股腘动脉慢性完全闭塞性病变腔内治疗效果及预后分析

Efficacy and prognosis of endoluminal treatment of femoropopliteal chronic total occlusions

目的 评价股浅动脉、近端腘动脉慢性完全闭塞性病变（CTO）腔内治疗的效果及预后.方法 回顾性分析北京协和医院血管外科2009年1月1日至2012年12月31日期间,股动脉、近端腘动脉闭塞性病变患者148例（156条肢体）,患者均接受腔内治疗.病变长度0.5～41.0 cm,平均（14＆#177;11） cm;按泛大西洋协作组织共识Ⅱ（TASC Ⅱ）分级划分,A级47条,B级40条,C级26条,D级43条.评估技术成功率、临床症状缓解率、围手术期保肢率及并发症发生率.Kaplan-Meier方法计算一期通畅率、二期通畅率、保肢率、生存率.Cox回归分析计算影响一期通畅率的危险因素.结果 腔内治疗技术成功率98.7%,临床成功率96.2%,围手术期保肢率99.4%,局部并发症发生率4.5%,系统并发症发生率1.9%.术后3、6、12、24、36个月的一期通畅率分别为 95.1%＆#177;1.8%,80.2%＆#177;3.4%,65.6%＆#177;4.3%,60.9%＆#177;4.6%,53.7%＆#177;5.8%;二期通畅率分别为 97.9%＆#177;1.2%,94.2%＆#177;2.0%,89.6%＆#177;2.8%,81.4%＆#177;3.9%,78.0%＆#177;5.0%;保肢率分别为99.4%＆#177;0.6%,99.4%＆#177;0.6%,97.8%＆#177;1.2%,97.8%＆#177;1.2%,97.8%＆#177;1.2%;生存率分别为99.2%＆#177;0.8%,98.4%＆#177;1.1%,97.5%＆#177;1.5%,94.9%＆#177;2.3%,91.2%＆#177;4.2%.Cox回归分析发现TASC Ⅱ C、D级病变（OR=1.776,95%CI 1.013~3.116）、流出道评分（OR=1.138,95%CI 1.016~1.275 ）是影响一期通畅率的危险因素.结论 股浅动脉、近端腘动脉慢性完全闭塞性病变的腔内治疗安全、可靠.术后再狭窄发生率高,但通过再次干预仍可达到满意的保肢效果.TASC Ⅱ C、D级病变与流出道评分是导致再狭窄的相关危险因素.

Objectives To evaluate the efficacy and prognosis of endoluminal treatment of superficial femoral artery and proximal popliteal artery chronic total occlusions.Methods A prospectively collected database of 148 patients （156 limbs） between January 1, 2009 and December 31, 2012 was retrospectively analysed.All the patients were treated with endoluminal interventions.The mean lesion length was （14＆#177;11） cm （0.5-41.0 cm）.According to Trans-Atlantic Inter-Society Consensus Ⅱ （TASC Ⅱ）, 47 lesions were type A, 40 were type B, 26 were type C and 43 were type D.Technical success rate, clinical success rate, perioperative limb salvage rate and complication rate were evaluated.Primary patency rate, secondary patency rate, limb salvage rate and survival rate were calculated with Kaplan-Meier analysis.Cox-regression analysis was used to evaluate risk factors associated with loss of primary patency.Results Technical success rate was 98.7%, clinical success rate was 96.2%, perioperative limb salvage rate was 99.4%, local complication rate was 4.5% and systemic complication rate was 1.9%.At 3, 6, 12, 24 and 36 months after surgery, the primary patency rates were 95.1%＆#177;1.8%,80.2%＆#177;3.4%, 65.6%＆#177;4.3%,60.9%＆#177;4.6% and 53.7%＆#177;5.8%, respectively.The secondary patency rates were 97.9%＆#177;1.2%,94.2%＆#177;2.0%,89.6%＆#177;2.8%,81.4%＆#177;3.9% and 78.0%＆#177;5.0%, respectively.The limb salvage rates were 99.4%＆#177;0.6%,99.4%＆#177;0.6%, 97.8%＆#177;1.2%, 97.8%＆#177;1.2%, and 97.8%＆#177;1.2%, respectively.The survival rates were 99.2%＆#177;0.8%,98.4%＆#177;1.1%,97.5%＆#177;1.5%,94.9%＆#177;2.3% and 91.2%＆#177;4.2%, respectively.TASC Ⅱ C/D lesions （OR=1.776, 95%CI 1.013~3.116） and runoff score （OR=1.138, 95%CI 1.016-1.275） were found to be associated with loss of primary patency.Conclusion Endoluminal intervention was a safe and efficacious method for treating femopopliteal artery chronic total occlusions.Satisfactory limb salvage rate can be reached despite of the high restenosis rate.TASC Ⅱ C/D lesions and runoff score were found to be risk factors associated with restenosis.