下肢动脉慢性完全闭塞病变介入治疗的血管评估方案研究进展  

Advances in research on vascular assessment of lower extremity chronic total occlusion for interventional therapy

作　　者：薛双龙 张军波[1] 李尤 付博文 康梦阳 田红燕[1] XUE Shuanglong;ZHANG Junbo;LI You;FU Bowen;KANG Mengyang;TIAN Hongyan(Department of Peripheral Vascular Diseases,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院周围血管科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2023年第1期147-152,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省重点研发计划项目(No.2019SF-153)。

摘　　要：下肢动脉慢性完全闭塞性病变(chronic total occlusion,CTO)是下肢动脉硬化闭塞症(peripheral artery disease,PAD)最严重的类型,易引发高截肢及死亡率。介入治疗(endovascular therapy,EVT)为目前下肢动脉CTO的主要治疗策略,但由于CTO病变复杂程度高,常导致手术成功率较低且并发症发生。分析下肢动脉CTO的特征,建立一个有效预测下肢动脉CTO血运重建成功率的分级或评分系统,有助于制定合理治疗策略及评估获益/风险等。本文主要介绍近年来的一些分级及评分系统,包括钙化分级(PACSS、PARC、TAC)、CTOP分型、Infrapop-CTO评分及J-BTK CTO评分等。其中PACSS分级及PARC钙化分级适用于髂股段、股腘段及膝下动脉段钙化评估;TAC分级适用于膝下动脉段钙化评估。随着下肢动脉钙化分级增加,其CTO病变的血运重建成功率呈下降趋势。CTOP分型是依据下肢动脉CTO近远端纤维帽形态所研发,其Ⅳ型顺行介入成功率低。Infrapop-CTO评分及J-BTK CTO评分适用于预测膝下动脉段CTO血运重建成功率,其均包含闭塞段长度>200 mm、近端钝形及钙化;伴随着评分增加,膝动脉段CTO介入成功率逐步下降。Lower extremity chronic total occlusion(CTO)is the most severe manifestation of peripheral artery disease(PAD),with high amputation and mortality rates.As a minimal invasive reconstruction therapy,endovascular therapy(EVT)plays an important role in limb salvage for CTO in current clinical practice.The complexity of CTO lesions leads to a high risk for complications and a low success rate of EVT.Therefore,establishing a grading or scoring system to predict the success rate of revascularization strategy will be helpful in developing appropriate treatment strategies and assessing benefits and risks.This paper summarizes the most popular CTO scoring systems,such as PACSS grading,PARC grading,TAC grading,CTOP classification,Infrapop-CTO scoring,and J-BTK CTO scoring.PACSS grading and PARC grading are suitable for evaluating the severity of vascular calcification including iliofemoral segment,femoral-popliteal segment,and below-the-knee artery segment.TAC grading is suitable for grading calcification below the knee lesions;with low intervention success rate in a high calcification grading.CTOP classification was developed by analyzing the effect of morphological characteristics of proximal and distal fibrous caps of lower extremity CTO lesions on the outcome of EVT.The success rate of antegrade intervention is lower in type IV.The Infrapop-CTO score and J-BTK CTO score can predict successful anterograde crossing of infrapopliteal CTO lesions,with low intervention success rate in high score.Both scoring systems use three variables,namely,shape of proximal stump,calcification,and occlusion length.

关 键 词：慢性肢体威胁性缺血 慢性完全闭塞性病变 经皮腔内血管成形术 评分 评估方案 

分 类 号：R543.5[医药卫生—心血管疾病]