彩色多普勒超声对股腘动脉TASC Ⅱ A、B型病变支架治疗有效性的评估研究

Evaluation of stenting therapy for patients with femoro-popliteal artery TASC Ⅱ A, B lesions by color duplex ultrasound

目的探讨彩色多普勒超声（CDU）评估股腘动脉TASCⅡA、B型病变支架治疗的有效性、支架通畅率及再狭窄相关影响因素。方法回顾性纳入2012年4月至2015年4月在首都医科大学宣武医院血管外科接受股-腘动脉（femoro-popliteal artery,FPA）支架成形术治疗,并进行超声术前评估及术后规律随访的股腘动脉TASCⅡA、B型病变患者。通过CDU观察支架术后血流动力学变化特征,计算术后3、6、12、24个月的支架通畅率,分析支架术后再狭窄影响因素。结果本研究入组患者139例（191个支架）,平均支架总长度（12.34±5.71）cm。随访时间3~24个月（中位时间12个月）,术后3、6、12、24个月的支架累及通畅率分别为97.0%（130/134）、88.3%（106/120）、73.6%（78/106）、61.1%（55/90）,TASCⅡB型患者各时期通畅率均低于TASCⅡA型患者（χ2=12.396,P〈0.01）。Cox多因素回归分析证实,TASCⅡ分级、糖尿病、性别及术前病变类型是支架术后再狭窄的独立危险因素。结论股腘动脉TASCⅡA、B型病变支架治疗效果较好,CDU可用于FPA支架术后通畅性的评估;TASCⅡ分级、糖尿病、性别及术前病变类型是支架术后再狭窄的独立危险因素。

Objective To retrospectively analyze the femoro-popliteal artery TASC Ⅱ A and B lesions stenting treatment effectiveness, patency and in-stent restenosis（ISR） related influencing factors by color duplex ultrasound（CDU）. Methods Patients with femoro-popliteal artery TASC Ⅱ A and B lesions after stent treatment at our institution from April 2012 to April 2015 were enrolled into our study. These patients underwent preoperative evaluation and regular follow-up by CDU. Hemodynamic changes and patency was observed after stenting. Predictors for ISR were assessed using a Cox proportional hazards model. Results A total of 191 stents were implanted in 139 cases, cumulative median length of the stent was（12.34±5.71） cm. Median follow-up was 12 months（range 3 to 24 months）. The patency at 3, 6, 12, 24 months post-procedure was 97.0%（130/134）, 88.3%（106/120）, 73.6%（78/106）, 61.1%（55/90）, respectively. TASC Ⅱ B was associated with lower patency compared with TASC Ⅱ A in each period. Cox regression analysis indicated that the TASC Ⅱ class, diabetes mellitus, gender and lesion types were significant risk factors for ISR in TASC Ⅱ A and B lesions. Conclusions The result was satisfying for femoro-popliteal artery TASC Ⅱ A and B lesions stenting. TASC Ⅱ class, diabetes mellitus, gender and lesion types were significant risk factors for ISR. CDU is a reliable method for monitoring patients with femoro-popliteal stenting.