药物涂层球囊治疗股腘动脉长段病变的中远期结果及其预后因素

Mid-and long-term outcomes and prognostic factors of drug-coated balloon angioplasty for treatment of femoropopliteal long lesions

目的探讨药物涂层球囊(DCB)治疗股腘动脉长段病变的中远期结果及其预后因素。方法回顾性分析2016年6月至2021年5月于清华大学附属北京清华长庚医院血管外科接受DCB治疗的114例股腘动脉长段病变(卢瑟福分级2~6级)患者的临床资料。男性75例,女性39例,年龄(71.9±8.4)岁(范围:49~89岁)。114例患者共有138处股腘动脉长段病变,其中初次病变111处(80.4%,111/138),闭塞病变116处(84.1%,116/138),病变长度(280.9±78.7)mm(范围:150~520 mm);联合减容治疗59处(42.8%,59/138),植入补救支架27处(19.6%,27/138)。通过Kaplan-Meier生存曲线分别计算患者的累积初始通畅率、免于临床驱动的靶病变再次干预率、累积总体生存率。通过Cox比例风险模型进行单因素及多因素分析,筛选影响股腘动脉长段病变通畅率的相关因素。结果114例患者均完成DCB治疗,技术成功率为98.2%(112/114)。术后平均随访18个月(范围:3~54个月)。术后12、24和36个月累积初始通畅率分别为87.5%、75.2%和55.1%,免于临床驱动的靶病变再次干预率分别为92.4%、81.8%和68.7%,累积总体生存率分别为96.2%、94.0%和80.2%。单因素及多因素分析结果显示,慢性肢体威胁性缺血(HR=2.629,95%CI:1.519~4.547,P<0.01)、合并高脂血症(HR=2.228,95%CI:1.004~4.948,P=0.026)是影响股腘动脉长段病变DCB术后通畅率的独立预后因素。结论DCB治疗股腘动脉长段病变的中远期效果满意,慢性肢体威胁性缺血、合并高脂血症是影响股腘动脉长段病变DCB治疗后通畅率的独立预后因素。

Objective To examine the effective and safe outcomes of drug-coated balloon(DCB)angioplasty for the treatment of femoropopliteal long lesions in mid-term and long-term follow-up.Methods The clinical data of 114 patients with symptomatic(Rutherford 2 to 6)femoropopliteal long lesions who underwent angioplasty with DCB between June 2016 and May 2021 at Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital were retrospectively analyzed.A total of 75 males and 39 females were enrolled,aged(71.9±8.4)years(range:49 to 89 years).Among 138 lesions in 114 patients,there were 111 de nove lesions(80.4%,111/138).Total occlusions were recanalized in 116 limbs(84.1%,116/138).The lesion length was(280.9±78.7)mm(range:150 to 520 mm).DCB angioplasty combined with debulking devices was used in 59 lesions(42.8%,59/138).The bail-out stent implantation was performed in 27 limbs(19.6%,27/138).The Kaplan-Meier method was used to evaluate cumulative primary patency rate,freedom from the clinically driven target lesion revascularization(CD-TLR)rate and accumulate survival rate.Univariate and multivariate analyses with Cox proportional hazards models were performed to determine the significant prognostic factors for primary patency.Results DCB angioplasty was completed in 114 patients.The technical success rate was 98.2%(112/114).The mean follow-up time was 18 months(range:3 to 54 months).The results showed that primary patency rates at 12,24 and 36 months postoperatively were 87.5%,75.2%and 55.1%,respectively.Freedom from CD-TLR rate at 12,24 and 36 months postoperatively were 92.4%,81.8%and 68.7%,respectively.Accumulate survival rate at 12,24 and 36 months postoperatively were 96.2%,94.0%and 80.2%.Multivariate Cox′s regression analyses showed that chronic limb-threatening ischemia(CLTI)(HR=2.629,95%CI:1.519 to 4.547,P<0.01)and hyperlipidemia(HR=2.228,95%CI:1.004 to 4.948,P=0.026)were independent prognosis factors for primary patency in DCB treatment of femoropopliteal long lesions.Conclusions DCB provided favorable outcomes for the treatment of femoropopliteal long lesions.CLTI and hyperlipidemia are independent prognosis factors for restenosis after DCB angioplasty.