准分子激光消蚀辅助普通球囊扩张治疗膝下动脉病变临床研究

Excimer laser atherectomy-assisted plain old balloon angioplasty for the treatment of arteriosclerosis obliteration below the knee:a clinical study

目的评价准分子激光旋切消蚀术(ELA)辅助普通球囊血管成形术(POBA)治疗膝下动脉硬化闭塞症的安全性和有效性。方法回顾性分析2016年11月至2019年1月首都医科大学宣武医院采用ELA治疗的21例膝下动脉硬化闭塞症患者临床资料。其中男18例,女3例;年龄57~88(76.1±9.5)岁。结果21例手术均获成功。无血栓形成、穿刺点血肿和围术期死亡病例。术后患者临床症状均较术前改善,跛行患者跛行距离较术前增加50~200 m,6例静息痛患者静息痛均消失,溃疡愈合率为7/8。术后裸-肱指数(ABI)较术前明显改善。21例患者均获平均8.6个月随访,术后3个月、6个月一期通畅率分别为86.7%、80.0%。结论ELA联合POBA治疗膝下动脉硬化症安全,近中期疗效尚可,但仍需大样本随访观察远期疗效。

Objective To evaluate the safety and effectiveness of excimer laser atherectomyassisted(ELA-assisted)plain old balloon angioplasty(POBA)in treating arteriosclerosis obliteration below the knee.Methods The clinical data of 21 patients with arteriosclerosis obliteration below the knee,who received ELA-assisted POBA at the Xuanwu Hospital of Capital Medical University of China during the period from November 2016 to January 2019,were retrospective analyzed.The patients included 18 males and 3 females,with a mean age of(76.1±9.5)years(57-88 years).Results Successful ELA-assisted POBA was accomplished in all 21 patients.No thrombosis,puncture point hematoma,or perioperative death occurred.After the treatment,the clinical symptoms of the patients were improved when compared with preoperative ones.In patients with claudication,the postoperative limp distance was 50-200 meters longer than preoperative limp distance.In 6 patients with resting pain,the resting pain disappeared after treatment.The ulcer healing rate was 87.5%(7/8).The postoperative ankle-brachial index(ABI)was significantly improved when compared with preoperative one.The patients were followed up for a mean period of 8.6 months.The 3-month and 6-month postoperative primary patency rates were 86.7%and 80.0%,respectively.Conclusion For the treatment of arteriosclerosis obliteration below the knee,ELA-assisted POBA is clinically safe with satisfactory mid-term effect.However,large sample studies and long-term follow-up observation are still needed before the long-term curative effect can be clarified.