股腘动脉TASCⅡ C/D型病变腔内重建与旁路手术的疗效对比

Comparison of the clinical efficacy of endovascular reconstruction versus bypass surgery for trans-atlantic inter-society consensus Ⅱ C / D femoropopliteal artery lesion resulted from arteriosclerosisobliterans

目的：比较腔内重建与旁路手术两种方法治疗股腘动脉TASCⅡ（trans-atlantic inter-society consensusⅡ）C/D型病变的近、远期疗效。方法：回顾性分析2002年1月至2012年12月北京大学第三医院介入血管外科收治的103例（119条患肢）股腘动脉TASCⅡC/D型病变患者的临床资料,其中71条患肢应用球囊扩张和/或支架植入重建股浅动脉血运（腔内组）,48条患肢行旁路转流术（旁路组）。比较两组患者围手术期并发症发生率、死亡率、住院时间、近远期疗效、再手术率、1~10年通畅率及保肢率。结果：与腔内组相比,旁路组住院时间更长[（13.2±4.7）d vs.（6.5±3.1）d,P〈0.001],并发症发生率和再手术率更高（10.4%vs.1.4%,P=0.039;58.3%vs.31.0%,P=0.003）,近期显效率更高（25.0%vs.9.9%,P=0.027）,远期恶化率更高[37.5%vs.18.3%,P=0.019],1~10年一期及二期累积通畅率更高（P=0.001,P=0.001）。两组近期及远期总有效率相当（89.6%vs.84.5%,P=0.426,45.8%vs.56.3%,P=0.260）;保肢率差异无统计学意义（83.3%vs.94.4%,P=0.051）。结论：腔内治疗对于股腘动脉TASCⅡC/D型病变是一种安全、有效、微创的治疗方法。

Objective： To study the clinical effects of endovascular reconstruction versus bypass surgery for TASC Ⅱ（ trans-atlantic inter-society consensus Ⅱ） C / D femoropopliteal artery lesion resulted from arteriosclerosis obliterans. Methods： One hundred and three patients（ 119 limbs） accepted bypass surgery or endovascular therapy for TASCⅡ C / D femoropopliteal artery lesion between January 2002 and December 2012 at our institution were retrospectively assessed. All the patients were diagnosed with arteriosclerosis obliterins,and all their Rutherford classifications were from 2 to 5 degrees. Among them there were71 limbs treated by endovascular reconstruction and the other 48 limbs were treated with bypass surgery.We evaluated the short term clinical effect according to the condition when patients left the hospital,and evaluated the long term clinical effect according to the results of the patients＇ latest follow-up in 2014.Their clinical data before treatment,complication rates,death rates,hospital stays,short term and long term effects,reoperation rates,1 to 10 years primary and secondary accumulative patency rates and limb salvage rates were compared. Results： There was no significant difference between the bypass group and the endovascular group on the mean age and ankle brachial index before treatment [（ 67. 1 ± 7. 1） years（ 51 to 80 years） vs.（ 68. 0 ± 9. 4） years（ 49 to 91 years）,P = 0. 561;（ 0. 41 ± 0. 23） vs.（ 0. 40 ±0. 26）,P = 0. 928]. There were more TASCⅡ D patients in the bypass group than those in the endovascular group（ P〈0. 001）,and the rutherford classification was higher in the endovascular group than that in the bypass group. The difference in the mean follow-up between the bypass group and the endovascular group was not significant[（ 41. 7 ± 23. 6） months vs.（ 59. 5 ± 41. 6） months,P = 0. 065]. Five perioperative complication cases occurred in the bypass group,including 2 cases of acute thrombosis,1 case of infection and 2 cases of heart failure,and only 1 complication case occurred in the endovascular group that was heart failure. The complication rate was higher in the bypass group than that in the endovascular group [10. 4% vs. 1. 4%,P = 0. 039]. And there was no death in both the groups. Compared with the endovascular group,the bypass group had a longer hospital stays [（ 13. 2 ± 4. 7） d vs.（ 6. 5 ± 3. 1） d,P〈0. 001],a higher reoperation rate（ 58. 3% vs. 31. 0%,P = 0. 003）,a better short term,obvious,and effective rate（ 25. 0% vs. 9. 9%,P = 0. 027）,a worse long term deterioration rate（ 37. 5% vs.18. 3%,P = 0. 019） and higher 1 to 10 years primary and secondary accumulative patency rates（ P =0. 001,P = 0. 001）. There was no significant difference between the two groups on the increase of ankle brachial index[（ 0. 34 ± 0. 28） vs.（ 0. 31 ± 0. 23）,P = 0. 371],and short term and long term total effective rates（ 89. 6% vs. 84. 5%,P = 0. 426; 45. 8% vs. 56. 3%,P = 0. 260）,and limb salvage rate（ 83. 3% vs. 94. 4%,P = 0. 051）. Conclusion： Endovascular therapy is a safe,effective and minimally invasive therapy for TASCⅡ C / D femoropopliteal artery lesion resulted from arteriosclerosis obliterans.