药物涂层球囊治疗股腘动脉硬化闭塞症术后再狭窄的危险因素分析

Analysis of risk factors for restenosis of drug-coated balloon angioplasty for femoropopliteal arterial occlusive disease

目的评价药物涂层球囊治疗股腘动脉硬化闭塞症的疗效并分析再狭窄的危险因素。方法回顾性收集大连医科大学附属第一医院2016年6月至2018年9月药物涂层球囊治疗股腘动脉硬化闭塞100例患者(103条患肢)的临床资料,分析一期通畅率、避免靶病变血管重建率及影响再狭窄相关因素。结果手术成功率为100%,患者术后临床症状好转,ABI为0.82±0.16,Rutherford分级明显改善,和术前相比差异有统计学意义(P<0.001)。患者术后1年和2年的一期通畅率分别为80.58%和66.99%,1年和2年避免靶病变血管重建率分别为86.41%和76.70%。肾功能不全(HR=2.721,95%CI=1.181~6.269,P=0.019)和重度钙化(HR=3.333,95%CI=1.581~7.026,P=0.002)是DCB术后再狭窄的独立危险因素。结论药物涂层球囊治疗股腘动脉硬化闭塞症短期疗效良好,但2年通畅率呈现迟发追赶现象;肾功能不全和重度钙化是药物涂层球囊术后再狭窄的独立危险因素。

Objective To evaluate the efficacy of drug-coated balloon(DCB)angioplasty in the treatment of femoropopliteal arterial lesions and to identify the risk factors of restenosis.Methods A retrospective study of 100 patients(103 limbs)who were treated with DCBs for femoropopliteal lesions at the First Affiliated Hospital of Dalian Medical University between June 2016 and September 2018 were performed.Primary patency,target lesion revascularization(TLR)rate and risk factors of restenosis were analyzed.Results The success rate of the operation was 100%.Clinical symptoms of patients improved after the operation.The postoperative ABI was 0.82±0.16 and he Rutherford grade was significantly improved,and the differences were statistically significant(P<0.001).The primary patency rates of patients at 1 and 2 years after surgery were 80.58%and 66.99%,respectively,and the TLR rates at 1 and 2 years were 86.41%and 76.70%,respectively.Chronic kidney disease(HR=2.721,95%CI=1.181~6.269,P=0.019)and severe calcification(HR=3.333,95%CI=1.581~7.026,P=0.002)were identified as independent risk factors of restenosis.Conclusion The short term effect of DCBs for femoropopliteal lesions is effective,but the primary patency may reveal a late catch-up phenomenon at two years after operation.Chronic kidney disease and severe calcification were identified as independent risk factor of restenosis.