斑块旋切术联合药物涂层球囊治疗股腘动脉硬化闭塞症

Clinical efficacy of combined directional atherectomy and drug-coated balloon angioplasty in treatment of femoropopliteal artery occlusion disease

目的评价TurboHawk斑块旋切术(DA)联合药物涂层球囊(DCB)治疗股腘动脉硬化闭塞症的中短期临床疗效。方法回顾性分析2016年4月至2017年10月采用腔内治疗的43例股腘动脉硬化闭塞症患者的临床资料,22例行DA联合DCB治疗,21例行DA联合普通球囊(POBA)治疗,术后对比两组的中短期临床效果。结果 43例患者手术均获成功,无死亡或截肢患者。DA+DCB组与DA+POBA组相比,术后3、6个月靶血管一期通畅率差异无统计学意义(100%vs. 95.2%,95.5%vs. 85.7%,均P> 0.05),但术后12个月一期通畅率较DA+POBA组明显提高(90.9%vs. 66.7%,P <0.05)。两组患者术前、术后即刻及术后6个月的最小管腔直径(MLD)差异均无统计学意义(P> 0.05),而术后12个月DA+DCB组MLD高于DA+POBA组,晚期管腔丢失率(LLL)低于DA+POBA组(均P <0.05)。结论 DA联合DCB治疗股腘动脉硬化闭塞症具有较好的中短期疗效。

Objective To evaluate the short and mid-term clinical efficacy of combined directional ather-ectomy and drugcoated balloon angioplasty in treatment of femoropopliteal artery occlusion disease.Methods The clinical data of 43 patients with femoropopliteal artery occlusion disease underwent endovascular surgery from April 2016 to October 2017 were analyzed retrospectively. Among all patients,22 cases underwent treatment with DA and DCB angioplasty and 21 cases with DA and POBA angioplasty. The clinical outcomes between the two groups of patients were compared.Results The procedures were successfully performed in all the cases. There were no amputation needed or death occurred. In DA + DCB group compared to DA + POBA group,the primary patency rate at postoperative 3 and 6 months showed no significant difference(100% vs. 95.2%,95.5% vs. 85.7% both P > 0.05),while it was significantly different at postoperative 12 months(90.9% vs. 66.7%,P < 0.05). MLD changes and LLL:The MLD in preoperative,immediate postoperative and 6 months was not statistically significant between the two group(P > 0.05 for both). Twelve months after operation,MLD of DA + DCB group was higher than DA + POBA group,and LLL in DA + DCB group was significantly lower than the DA + POBA group(both P < 0.05).Conclusion Combined treatment of FAD using TurboHawk directional atherectomy and DCB is the safe and effective method,which has better short and mid-term efficacy than TurboHawk combined with POBA.