药物涂层球囊扩张治疗慢性肢体威胁性缺血患者腘动脉病变的效果  

Clinical outcomes after drug-coated balloon angioplasty of isolated popliteal lesions in patients with chronic limb-threatening ischemia

作　　者：王盛兴 任华亮[1] 孙明胜 李春民[1] 张望德[1] WANG Shengxing;REN Hualiang;SUN Mingsheng;LI Chunmin;ZHANG Wangde(Department of Vascular Surgery,Affiliated Beijing Chaoyang Hospital of Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,北京100020

出　　处：《中国临床保健杂志》2024年第3期293-296,共4页Chinese Journal of Clinical Healthcare

摘　　要：目的探讨在慢性肢体威胁性缺血(CLTI)患者中运用药物涂层球囊(DCB)扩张治疗腘动脉病变的有效性和安全性。方法回顾性分析2019年6月至2021年6月首都医科大学附属北京朝阳医院血管外科收治的110例CLTI患者病历资料,DCB干预的靶病变为腘动脉。评估患者术后Rutherford分级和肢体威胁程度(WIfI)分期,以及临床驱动的靶血管重建(TLR)。主要安全终点包括全因死亡和截肢。通过多因素生存分析评估影响无截肢生存率的因素。结果患者年龄(72.7±9.2)岁,靶病变长度(127.6±56.8)mm,闭塞性病变和重度钙化分别占79.1%和62.7%,重度肢体威胁患者占20.9%。在12个月的随访中,患者的全因死亡率、无截肢生存率和TLR分别为11.8%、81.8%和12.7%。在3个月和12个月的随访中,Rutherford分级和WIfI分期均得到改善(P均<0.001)。在12个月的随访中,重度肢体威胁患者中有43.5%死亡或截肢。多因素生存分析提示,WIfI分期是患者无截肢生存的独立危险因素。结论DCB扩张治疗CLTI患者的腘动脉病变安全有效。WIfI分期可用于评估CLTI患者预后情况。Objective To explore the effectiveness and safety of drug-coated balloon(DCB)angioplasty for isolated popliteal lesions in patients with chronic limb-threatening ischemia(CLTI).Methods A retrospective analysis was conducted among 110 CLTI patients treated at Department of Vascular Surgery,Affiliated Beijing Chaoyang Hospital of Capital Medical University from June 2019 to June 2021.The target lesions for DCB intervention were popliteal artery.The primary effectiveness outcomes were clinical improvement of Rutherford classification and wound,ischemia,foot infection(WIfI)classification,and clinically driven target lesion revascularization(TLR).The primary safety endpoints included all-cause mortality and amputation.Potential factors influencing amputation-free survival were analyzed by multivariate analyses.Results The average age of the patients was(72.7±9.2)years.The mean lesion length was(127.6±56.8)mm.Chronic total occlusion and severe calcification occurred in 79.1%and 62.7%of patients,respectively.Patients with advanced limb threat accounted for 20.9%.The incidences of all-cause mortality,amputation-free survival,and clinically driven TLR during the 12-month follow-up were 11.8%,81.8%,and 12.7%,respectively.Rutherford grade and WIfI(all P<0.001)stage were significantly improved after 3-month and 12-month follow-up.43.5%patients with advanced limb threat died or underwent major amputation during the 12-month follow-up.The Cox proportional hazards model revealed WIfI classification as independent predictors of amputation-free survival.Conclusions DCB angioplasty is safe and effective in isolated popliteal lesions patients with CLTI over the medium term.WIfI staging can be utilized for prognostic assessment in CLTI patients.

关 键 词：慢性肢体威胁性缺血 血管成形术 腘动脉 危险因素 

分 类 号：R654.4[医药卫生—外科学]