糖尿病患者股腘动脉闭塞性病变内膜下成形术后一期通畅率及其影响因素分析

Risk factors for primary patency of occlusive femoral artery after subintimal angioplasty in diabetics

目的 回顾性分析合并下肢股腘动脉闭塞性病变的糖尿病患者行股腘动脉内膜下成形术后的一期通畅率,并分析导致术后再狭窄或闭塞的危险因素.方法 2009年1月至2011年5月,共43例（单肢体）合并股腘动脉闭塞性病变的糖尿病患者成功接受内膜下成形术,部分患者一期行支架置入.动脉再狭窄定义为管腔直径缩小超过50％或彩色多普勒峰值收缩期血流速度在参考值的2倍以上;动脉闭塞定义为超声检查动脉腔内无血流信号.采用Kaplan-Meier方法确定术后一期通畅率;多因素分析用于判断影响一期通畅率的危险因素.结果 43例糖尿病患者的中位随访时间21个月（14～32个月）.其中4例患者出现轻微并发症,无围手术期死亡病例.随访期间17例患者出现再狭窄或闭塞：6、12和24个月的累积一期通畅率分别为（86±5）％、（75±7）％和（43±12）％.一期通畅率的影响因素为远端流出道闭塞血管数目（B=-4.417,S（x）=1.627,P=0.007）、TASCⅡ分型（B=-2.502,（Sx）=0.955,P=0.009）和吸烟史（B=3.115,Sx=1.523,P=0.041）.结论 内膜下成形治疗股腘动脉闭塞性病变具有微创和并发症少的优点.糖尿病患者肢体远端流出道闭塞血管数目、病变的TASCⅡ分型和吸烟史对内膜下成形术后的一期通畅率存在影响.

Objective To retrospectively explore the status of primary patency after subintimal angioplasty （SIA） and identify the risk factors affecting for primary patency of occlusive lesions in femoral arteries after SIA in patients with diabeticses mellitus.Methods From January 2009 to May 2011,43 diabetics patients with 43 occlusive femoral arteries were successfully underwent subintimal angioplasty successfully with or without stenting.Recurrent stenosis was defined as an arterial diameter reduction of over 50%.And arterial occlusion was confirmed by an absence of color or power signal in the arterial lumen measured on color Doppler.The Kaplan-Meier method was employed to determine the primary patency.A multivariate analysis was performed with Cox＇s proportional hazard regression model to determine the independent factors for effects on primary patency.Results A total of 17 morphologic abnormalities occurred during a median follow-up period of 21 （14-32） months.The median follow time of the successful 43 patients was 21 months （from 14 to 32 month）.Minor complications occurred in 4 patents.There was no early mortality.A total of 17 morphologic abnormalities occurred during follow-up.The cumulative primary patency at 6、12,12 and 24 months were （86 ±5）%,（75% ±7）% and （43 ± 12）% respectively.Primary patency was affected negatively by the number of occlusive run-off vessels （B =-4.417,S（x） =1.627,P =0.007） and the severity degree according to the Inter-society consensus for the management of peripheral arterial disease （TASC Ⅱ） classification（B =-2.502,S（x） =0.955,P =0.009）,and positively by the a history of smoking（B =3.115,Sx =1.523,P=0.041）.Conclusions Subintimal angioplasty is a less invasive procedure with a lower rate of morbidity and adequate cceptable patency.And the number of occlusive run-off vessels,lesion typing degree of severity according to the TASC Ⅱ classification negatively and smoking positively have significant influence effects on the primary patency in diabetics patients.