准分子激光斑块消蚀术联合药物涂层球囊治疗糖尿病膝下动脉病变的早期疗效分析

Early therapeutic effect of excimer laser atherectomy combined with drug-coated balloon angioplasty in the treatment of diabetes patients with infragenicular artery disease

目的探讨准分子激光斑块消蚀术(excimer laser atherectomy,ELA)联合药物涂层球囊(drug-coated balloon,DCB)治疗糖尿病膝下动脉病变的早期临床效果。方法回顾性选择2021年7月至2022年12月上海交通大学医学院附属第九人民医院收治的糖尿病膝下动脉病变患者48例,接受ELA联合DCB治疗的24例患者为实验组,接受普通球囊联合DCB的24例患者对照组,Rutherford分级为2~5级。记录患者手术过程、术中并发症、踝肱指数和症状改善等情况。结果实验组平均年龄72.1岁,共26条患肢,49处血管病变,34处慢性完全闭塞性病变;对照组平均年龄74.1岁,共27条患肢,41处血管病变,32处慢性完全闭塞性病变。实验组手术均顺利完成,未发生穿孔、远端栓塞等并发症,有2例腓动脉和2例胫前动脉因ELA治疗后出现限流性夹层植入补救性支架;踝肱指数由术前的0.52上升至术后0.89;19条患肢(19/20)静息痛明显减轻或消失,10例(10/11)溃疡已愈合,1例患者在随访期间溃疡症状未明显改善再次入院介入干预。对照组踝肱指数由术前的0.63上升至术后0.85;16条患肢(16/19)静息痛明显减轻或消失,4例(4/10)溃疡已愈合,6例患者在随访期间溃疡症状未明显改善再次入院介入干预。实验组和对照组术后1个月靶血管通畅率分别为95.8%和75%。随访患者均无截肢或死亡。结论采用ELA联合DCB治疗糖尿病膝下动脉病变成功率高、并发症少,早期临床疗效优于单纯采用球囊扩张,但仍需大样本随访观察中远期疗效。

Objective To explore the early clinical outcomes of excimer laser atherectomy combined with drug-coated balloon angioplasty in the treatment of diabetic infrapopliteal arterial lesions.Methods From July 2021 to December 2022,48patients with diabetes infragenicular artery disease were retrospectively selected from the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.Twenty four patients received excimer laser combined with DCB as the experimental group,and 24 patients received conventional balloon combined with DCB as the control group.The Rutherford classification was 2-5.Patients’surgical procedures,intraoperative complications,ankle-brachial index and improvement of symptoms were recorded.Results The mean age of the experimental group was 72.1 years,with a total of 26 affected limbs,49 vascular lesions and 34chronic total occlusive lesions;the mean age of the control group was 74.1 years,with a total of 27 affected limbs,41 vascular lesions and 32 chronic total occlusive lesions.The procedures were completed successfully in the experimental group without complications such as perforation or distal embolism.Remedial stents were implanted in two cases of flow-limiting entrapment of the peroneal artery and two cases of the anterior tibial artery after laser ablation treatment;the ankle-brachial index increased from 0.52preoperatively to 0.89 postoperatively;resting pain was significantly reduced or disappeared in 19 affected limbs(19/20),and Ten(10/11)ulcers had healed,and only one patient was readmitted for intervention during follow-up without significant improvement in ulcer symptoms.In the control group,the ankle-brachial index increased from 0.63 preoperatively to 0.85 postoperatively;16affected limbs(16/19)showed a significant reduction or disappearance of resting pain,4(4/10)ulcers had healed,and 6 patients were readmitted to the hospital for intervention without significant improvement in ulcer symptoms during the follow-up period.The target vessel patency rate at 1 month after surgery was 95.8%and 75%in both groups,respectively.There was no amputation or death in any of the patients at follow-up.Conclusions The use of excimer laser atherectomy combined with drug-coated balloons for the treatment of diabetic infrapopliteal arteriopathy has a high success rate with few complications,and the early clinical outcome is better than that of the balloon dilation group alone,but a large follow-up sample is still needed to observe the medium and long-term outcomes.