股腘动脉慢性完全闭塞病变分布及影响因素分析

The distribution and related risk factors of femoro- popliteal artery chronic total occlusion lesions

目的探讨股腘动脉慢性完全闭塞（CTO）病变分布特征,分析不同致病危险因素对病变分布的影响。方法选择2013年1月至2015年5月首都医科大学附属北京世纪坛医院收治的经CTA、DSA检查证实的47例股腘动脉CTO患者,将股动脉均分为3段（F1-F3）,将腘动脉按骨性解剖标志分为3段（P1-P3）,基于股腘动脉CTA断层扫描、三维重建及DSA图像获取股腘动脉CTO病变解剖分布情况。采集影响病变分布的不同因素,并作多因素Logistic回归分析。结果共有47例患者59条股腘动脉CTO病变纳入研究。病变段平均长度为（12.91±10.13）cm。根据股腘动脉6段分法,病变累及F1段23肢,F2段34肢,F3段48肢,P1段18肢,P2段6肢,P3段5肢。多因素Logistic回归分析发现,高血压（RR=3.21）、吸烟史（RR=1.76）患者CTO病变最易累及F1段,男性（RR=1.98）患者CTO病变更易发生在P1段,而糖尿病患者病变分布RR值自血管近端至远端逐渐变大,说明病变更易累及远端血管。结论股腘动脉CTO病变分布具有特征性,与股腘动脉血流动力学及动脉硬化危险因素密切相关。

Objective To investigate the distribution of femoro- popliteal artery chronic totally occlusions（CTO） and to analyze the influence of different risk factors on the distribution of lesions. Methods A total of 47 patients with CTA and DSA proved femoro- popliteal artery CTO, who were admitted to the Affiliated Beijing Shijitan Hospital of Capital Medical University during the period from January 2013 and May 2015,were enrolled in this study. In order to make a clear description about the distribution characteristics of the lesions, the superficial femoral artery was averagely divided into three segments（F1- F3）, and the popliteal artery was also divided into three segments（P1- P3） according to the bony landmarks. Based on the CTA images（including 3D reconstruction images） and DSA images, the distribution of CTO lesions was determined.The factors that might influence the distribution of CTO lesions were collected, and the results were analyzed using multivariable logistic regression analysis. Results A total of 59 femoro- popliteal artery CTO lesions detected in 47 patients were included in this study. The average length of lesion segment was（12.91 ±10.13） cm. According to the 6- section division method of femoro- popliteal artery, the lesions involved F1（n=23）, F2（n=34）, F3（n=48）, P1（n=18）, P2（n=6） as well as P3（n=5） segments. Multivariable logistic regression analysis reveals that F1 segment was most prone to be affected by CTO lesions in patients with hypertension（RR=3.21） and in patients who had cigarette smoking habit（RR=1.76）. In male patients, P1 segment was more easil y involved by CTO lesions（RR =1.98）. In patients with diabetes mellitus, the RR value was gradually increased from the proximal to the distal end of the blood vessel, indicating that the lesion was more likely to involve distal vessels. Conclusion The distributions of femoro- popliteal artery CTO lesions have certain characteristics, which are closely associated with femoro- popliteal artery hemodynamics and atherosclerosis risk factors.