股腘动脉闭塞的病变特征对血管内治疗入路和近期疗效的影响  

Impact of lesion characteristics of femoropopliteal artery occlusion on endovascular treatment approach and short-term efficacy

作　　者：权建军[1] 卢翔[1] 岳江 韩阳 杨林[2] Quan Jianjun;Lu Xiang;Yue Jiang;Han Yang;Yang Lin(Department of Vascular and Interventional Surgery,Hanzhong Central Hospital,Hanzhong723000,China;Department of Vascular Surgery,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an710061,China)

机构地区：[1]陕西省汉中市中心医院介入与血管外科,汉中723000 [2]西安交通大学第一附属医院血管外科,西安710061

出　　处：《中华血管外科杂志》2024年第6期379-385,共7页Chinese Journal of Vascular Surgery

基　　金：汉中市中心医院院级科研基金(YK2307)。

摘　　要：目的探讨股腘动脉闭塞(FPO)的病变特征对血管内治疗(EVT)入路和近期疗效的影响。方法本研究为回顾性队列研究。回顾性分析2020年1月至2021年12月汉中市中心医院和西安交通大学第一附属医院实施EVT的248例(260条患肢)FPO患者的临床资料,其中男性172例,女性76例,年龄为(68.87±8.99)岁。观察EVT的入路、方式、技术成功率及随访结果。采用χ^(2)检验或Fisher精确概率法比较不同临床特征间顺行入路和逆穿占比的差异。采用Logistic回归模型分析顺行开通失败的危险因素。采用Kaplan-Meier生存曲线比较各病变特征之间一期通畅率的差异。结果260条患肢均先采用顺行入路,其中217条(83.5%)顺行开通,43条(16.5%)顺行未开通者采用逆穿并均成功开通,技术成功率100%。跨大西洋协作组织(TASC II)各分型之间(顺行:TASCⅡB~D型分别为19.4%、24.9%、55.7%;逆穿:TASCⅡB~D型分别为4.7%、9.3%、86.0%;χ^(2)=13.908,P=0.001)、外周动脉钙化评分(PACSS)各分级之间(顺行:PACSS 0~4级分别为23.0%、16.1%、9.2%、21.2%、30.5%;逆穿:PACSS 0~4级分别为7.0%、7.0%、4.7%、13.9%、67.4%;χ^(2)=21.672,P<0.001)、不同闭塞部位之间(顺行:股浅、股浅开口、股腘、腘动脉分别为56.7%、7.8%、24.9%、10.6%;逆穿:股浅、股浅开口、股腘、腘动脉分别为37.2%、20.9%、32.6%、9.3%;χ^(2)=8.963,P=0.027)和基于斑块帽形态的慢性完全闭塞(CTOP)各分型之间(顺行:CTOPⅠ~Ⅳ型分别为28.6%、41.5%、13.8%、16.1%;逆穿:CTOPⅠ~Ⅳ型分别为18.6%、11.6%、25.6%、44.2%;χ^(2)=26.822,P<0.001)顺行开通和逆穿开通的患肢情况比较,差异均有统计学意义。Logistic多因素分析显示,CTOPⅣ型(OR=2.977,95%CI:1.077~8.229,P=0.035)、PACSS 4级(OR=5.777,95%CI:1.539~21.678,P=0.009)是顺行开通失败的独立危险因素。TASCⅡB型、C型、D型6和12个月的一期通畅率分别为97.4%、86.5%、89.7%和90.6%、78.7%、72.4%;PACSS 0级、1级、2级、3级、4级6ObjectiveTo investigate the impact of lesion characteristics of femoropopliteal artery occlusion(FPO)on endovascular treatment(EVT)approach and short-term efficacy.MethodsIn this retrospective cohort study,clinical data from 248 patients(260 affected limbs)with FPO who underwent EVT in Hanzhong Central Hospital and the First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to December 2021 were analyzed.The approaches,methods,technical success rate,and follow-up results of EVT were observed.Theχ^(2)Test and Fisher's Exact Test were adopted to compare the differences in the proportion of antegrade and retrograde approaches among different clinical characteristics.Logistic regression was used to analyze the risk factors for the failure of antegrade recanalization.Kaplan-Meier survival curve was used to compare the differences in primary patency(PP)rate among different lesion characteristics.Results(1)An antegrade approach was first adopted in all 260 limbs.Successful antegrade crossing was achieved in 83.5%of the affected limbs(217 of 260);16.5%of the limbs(43 of 260)were treated through the retrograde approach after the failure of the antegrade one.The technical success rate was 100%.Among the sub-classifications of TASCⅡ(antegrade,type B-D:19.4%,24.9%,55.7%;retrograde,type B-D:4.7%,9.3%,86.0%;χ^(2)=13.908,P=0.001),the sub-grades of PACSS(antegrade,grade 0-4:23.0%,16.1%,9.2%,21.2%,30.5%;retrograde,grade 0-4:7.0%,7.0%,4.7%,13.9%,67.4%;χ^(2)=21.672,P<0.001),the occlusion sites(antegrade,from superficial femoral,superficial femoral opening,femoropopliteal,to popliteal:56.7%,7.8%,24.9%,10.6%;retrograde,from superficial femoral,superficial femoral opening,femoropopliteal,to popliteal:37.2%,20.9%,32.6%,9.3%;χ^(2)=8.963,P=0.027),and the sub-classifications of CTOP(antegrade,from typeⅠ,Ⅱ,ⅢtoⅣ:28.6%,41.5%,13.8%,16.1%;retrograde,from typeⅠ,Ⅱ,ⅢtoⅣ:18.6%,11.6%,25.6%,44.2%;χ^(2)=26.822,P<0.001),statistically significant differences were found between situations of the affected limbs tre

关 键 词：股动脉 腘动脉 动脉硬化闭塞症 血管成形术 逆行穿刺 

分 类 号：R654.3[医药卫生—外科学]