机构地区:[1]蚌埠医学院第一附属医院血管外科,蚌埠233004 [2]安徽医科大学附属阜阳医院血管外科,阜阳236000
出 处:《中华解剖与临床杂志》2023年第6期388-394,共7页Chinese Journal of Anatomy and Clinics
基 金:安徽省科技攻关项目(201904a07020020)。
摘 要:目的探讨药物涂层球囊(DCB)血管成形术治疗股腘动脉支架内再狭窄(ISR)患者术后1年再狭窄发生的影响因素。方法横断面研究。纳入2016年1月—2021年8月蚌埠医学院第一附属医院血管外科股腘动脉ISR患者58例(58条肢体),其中男40例、女18例,年龄52~85(71.9±7.6)岁。术前踝肱指数(ABI)为0.34±0.10,下肢缺血Rutherford分级为2级6例、3级23例、4级20例、5级9例。58例患者均采用DCB血管成形术治疗,手术均获得成功。术后12个月,根据患者有无临床驱动的靶病变段重建(CD-TLR),结合多普勒超声检查参数收缩期峰值流速比(PSVR),评价手术患者靶病变段通畅与否,并据此将患者分为通畅组(无CD-TLR、PSVR≤2.4,43例)与非通畅组(有CD-TLR、PSVR>2.4,15例)。对比分析2组患者的临床病理因素,采用Kaplan-Meier生存曲线分析患者术后1年靶病变段通畅率和免于CD-TLR率,采用logistic回归模型分析患者DCB血管成形术后1年再狭窄的影响因素。结果本组58例患者股腘动脉ISR血管均重建成功,术后间歇性跛行及静息痛等临床症状较术前明显好转。术后第3天患者Rutherford分级为0级17例、1级19例、2级19例、3级3例,术后1年ABI为0.72±0.16,较术前均有明显改善,差异均有统计学意义(Z=-6.73,t=-24.32,P值均<0.001)。靶病变段血管术后1年通畅率为74.1%,1年免于CD-TLR率为78.4%。单因素分析结果显示,通畅组和非通畅组患者的血管钙化程度、TosakaⅢ型、术后规律用药及甘油三酯水平比较,比值比(OR值)及[95%可信区间(CI)]分别为4.714(1.915~11.606)、14.458(3.058~68.357)、0.048(0.005~0.454)和1.969(1.119~3.465),差异均有统计学意义(P值均<0.05)。多因素分析结果显示,重度钙化和TosakaⅢ型是术后再狭窄发生的危险因素[OR值(95%CI)分别为10.965(1.786~67.326)、57.385(1.848~1782.021),P值均<0.05],术后规律用药是DCB治疗ISR术后发生狭窄的保护因素[OR值(95%CI)为0.041(0.002~0.799),P=0.035]Objective This study aims to investigate the 1-year restenosis rate and influencing factors of drug-coated balloon(DCB)angioplasty in the treatment of femoral-popliteal in-stent restenosis(ISR).Methods In this cross-sectional study,58 patients(58 limbs)with ISR who were treated with DCB in the Department of Vascular Surgery,the First Affiliated Hospital of Bengbu Medical College from January 2016 to August 2021 were enrolled.The participants included 40 males and 18 females aged 52−85(71.9±7.6)years.The preoperative ankle brachial index(ABI)was 0.34±0.10,and the Rutherford grades of lower extremity ischemia were as follows:6 patients had grade 2,23 patients had grade 3,20 patients had grade 4,and 9 patients had grade 5.All 58 patients were treated with DCB angioplasty successfully.At 12 months after the surgery,the patency of the target lesion segment was evaluated according to the presence or absence of clinically driven-revascularization of target lesions(CD-TLR)combined with Doppler ultrasound parameter peak systolic velocity ratio(PSVR).The patients were divided into patency group(no CD-TLR,PSVR≤2.4,43 patients)and non-patency group(with CD-TLR,PSVR>2.4,15 patients).The clinicopathological factors of the two groups were compared and analyzed.Kaplan-Meier survival curve was used to analyze the patency rate of target lesion segment and the rate of free CD-TLR at 1 year after the operation.Logistic regression model analysis was used to evaluate factors influencing restenosis rate at 1 year after DCB angioplasty for ISR.Results In this group of 58 patients,the femoral popliteal artery ISR vessels were successfully reconstructed,and the clinical symptoms such as intermittent claudication and rest pain were significantly improved after the operation.On the 3rd day after operation,the Rutherford grade of lower extremities ischemia of the 58 patients were grade 0 in 17 patients,Grade 1 in 19 patients,grade 2 in 19 patients,Grade 3 in 3 patients,and the ABI of 1 year after operation was 0.72±0.16,which were sig
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