药物涂层球囊治疗股腘动脉硬化闭塞症24个月临床效果评价  

Mid-term outcome of drug coated balloon in the treatment of femoropopliteal artery disease

作　　者：王预立 倪其泓[1] 张岚[1] 叶猛[1] Wang Yuli;Ni Qihong;Zhang Lan;Ye Meng(Department of Vascular Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,上海200120

出　　处：《中华普通外科杂志》2023年第12期926-930,共5页Chinese Journal of General Surgery

基　　金：上海交通大学医学院附属仁济医院临床科研创新培育基金(PYIII-20-13)。

摘　　要：目的评价药物涂层球囊(drug coated ballloon,DCB)治疗股腘动脉硬化闭塞症(femoropopliteal arterial occlusive disease,FPOD)的中期临床结果。方法对2016年12月至2020年12月在上海交通大学医学院附属仁济医院血管外科接受DCB治疗的FPOD患者进行回顾性分析。评价术后24个月的靶血管一期通畅率(primary patency rate,PP)、一期辅助通畅率(assisted primary patency rate,AP)、二期通畅率(secondary patency rate,SP)、免于临床症状驱动的靶病变血运重建率(freedom from clinically-driven target lesion revascularization,F-TLR)有效性指标,以及围手术期不良反应事件、大截肢率、全因死亡率安全性指标。结果172例患者(191条下肢)接受了DCB治疗。其中TASC A型13条(6.8%)、B型38条(19.9%)、C型98条(51.3%)、D型42条(22.0%)。原发性病变126条(66.0%)、支架内再狭窄病变33条(17.3%),原发性病变合并支架内再狭窄32条(16.8%)。轻度钙化48条(25.1%)、中度钙化20条(10.5%)、重度钙化25条(13.1%)。原发性病变平均病变长度(27.8±10.4)mm。其中慢性全堵病变(chronic total occlusion,CTO)为97条(61.4%),平均CTO病变长度为(17.2±12.4)cm。技术成功率97.4%。一期补救性支架植入率为22.0%。术后12个月及24个月PP分别为68.4%和55.9%、AP为78.8%和69.8%、SP为95.8%和91.5%,F-TLR为85.3%和81.9%。原发性病变亚组术后24个月PP为62.7%、支架内再狭窄亚组术后24个月PP为44.9%。术后全因死亡率13.4%、大截肢率4.7%。影响一期通畅率的独立危险因素为慢性肢体威胁性缺血(P=0.046)和≥15 cm的CTO病变(P=0.006)。结论DCB是一种安全有效治疗股腘动脉硬化闭塞症的腔内介入手段。Objective To evaluate the mid-term outcome of drug coated balloon(DCB)in the treatment of femoropopliteal artery occlusive disease(FPOD).Methods Clinical date of FPOD patients receiving DCB treatment at Renji Hospital from Dec 2016 to Dec 2020 were retrospectively analyzed.The primary patency,primary assisted patency,secondary patency,free from clinically-driven target lesion revascularization(F-TLR)and the safety outcomes such as perioperative adverse events,major amputation rate and all-cause mortality were calculated.Results One hurdred and seventy two patients(191 lower limbs)received DCB treatment.Among them,13 lesions were TASC A(6.8%),38 lesions were TASC B(19.9%),98 lesions were TASC C(51.3%),and 42 lesions were TASC D(22.0%).One hundred and twenty six lesions were de novo lesions(66.0%),33 lesions were in-stent restenosis(17.3%,ISR),and 32 lesions were both de novo lesions and ISR(16.8%).The average length of lesions was(27.8±10.4)mm.Fourty-eight lesions were mildly calcified(25.1%),20 lesions were moderately calcified(10.5%),and 25 lesions were severely calcified(13.1%).Among de novo lesions,97 lesions were chronic total occlusion(CTO)lesions(61.4%),and the average length of CTO lesions was(17.2±12.4)cm.The technical success rate was 97.4%.The provisonal stent rate was 22.0%.12 month and 24 month after operation,the primary patency rate was 68.4%and 55.9%,the primary assisted patency rate was 78.8%and 69.8%,the secondary patency rate was 95.8%and 91.5%,and the F-TLR rate was 85.3%and 81.9%.The de novo lesion subgroup had a 24-month postoperative primary patency rate of 62.7%,while the in-stent restenosis subgroup had a rate of 44.9%.All cause mortality was 13.4%and major amputation rate was 4.7%.Chronic limb-threatening ischemia(P=0.046)and CTO lesions length≥15 cm(P=0.006)were independent risk factors affecting the primary patency rate.Conclusion DCB is a safe and effective endovascular intervention therapy for the treatment of femoropopliteal artery disease.

关 键 词：周围动脉疾病 血管成形术 气囊 股腘动脉 

分 类 号：R654.4[医药卫生—外科学]