紫杉醇药物球囊治疗股腘动脉粥样硬化性病变的疗效分析  

Paclitaxel coated balloon in the treatment of femoral popliteal artery disease

作　　者：张永保 滕乐群 房杰 刘新农 曲诚家 沈晨阳 Zhang Yongbao;Teng Lequn;Fang Jie;Liu Xinnong;Qu Chengjia;Shen Chenyang(Center of Vascular Surgery,Chinese Academy of Medical Sciences,Fuwai Hospital,Beijing 100037,China;Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院阜外医院血管中心,北京100037 [2]中国医学科学院北京协和医学院,北京100730

出　　处：《中华普通外科杂志》2022年第3期184-188,共5页Chinese Journal of General Surgery

摘　　要：目的分析紫杉醇药物球囊(drug-coated balloon,DCB)在股腘动脉粥样硬化性病变中的疗效及不同病变特征间的疗效差异。方法回顾性分析2016年6月至2019年7月阜外医院血管中心125例经DCB治疗的股腘动脉粥样硬化性病变患者(141侧肢体)的临床及随访资料。结果所有患者中位随访时间19个月,纳入病变平均长度(138±78)mm,总体术后12、24个月累积一期通畅率分别为81.4%和60.8%,免于再干预率(free of target lesion revascularization,f-TLR)分别为90.1%和83.0%。亚组分析显示在TASC C/D级原发病变中合并严重钙化者的一期通畅率以及累及腘动脉病变者f-TLR率显著下降。多因素分析显示TASC C/D级病变、严重钙化病变均是术后一期通畅率的独立危险因素,而合并高血压是独立保护性因素。支架内再狭窄病变(in-stent restenosis,ISR)亚组分析显示累及腘动脉段的ISR靶病变预后劣于单纯股浅动脉ISR。结论DCB在股腘动脉病变治疗中取得较满意的中期靶病变通畅率,但复杂性病变的疗效仍需要进一步的提高。Objective To summarize the clinical efficiency of paclitaxel drug coated balloon(DCB)in femoral popliteal artery disease.Methods Retrospective analysis was made on 125 patients(141 limbs)admitted from Jun 2016 to Jul 2019 for femoral popliteal disease treated with DCB.Results Median follow-up time was 19 months.The average lesion length was(138±78)mm,with an overall cumulative primary patency rate of 81.4%and 60.8%at 12 and 24 months postoperatively and f-TLR rates of 90.1%and 83.0%,respectively.In a total of 109 primary lesions,subgroup analysis showed that among the TASC C/D primary lesions,the primary patency rate was significantly lower in those with combined severe calcification and the f-TLR rate in those with popliteal involved lesions.TASC grade C/D lesions,severe calcified lesions were independent risk factors for patency,while hypertension was an independent protective factor.In-stent restenosis(ISR)target lesions involving the popliteal segment had a significantly worse prognosis than ISR of the superficial femoral artery.Conclusion DCB in the treatment of lower femoral popliteal artery lesions can achieve a satisfactory medium-term patency outcome,while the efficacy for complex lesions still needs further improvement.

关 键 词：动脉硬化 血管成形术 药物球囊 股腘动脉 

分 类 号：R543.5[医药卫生—心血管疾病]