血管内超声在准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症中的应用价值

Application and value of intravascular ultrasound for excimer laser ablation combined with drug-coated balloon in the treatment of lower limb arteriosclerotic obliterans

目的探讨血管内超声在准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症治疗中的效果。方法本研究为前瞻性病例系列研究,纳入2021年9月至2022年3月在复旦大学附属中山医院接受血管内超声辅助的准分子激光消蚀联合药物涂层球囊治疗的下肢动脉硬化闭塞患者的资料。记录患者病变特点、手术疗效和相关并发症。治疗前后资料的比较采用配对样本t检验。结果共10例患者纳入研究,男性8例,女性2例,年龄(72.0±5.9)岁(范围:61~81岁)。共11处病变,股浅动脉8处,腘动脉3处,病变长度(7.0±2.4)cm(范围:3.2~9.8 cm)。慢性闭塞病变4处,重度狭窄7处。患者均顺利完成手术,技术成功率为10/11,1处病变发生限流性夹层,行补救性支架植入。4处病变钙化分级为3~4级,9处病变钙化弧度≥180°。5处病变在血管内超声测量后选择更大直径的药物涂层球囊。随访(6.0±1.9)个月(范围:3~9个月),患者术后即刻踝肱指数(0.97±0.13比0.48±0.18,t=-7.60,P<0.01)与术后3个月踝肱指数(0.95±0.12比0.48±0.18,t=-7.17,P<0.01)均较术前明显增加。术后3个月的一期通畅率为11/11,无靶病变再干预,溃疡愈合率为3/4。结论血管内超声辅助下准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症的早期结果良好,手术安全。

Objective To examine the value of intravascular ultrasound(IVUS)for excimer laser ablation(ELA)combined with drug-coated balloon(DCB)in treating lower limb arteriosclerotic obliterans(ASO).Methods As a prospective case series study,patients who underwent ELA combined with DCB for lower limb ASO with the guidance of IVUS from September 2021 to March 2022 at Department of Vascular Surgery,Zhongshan Hospital,Fudan University were enrolled prospectively.Lesion characteristics,procedure-related outcomes and complications were collected.The therapy outcomes were compared with baseline data by paired t test.Results There were 8 males and 2 females,aged(72.0±5.9)years(range:61 to 81 years).Of all the 11 lesions,there were 8 lesions in superficial femoral artery and 3 in popliteal artery.The lesion length was(7.0±2.4)cm(range:3.2 to 9.8 cm).There were 4 chronic totally occlusion and 7 severe stenosis.All patients underwent the operation successfully.The technical success rate was 10/11.Bailout stenting was performed in one lesion because of flow-limiting dissection.Four lesions were grade 3 to 4 in peripheral artery calcium score system,and 9 lesions with calcification arc≥180°.Larger diameter drug-coated balloons were selected in 5 lesions after measurement of intravascular ultrasound.The follow-up time was(6.0±1.9)months(range:3 to 9 months).The ankle-brachial index of the patient was significantly improved immediately after surgery(0.97±0.13 vs.0.48±0.18,t=-7.60,P<0.01)and at 3 months after surgery(0.95±0.12 vs.0.48±0.18,t=-7.17,P<0.01).The 3-month primary patency rate was 11/11,the target lesion reintervention was 0 and ulcer healing rate was 3/4.Conclusion IVUS assisted ELA in the treatment of lower limb artery lesions is safe and effective in early stage.