2019年6月期间经DCB成形术治疗的孤立性腘动脉慢性闭塞性病变患者临床资料。主要研究终点为靶病变1年初期通畅率,次要研究终点1年二期通畅率、保肢率和临床症状改善等。结果共入组31例患者36条患肢(左侧19条),其中男20例;平均年龄72.7岁。14例患者16条患肢表现为重症肢体缺血(Rutherford分级4~6级)。手术技术成功率为83.3%(30/36)。6例患者靶病变需植入补救性支架,支架辅助技术均获成功。无患者发生远端动脉栓塞和腘动脉损伤,无死亡。平均随访7.8个月,有7例腘动脉再闭塞,其中3例系补救性支架植入患者,补救性支架再闭塞率为3/6。术后1年靶病变初期通畅率、二期通畅率分别为73.2%、83.6%,保肢率为86.1%,截肢/趾均发生于Rutherford分级6级患者。患肢平均踝-肱指数(ABI)由术前0.43上升至术后0.76,所有患者临床症状明显缓解。结论DCB成形术治疗孤立性腘动脉慢性闭塞性病变安全,近期效果满意。补救性支架似并不能显著提高靶病变通畅率。Objective To evaluate the short-term effect of drug-coated balloon(DCB)angioplasty for the treatment of isolated chronic occlusive disease of popliteal artery.Methods The clinical data of 31 patients with isolated chronic occlusive disease of popliteal artery,who received DCB angioplasty between January 2018 and June 2019,were retrospectively analyzed.The main study endpoint was the one-year primary patency rate of the target lesion,and the secondary study endpoints included one-year secondary patency rate,limb salvage rate,the improvement of clinical symptoms,etc.Results A total of 36 affected limbs(including 19 left affected limbs)were detected in the 31 patients,among them 20 were males.The mean age was 72.7 years.Fourteen patients(16 affected limbs in total)presented as critical limb ischemia(Rutherford classification of Ⅳ-Ⅵ grade).The technical success rate was 83.3%(30/36).In 6 patients the target lesions required remedial stent implantation,and successful stent-assisted technique was accomplished in all procedures.No distal arterial embolism,popliteal artery injury or death occurred.The patients were followed up for a mean period of 7.8 months,popliteal artery reocclusion occurred in 7 patients,and 3 of them had received remedial stent implantation,the reocclusion rate of remedial stents was 50%(3/6).The one-year primary patency rate and secondary patency rate of target lesions were 73.2% and 83.6% respectively.The one-year limb salvage rate was 86.1%.The amputation of foot/toe was required only in patients who had Rutherford classification of Ⅵ grade.After DCB angioplasty the average ankle-brachial index(ABI)increased from preoperative 0.43 to postoperative 0.76.In all patients the clinical symptoms were remarkably alleviated.Conclusion For the treatment of isolated chronic occlusion of popliteal artery,DCB angioplasty is safe with satisfactory short-term effect.It seems that the remedial stent implantation can not significantly improve the patency rate of target lesions.

关 键 词：腘动脉闭塞性病变 药物涂层球囊 血管腔内治疗 

分 类 号：R593.27[医药卫生—内科学]