TASCC型股浅动脉闭塞病变腔内治疗的临床分析

Clinical analysis on endovascular treatment for TASC type C occlusion of superficial femoral artery

目的观察泛大西洋协作组织共识（TASC）c型股浅动脉闭塞（或狭窄〉70％）腔内治疗效果及随访1年结果，分析支架内再狭窄（ISR）的相关因素。方法回顾首都医科大学附属北京天坛医院普通外科2011年5月至2014年5月期间收治的患下肢动脉硬化闭塞症TASCC型的患者58例（58条肢体）。手术方法为血管腔内球囊扩张＋支架置入术。术后1年随访是否有支架内再闭塞或狭窄（〉70％）。根据是否发生支架内再闭塞或狭窄（〉70％），将患者分为通畅组及再闭塞组，分析比较两组患者的临床资料。结果58例患者无围术期死亡。58条肢体中有6条未能开通，腔内治疗开通率为89．7％。1年后完成随访41例，通畅组30例，再闭塞组11例。两组患者踝肱指数相比差异具有统计学意义[（0．55±0．16）VS（0．41±0．24），P〈0．05]。两组患者的吸烟者比例和Fontaine分期虽无显著性差异，但尸值相对较低，提示二者也可能与术后ISR相关。结论腔内治疗TASCC型股浅动脉闭塞安全有效，血管病变严重程度与IsR相关。

Objective To observe the clinical efficiency of endovascular treatment for Trans-Atlantic Inter-Society Consensus （TASC） type C occlusion of superficial femoral artery （SFA） or more than 70% stenosis and the outcomes in 1 year＇s follow up, and investigate the relevant factors of in-stent restenosis （ISR）. Methods Clinical data of 58 cases（58 limbs） suffering from TASC type C occlusion of SFA or more than 70% stenosis in our hospital from May 2011 to May 2014 were collected and retrospectively analyzed. All of them received endovascular balloon dilatation and stent implantation. According to whether there was any occlusion or more than 70% stenosis in 1 year postoperatively, the patients were divided into patency group and re-occlusion group. Clinical data were compared and analyzed between the 2 groups. Results No perioperative death was found in the 58 patients. Out of 58 limbs there were 6 limbs not getting patency, with a patency rate of 89.7%. In 1 year＇s follow-up, there were 41 cases with complete follow-up, and 30 of them were accordingly assigned to the patency group and the other 11 to the re-occlusion group. There was significant difference in ankle-brachial index between the 2 groups [（0.55 ± 0.16） vs （0.41 ± 0.24）, P〈 0.05]. Though there were no significant differences in the ratio of smokers and Fontaine stage between them, the P value was comparatively smaller, which might suggest that the 2 indices were associated with ISR. Conclusion Endovascular treatment is safe and effective in the treatment of TASC type C occlusion of SFA. The severity of vascular disease is associated with restenosis.