支架植入对股腘动脉闭塞性病变内膜下成形术后通畅率的影响

The impact of stent implantation on the patency rate of femoropopliteal artery after subintimal angioplasty for occlusive arteriosclerosis

目的采用内膜下成形和(或)支架植入治疗股腘动脉闭塞性病变的临床疗效及支架植入对术后通畅率的影响。方法 2007年1月至2009年5月收治下肢股腘动脉闭塞患者43例(43条肢体),其中24例(非支架组)行单纯内膜下成形术,其余19例患者(支架组)在内膜下成形后一期行支架植术。术后行CTA或多普勒超声检查,对部分再狭窄或闭塞病变行再次介入治疗。术后随访1～27个月。结果术后12个月保肢率为98%(42/43),围手术期并发症发生率为7%(3/43),2年死亡率为7%(3/43)。随访期内22例出现再狭窄或闭塞,其中非支架组3例闭塞发生在术后1个月内;共有12条肢体行再次介入治疗。非支架组6、12和24个月的一期通畅率分别为83.3%±7.6%、74.0%±9.2%和56.1%±13.5%;支架组分别为89.5%±7.0%、77.5%±9.9%和32.2%±16.6%。非支架组12、24个月的一期辅助通畅率分别为90.9%±6.1%和64.2%±14.7%;支架组分别为94.4%±5.4%和39.0%±15.9%);支架组和非支架组整体间差异均无统计学意义P>0.05。远端血管通畅数目、股腘动脉闭塞类型和吸烟史对内膜下成形术后2年内一期通畅率有显著影响(r=-4.417,2.502,3.115;Sχ=1.627,0.955,1.523;P=0.007,0.009,0.041)。结论内膜下成形术后不必常规行支架植入;支架植入不会改善术后2年期内的通畅率;2年期内通畅率与周围血管条件密切相关,吸烟也对预后有重要影响。

Objective To assess the impact of stent implantation on the patency rate of femoropopliteal artery after subintimal angioplasty for occlusive arteriosclerosis. Methods During the period from January 2007 to May 2009, a total of 43 patients with occlusive femoropopliteal arteriosclerosis （43 diseased legs） were treated in authors＇ hospital. Of the 43 patients, simple percutaneous subintimal angioplasty was performed in 24 （non-stent group）, while percutaneous subintimal angioplasty with subsequent stent implantation was carried out in the remaining 19 （stent group）. After the treatment, CTA or Doppler ultrasonic examination was performed to check the results. Interventional therapy was repeated in some cases who developed restenosis. Results The 12-month limb salvage rate was 98%. Perioperative minor complications occurred in 7% of patients （3/43）. Two-year mortality rate was 7% （3/43）. During the follow-up period, arterial restenosis or occlusion occurred in 22 cases. Three cases in non-stent group developed arterial occlusion within one month after the treatment. Repeated interventional procedure was carried out for 12 diseased legs. The primary pateney rates of non-stent group at 6, 12 and 24 months were （83.3 ±7.6）%, （74.0 ± 9.2）% and （56.1 ± 13.5）%, respectively, while those of stent group were （89.5 ± 7.0）%, （77.5 ± 9.9）% and （32.2 ±16.6）%, respectively. The primary assisted patency rates at 12 and 24 months in non-stent group were （90.9 ±6.1）% and （64.2 ±14.7）%, respectively, while those in stent group were （94.4 ± 5.4）% and （39.0± 15.9）%,respectively. The differences in both the primary pateney rate and primary assisled pateney rate between the two groups were of no significance （P 〉 0.05）. Cox-regression analysis indicated that the number of patent distal vessels, the type of femoropopliteal occlusive diseases and the history of smoking bore a close relationship to the two-year primary patency rate after subiatimal angioplasty （r = -4.417, 2.502, 3.115; Sv = 1.627, 0.955, 1.523; P = 0.007, 0.009, 0.041）. Conclusion For the trealment o1＇ occlusive femoropopliteal arteriosclerosis, it is not necessary to routinely use stent implantation after subintimal angioplasty. Stent implantation will not obviously improve the two-year primary pateney rale. The patency of the distal vessels and the hislory of smoking have a very important effect on the two-year primary pateney rale.（J lntervent Radiol, 2012, 21： 278-283）