CDT对支架血管成形术治疗TASCⅡD级AIOD患者近中期有效性与安全性的影响  

Effects of CDT on the short and medium-term efficacy and safety of stent angioplasty in the treatment of patient with TASCⅡD classification AIOD

作　　者：刘宗玮 戴向晨[1] LIU Zong-wei;DAI Xiang-chen(Department of Vascular Surgery,General Hospital,Tianjin Medical University,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院血管外科,天津300052

出　　处：《天津医科大学学报》2022年第3期242-247,共6页Journal of Tianjin Medical University

基　　金：天津市自然科学基金青年项目(19JCQNJC09900)。

摘　　要：目的:探讨导管定向溶栓(CDT)减容治疗对支架血管成形术治疗TASCⅡD级主髂动脉闭塞症(AIOD)近中期有效性与安全性的影响。方法:回顾性分析2015—2020年天津医科大学总医院血管外科腔内治疗的105例(158条患肢)TASCⅡD级AIOD患者的临床资料。依照不同术式分为溶栓组(n=13)、支架组(n=53)及联合组(n=39)进行对比分析。比较术中射线暴露时间、支架置入长度、围手术期出血事件发生率、术后随访期间一期通畅率、免于不良事件发生率、各时段ABI、Rutherford分级改善程度等。结果:共100例患者(148条患肢)成功开通靶病变,患肢手术成功率93.6%(148/158)。52例经CDT治疗的患者围术期间未见CDT相关出血事件发生,其中41例(78.8%)患者TASCⅡ分级降低,52例经CDT治疗的患者中有39例联合金属裸支架置入,置入支架长度明显短于原始病变长度(t=5.019,P=0.000)。联合组射线暴露时间少于支架组(P=0.000)。36个月随访时支架组及联合组一期通畅率优于溶栓组(Log-Rank=5.409、6.748,P=0.020、0.034),60个月随访时联合组一期通畅率优于溶栓组(Log-Rank=4.414,P=0.036)。不同手术方式患者在随访36、60个月时免于不良事件发生率差异无统计学意义(P>0.05)。与术前ABI值相比,术后各组ABI值均提升(P<0.05),随访6个月时联合组和支架组ABI值优于溶栓组(P=0.014、0.046),联合组与支架组相比差异无统计学意义(P=0.564);各组Rutherford分级均较术前降低(P=0.000),联合组和支架组比溶栓组术后Rutherford分级改善程度更优(P=0.001、P=0.021),支架组与联合组比较差异无统计学意义(P=0.296)。结论:CDT辅助支架血管成形术治疗TASCⅡD级AIOD患者临床效果好安全性高。Objective:To study the effects of catheter-directed thrombolysis(CDT)on the short and medium-term efficacy and safety of stent angioplasty in the treatment of TASCⅡD classification aortoiliac occlusive disease(AIOD).Methods:The clinical data of 105 AIOD patients(158 target limbs)with TASCⅡD classification treated by endovascular treatment in General Hospital,Tianjin Medical University from 2015 to 2020 were retrospectively analyzed.They were divided into the thrombolysis group(n=13),the stent group(n=53),and the combined group(n=39)according to the different operating procedures.The intraoperative radiation exposure time,stent length,perioperative bleeding event rate,primary patency rate,and percentage of freedom from the adverse event during postoperative follow-up,ABI,and Rutherford classification improvement in each period were compared.Results:There were 100 patients(148 target limbs)revascularized successfully by endovascular treatment,and the target limb revascularized rate was 93.6%(148/158).There was no CDT-related bleeding event during perioperative period in 52 patients treated with CDT.There were 41 of 52 patients(78.8%)who performed DSA inspection again after CDT treatment,which was found that the TASCⅡclassification decreased than that before the treatment.There were 39 of 52 cases treated with CDT combined with bare metal stent implantation,and the stent length was significantly shorter than the original lesion length(t=5.019,P=0.000).The radiation exposure time in the combined group was significantly less than that in the stent group(P=0.000).The patients in the stent and combined groups had better primary patency rates than patients in the thrombolysis group at 36-month follow-up(Log-Rank=5.409,6.748,P=0.020,0.034),and patients in the combined group had better primary patency rates than patients in the thrombolysis group at 60-month follow-up(Log-Rank=4.414,P=0.036).There was no statistical difference in the rate of percentage of freedom from adverse events at 36 and 60 months of follow-up a

关 键 词：导管定向溶栓 主髂动脉闭塞症 裸支架 

分 类 号：R615[医药卫生—外科学]