老年下肢动脉硬化闭塞症患者不同治疗方式的预后分析

Prognostic analysis of different treatments in elderly patients with arteriosclerosis obliterans of lower limbs

目的 探究不同治疗方法对老年下肢动脉闭塞症患者不良预后的影响。方法 回顾性选取2020年5月至2022年5月在西安交通大学第一附属医院周围血管科住院的老年下肢动脉闭塞症患者352例,根据患者意愿和病变特征分为球囊扩张组142例、支架置入组145例及保守治疗组65例,对所有患者进行13~24个月的随访,随访内容:主要不良心血管事件(MACE),包括全因死亡、急性心肌梗死、急性缺血性脑卒中和主要不良下肢事件(MALE),包括下肢静息痛、溃疡或皮肤缺损、坏疽、再闭塞、截肢发生情况,比较分析3组临床资料和预后,绘制Kaplan-Meier生存曲线。结果 支架置入组全因死亡发生率显著低于保守治疗组(9.7%vs 23.1%,P<0.01)。支架置入组和球囊扩张组MALE静息痛发生率明显低于保守治疗组(4.8%、9.2%vs 24.6%,P<0.01)。结论 适合行介入治疗的老年下肢动脉闭塞症患者接受血管腔内治疗可以降低部分患者发生全因死亡和MALE事件风险。

Objective To explore the effect of different treatment methods on prognosis in elderly patients with lower extremity arterial occlusive disease.Methods A total of 352elderly patients with lower extremity arterial occlusive disease admitted in our hospital from May 2020to May 2022were enrolled,and according to their willingness and characteristics of lower extremity le-sions,they were divided into balloon dilation group(142patients),stent implantation group(145 patients)and conservative treatment group(65patients).All patients were followed up for 13-24 months.The incidences of major adverse cardiovascular events(MACE),including all-cause death,acute myocardial infarction,acute ischemic stroke,and major adverse lower limb events(MALE),including lower extremity pain at rest,ulcers or skin defects,gangrene,reocclusion,and amputation were observed and recorded.The clinical data and prognosis were compared and ana-lyzed of the three groups.Kaplan-Meier survival curves were drawn.Results The incidence of all-cause mortality was significantly lower in the stent implantation group than the conservative treatment group(9.7%vs 23.1%,P<0.01).The incidence of MALE was obviously lower in the stent implantation group and the balloon dilatation group than the conservative treatment group(4.8%and 9.2%vs 24.6%,P<0.01).Conclusion Endovascular therapy can reduce the risk of all-cause death and MALE occurrence in elderly patients with lower extremity arterial occlusive disease who are suitable for interventional therapy.