膝下动脉通畅性对股腘动脉硬化闭塞性病变患者药物涂层球囊扩张术后一期通畅率的影响

Effect of infrapopliteal artery patency on primary patency rate of patients with femoropopliteal arteriosclerosis obliterans after drug-coated balloon expansion

目的探讨膝下动脉通畅性对股腘动脉硬化闭塞性病变患者药物涂层球囊(DCB)扩张术后一期通畅率的影响。方法收集2017年1月至2020年6月于成都中医药大学附属医院治疗的120例股腘动脉硬化闭塞性病变患者(共132条肢体)的临床资料,根据术前血管造影检查显示的通畅膝下动脉数目将患者分为A组(通畅膝下动脉≥2条,34例患者,40条肢体)和B组(通畅膝下动脉≤1条,86例患者,92条肢体),并将术后1年一期通畅率较低的B组根据术后血管造影检查显示的通畅膝下动脉增加情况分为b1组(增加通畅膝下动脉,66条肢体)和b2组(未增加通畅膝下动脉,26条肢体)。分析膝下动脉通畅性对DCB扩张术后股腘动脉硬化闭塞性病变患者临床疗效的影响,并分析B组股腘动脉硬化闭塞性病变患者、DCB扩张术后1年一期通畅情况的影响因素。结果两组患者的术后1年下肢相关病死率比较,差异无统计学意义(P>0.05)。A组患者的术后ABI、术后1年一期通畅率均高于B组患者(P<0.05)。亚组分析中,b1组患肢的术后1年一期通畅率高于b2组患肢(P<0.05)。单因素分析结果显示,发生主要终点事件患者的术后流出道数目少于通畅患者,闭塞病变长度大于通畅患者(P<0.05)。多因素分析结果显示,术后膝下动脉通畅数目≥1条是股腘动脉硬化闭塞性病变患者DCB扩张术后发生主要终点事件的保护因素(P<0.05);闭塞病变长度>14.00 cm是股腘动脉硬化闭塞性病变患者DCB扩张术后发生主要终点事件的危险因素(P<0.05)。结论闭塞病变长度、膝下动脉通畅性是股腘动脉硬化闭塞性病变患者DCB扩张术后一期通畅率的影响因素,开通闭塞膝下动脉有利于提高DCB扩张术治疗股腘动脉硬化闭塞性病变的临床效果。

Objective To investigate the effect of infrapopliteal artery patency on primary patency of patients with femoropopliteal arteriosclerosis obliterans after drug-coated balloon(DCB)expansion.Method Clinical data of 120 patients with femoropopliteal lesions(132 limbs)in the Hospital of Chengdu University of Traditional Chinese Medicine from January 2017 to June 2020 were collected.The patients were divided into group A(the number of unobstructed infrapopliteal artery≥2,40 limbs of 34 patients)and group B(number of unobstructed infrapopliteal artery during preoperative angiography≤1,92 limbs of 86 patients)according to the number of unobstructed infrapopliteal artery during preoperative angiography.The patients in group B with lower 1-year postoperative primary patency were divided into group b1(increased number of infrapopliteal artery,66 limbs)and group b2(no increase of the number of infrapopliteal artery,26 limbs)according to whether the number of unobstructed infrapopliteal artery were increased in postoperative angiography.The effect of infrapopliteal artery patency on the clinical efficacy of patients with femoropopliteal arteriosclerosis obliterans after DCB expansion,and the influencing factors of the 1-year postoperative primary patency of femoropopliteal arteriosclerosis obliterans in patients with the injured limb DCB expansion in group B were analyzed.Result There was no significant difference for the mortality related to lower limbs after 1 year of surgery in both groups(P>0.05).The postoperative ABI and primary patency rate after 1 year of surgery in group A were higher than that in group B(P<0.05).In subgroup analysis,the primary patency rate after 1 year of surgery in group b1 was higher than that in group b2(P<0.05).Univariate analysis showed the number of postoperative run off arteries in patients experienced primary endpoint was lower than patent patients,length of occlusive lesions longer than the patent patients(P<0.05).Multivariate analysis showed that the patency number of inferior genicular artery≥1 after operation was the protective factor and length of occlusive lesions>14.00 cm was the risk factor of primary endpoint for patients with femoropopliteal arteriosclerosis obliterans after DCB expansion(P<0.05).Conclusion The length of occlusive lesion and patency of infrapopliteal artery are influencing factors of primary patency of patients with femoropopliteal arteriosclerosis obliterans after DCB expansion.Opening the occlusive infrapopliteal artery can improve clinical effect of femoropopliteal arteriosclerosis obliterans after DCB expansion.