减容手术治疗下肢动脉疾病101例效果分析

Debulking strategy of endovascular treatment for lower extremity artery lesions

目的探讨下肢动脉病变腔内治疗的减容策略与临床效果。方法回顾性分析2019年6月至2020年6月在复旦大学附属中山医院血管外科接受减容治疗的101例下肢动脉病变患者的临床资料。男性74例,女性27例,年龄(73.2±11.7)岁(范围:35~93岁)。其中卢瑟福分级3级31例,4级39例,5级31例;合并高血压72例。101例患者共有140处病变,其中髂动脉段病变13处(9.3%),股浅动脉病变72处(51.4%),腘动脉病变41处(29.3%),胫腓干病变10处(7.1%),膝下动脉病变4处(2.9%)。根据患者病变情况选择减容方法,经皮机械血栓清除主要用于急性血栓形成的病变,准分子激光消蚀主要适用于慢性支架内再狭窄和慢性狭窄/闭塞的病变,斑块定向旋切主要用于短段的钙化病变。观察患者手术情况及术后效果,治疗前后数据的比较采用配对样本t检验。结果所有患者均顺利接受减容治疗,其中82处(58.6%,82/140)使用经皮机械血栓清除治疗,56处(40.0%,56/140)使用准分子激光消蚀术治疗,2处(1.4%,2/140)使用斑块定向旋切。患者术前病变侧肢体踝肱指数为0.44±0.19,术后即刻为0.87±0.17(t=-16.26,P<0.01),术后6个月为0.81±0.20(t=-14.67,P<0.01),12个月为0.79±0.15(t=-14.12,P<0.01),均较术前明显增加。患者术后12个月的一期通畅率为86.1%(87/101)、病死率为5.0%(5/101)、无截肢生存率为93.1%(94/101),病变血管再次干预率为9.9%(10/101)。结论根据病变性质、节段选择合适的减容方式,有助于提高腔内治疗手术成功率,临床效果满意。

Objective To explore the debulking strategy of lower extremity artery lesions.Methods Retrospectively analyzed the clinical data of 101 patients underwent debulking therapy at Department of Vascular Surgery,Zhongshan Hospital,Fudan University from June 2019 to June 2020.There were 74 males and 27 females,aged(73.2±11.7)years(range:35 to 93 years).There were 31 cases in Rutherford class 3,39 cases in class 4 and 31 cases in class 5.Hypertension occurred in 72 patients.One hundred and forty lesions were treated in 101 patients.Among them,there were 13 lesions(9.3%)in iliac artery,72 lesions(51.4%)in superficial femoral artery,41(29.3%)lesions in popliteal artery,10 lesions(7.1%)in tibiofibular trunk,and 4 lesions(2.9%)in below the knee artery.Percutaneous mechanical thrombectomy(PMT)was mainly used in acute thrombosis,excimer laser ablation(ELA)was mainly used for chronic in-stent restenosis and chronic stenosis or totally occlusive lesions,while directional atherectomy(DA)was mainly used for short calcified lesions.Results All of the patients underwent debulking therapy.Eighty-two lesions(58.6%,82/140)were treated by PMT,56(40.0%,56/140)were treated by ELA,and 2(1.4%,2/140)were treated by DA.The ankle-brachial index of the patient was 0.44±0.19 before surgery,0.87±0.17 immediately after surgery(t=-16.26,P<0.01),and 0.81±0.20 at 6 months after surgery(t=-14.67,P<0.01),and 0.79±0.15(t=-14.12,P<0.01)at 12 months after surgery.At 12 months,the primary patency was 86.1%(87/101),mortality was 5.0%(5/101),freedom from major-amputation survival rate was 93.1%(94/101),and target lesion reintervention rate was 9.9%(10/101).Conclusions Debulking is feasible and effective to eliminate the arterial contents and maximize the acquisition of lumen.Selection of suitable debulking methods for different segments and lesions would be helpful to improve the technical success and obtain satisfactory results.