TurboHawk斑块旋切系统治疗下肢动脉硬化闭塞症支架内再狭窄:单中心经验

TurboHawk plaque excision system in the treatment of in-stent restenosis in patients with arteriosclerotic obliterans:single center experience

目的探讨TurboHawk斑块旋切系统治疗下肢动脉硬化闭塞症(ASO)支架内再狭窄(ISR)患者的安全性及有效性。方法收集2017年5月至2018年11月在南京大学医学院附属鼓楼医院血管外科住院的ASO患者资料,共纳入28例符合诊断及排除标准的研究对象,均应用TurboHawk斑块旋切系统治疗ISR。采用秩和检验比较患者术前、术后2 d、术后3个月的踝肱指数(ABI)、Rutherford分级差异性。结果28例患肢病变段均开通成功。术中出现不良事件共2例,分别为胫腓干栓塞及血管穿孔。26例达到临床成功标准。(1)术后2 d观察指标:术后2 d ABI与术前比较,差异有统计学意义(0.66±0.17比0.27±0.19;P<0.05);术后2 d Rutherford分级与术前比较,差异有统计学意义(2.11±0.83比4.00±0.72;P<0.05)。(2)术后3个月观察指标:术后3个月ABI与术前比较,差异有统计学意义(0.63±0.16比0.27±0.19;P<0.05);与术后2 d比较,差异无统计学意义(0.63±0.16比0.66±0.17;P=0.11);术后3个月Rutherford分级与术前比较差异有统计学意义(1.96±0.76比4.00±0.72;P<0.05),与术后2 d比较差异无统计学意义(1.96±0.76比2.11±0.83;P=0.53)。26例患者术后3个月靶血管通畅,1例术后76 d因肢体坏死行大腿截肢术,1例术后40 d因股动脉栓塞行股动脉切开取栓术。结论TurboHawk斑块旋切系统治疗ASO且ISR患者的安全性及有效性良好,可以推广使用,术中应小心规范操作,减少术中不良事件的发生。

Objective To explore the safety and effectiveness of TurboHawk plaque excision system in the treatment of instent restenosis(ISR)in patients with arteriosclerotic obliterans(ASO).Methods Twenty eight patients with ASO who underwent the treatment of ISR by TurboHawk plaque excision system in Department of Vascular Surgery,Drum Tower Hospital Affiliated to Nanjing University Medical School became study subjects.The difference of their ankle brachial index(ABI)and Rutherford grade before revascularization and after revascularization were analyzed by rank sum test.Results Twenty-eight patients all gained successful revascularization.Two adverse events happened which were tibiofibular artery embolization and perforation.Twenty-six patients were up to clinical success standard.The ABI ranged from 0.25 to 0.92 after 2 days,with a mean index of 0.66±0.17,and the difference was statistically significant compared with the ABI ranged from 0 to 0.64 before revascularization,with a mean index of 0.27±0.19(P<0.05).The Rutherford grade ranged from 1 to 4 after 2 days,with a mean grade of 2.11±0.83,and the difference was statistically significant compared with the Rutherford grade ranged from 3 to 5 before revascularization,with a mean index of 4.00±0.72(P<0.05).Twenty-six patients had vascular patency after 3 months,1 patient underwent"thigh amputation"after 76 days because of limb necrosis and 1 patient underwent"thrombectomy"after 40 days because of femoral embolism.The ABI ranged from 0.34 to 0.90 after 3 months,with a mean index of 0.63±0.16,and the difference was statistically significant compared with the ABI before revascularization(P<0.05)and not statistically significant compared with the ABI after 2 days(P=0.11).The Rutherford grade ranged from 1 to 3 after 3 months,with a mean grade of 1.96±0.76,and the difference was statistically significant compared with the Rutherford grade before revascularization(P<0.05)and not statistically significant compared with the Rutherford grade after 2 days(P=0.53).Conclusions TurboHawk plaque excision system is safe and effective in the treatment of ISR in the elderly patients with ASO and can be spread.Surgeon should operate carefully and normatively to reduce the occurrence of adverse events.