超声引导下准分子激光消蚀术治疗股腘动脉慢性完全闭塞

Ultrasound-guided excimer-laser atherectomy for treating chronic total occlusions of femoral popliteal arteries

目的评价血管外超声(EVUS)引导下准分子激光消蚀术(ELA)经真腔开通股腘动脉(FPA)长段慢性完全闭塞(CTO)的效果及安全性。方法纳入41例接受EVUS引导下ELA治疗FPA CTO病变患者,根据病变部位分为股浅动脉(SFA)组(n=23)及FPA组(n=18);评价治疗效果,记录踝肱指数(ABI)及Rutherford分级等。结果术前FPA组病变长度长于SFA组(P<0.05)。术中均成功建立导丝通路,初期通过成功率80.49%(33/41)。术后2组ABI较术前均明显提高(P均<0.05)。术后FPA组Rutherford分级较术前均明显降低(P均<0.05);SFA组术后1个月较术前明显降低(P<0.05),术后6个月与术前差异无统计学意义(P>0.05)。术后12个月SFA组通畅率明显高于FPA组(P<0.05)。结论EVUS引导下ELA可成功治疗复杂FPA CTO病变。

Objective To evaluate the efficacy and safety of extravascular ultrasound(EVUS)guided excimer-laser atherectomy(ELA)for opening long chronic total occlusions(CTO)of femoral popliteal arteries(FPA)crossed the true-lumen.Methods A total of 41 patients with CTO of FPA underwent EVUS-guided ELA.According to the locations of lesions,the patients were divided into superficial femoral artery(SFA)group(n=23)and FPA group(n=18).The operation outcomes were evaluated,and the ankle brachial index(ABI)and Rutherford stage were recorded.Results The preoperative length of lesions in FPA group were longer than that in SFA group(P<0.05).The primary success rate of passing was 80.49%(33/41).ABI after operation was significantly higher than that before operation(all P<0.05).Rutherford grade was significantly lower than that before operation in FPA group(all P<0.05),while in SFA group,Rutherford grade 1 month after operation was significantly lower than that before operation(P<0.05),but there was no significant difference between 6 months after operation and that before operation(P>0.05).The patency rate in SFA group was significantly higher than that in FPA group 12 months after operation(P<0.05).Conclusion EVUS-guided ELA could be used to successfully open complex CTO lesions of FPA.