支架置入与斑块旋切治疗TASCⅡA、B型股浅动脉病变的疗效观察

Percutaneous transluminal stenting versus directional atherectomy for lower limb artery TASCⅡ Class A and B superficial femoral artery lesions

目的探讨腔内支架置入与斑块旋切治疗下肢动脉短段病变的临床疗效及安全性。方法对我院符合泛大西洋协会指南(TASC)Ⅱ分型为A、B型股浅动脉病变的患者随机分两组纳人研究,支架置人组50例(50条动脉)和斑块旋切组50例(50条动脉).Rutherford分级3~5级。通过随访对比两组患者在技术成功率、治疗成功率、首次手术费用、通畅率、术后踝肱指数(ABI)、保肢率方面的差异。结果支架置人组与斑块旋切组技术成功率均为100%;治疗成功率分别为98%和86%(P>0.05)。术后AB1分别为0.82±0.19和0.80±0.27(P>0.05)。首次手术费[(34820±1051)元比(45635±1358)元,P<0.001],差异有统计学意义。随访6个月(98.0%比98.0%)、1年(89.8%比85.7%)及2年(73.5%比68.8%)—期累积通畅率差异均无统计学意义(P>0.05),2年二期累积通畅率(81.6%比72.9%)差异均无统计学意义(P>0.05)。保肢率(97.9%比93.8%)差异无统计学意义(P>0.05)。结论支架置入和斑块旋切治疗TASC A、B型股浅动脉病变近期疗效及安全性无明显差异。

Objective To compare the effect and safety of stenting versus directional atherectomy(DA)in the treatment of TASCⅡ A and B superficial femoral artery lesions.Methods 100 patients with TASC Ⅱ A and B lesions were divided into percutaneous transluminal stenting(PTS)group(n=50)and DA group(n=50).Patients were compared in terms of technical success rate,treatment success rate,first operation cost,postoperative ankle brachial index(ABI),limb salvage rate,survival,and patency.Results The technical success rate in both PTS and DA group was 100%.The treatment success rate was 98%vs.86%,P>0.05.Postoperative ABI:0.82±0.19 vs.0•80土0•27,P>0.05.First operation cost:(34820±1051)yuan vs.(45635±1358)yuan,p<0•001;All patients were followed-up for up to 2-year,the cumulative patency rate was 81.6%vs.72.9%(P>0.05).Limb salvage rate was 97.9%vs.93.8%,P>0.05.Conclusion There were no significant differences in the effect and safety of PTS versus DA in the treatment of TASCII A and B superficial femoral artery lesions.