接触性导管溶栓联合药物涂层球囊扩张治疗股腘型血栓闭塞性脉管炎的疗效分析

Catheter-directed thrombolysis combined drug coated balloon dilation in femoral-popliteal thromboangiitis obliterans

目的 探讨接触性导管溶栓(CDT)联合药物涂层球囊(DCB)扩张治疗股腘型血栓闭塞性脉管炎(TAO)的临床疗效.方法 收集2017年5月至2020年11月空军军医大学第二附属医院行CDT联合DCB扩张治疗的18例股腘型TAO患者临床资料.比较不同时间点(术前、术后24 h、术后6个月)的临床疗效[疼痛评分、Rutherford级别、踝肱指数(ABI)];术后6个月到院检测靶血管通畅情况;统计随访期间不良事件发生情况(栓塞、截肢及死亡).结果 18例患者均成功开通股腘段闭塞动脉,术中未发生血栓、血管破裂及远端栓塞等并发症.术后24 h和术后6个月,疼痛评分、Rutherford级别低于术前,ABI高于术前,差异有统计学意义(P<0.05).18例患者均获得6个月随访,术后6个月血管通畅率为88.9%(16/18),无靶血管血运重建患者.1例患者发生溶栓相关出血并发症,1例患者在随访过程中发生大截肢.结论 CDT联合DCB扩张治疗的股腘型TAO患者的初步疗效尚可,仍需进一步对比研究证实.

Objective To investigate the clinical effect of catheter-directed thrombolysis(CDT)combined drug-coated balloon(DCB)dilation in the treatment of femoral-popliteal thromboangiitis obliterans(TAO).Method The clinical data of 18 patients with femoral-popliteal TAO were collected from the Second Affiliated Hospital of Air Force Military Medical University from May 2017 to November 2020 after CDT combined with DCB dilatation.The clinical effect(pain score,Rutherford grade,ankle-brachial index[ABI])were compared at different time points(pre-operation,24 h post-operation,6 months post-operation),and the target vessel patency was measured at 6 months postoperatively.Adverse events(embolism,amputation and death)were collected during follow-up.Result The femoral-popliteal artery occlusions were successfully unblocked in all 18 patients.No complications such as thrombus,rupture of vessel and distal embolism occurred during the operation.The pain score and Rutherford grade were lower and ABI was higher at 24 h and 6 months postoperatively(P<0.05).All patients were followed up for 6 months.The patency rate was 88.9%(16/18)at 6 months postoperatively.There was no revascularization for the target vessels;thrombolytic-related hemorrhage occurred in 1 patient and large amputation occurred in 1 patient during follow-up.Conclusion The initial efficacy of CDT combined DCB dilatation for femoral-popliteal thromboangiitis obliterans is acceptable and needs to be further confirmed by comparative studies.