定向斑块旋切联合药涂球囊与联合普通球囊治疗股腘动脉病变的疗效比较

Comparison of directional atherectomy combined with drug-coated balloon versus plain old balloon angioplasty for femoropopliteal artery disease

目的对比定向斑块旋切(directional atherectomy,DA)联合药物涂层球囊(drug coating balloon,DCB)与联合普通球囊(plain old balloon,POB)治疗股腘动脉病变的疗效。方法回顾性分析2015年8月至2022年4月中山大学附属第一医院收治的22例股腘动脉病变患者的临床治疗,其中DA+DCB组和DA+POB组各11例,观察两组患者临床症状改善情况、ABI变化并比较短中期通畅率。结果患者狭窄闭塞病变段均成功开通,其中20例患者临床症状得到改善,术后ABI较术前显著提高(P<0.001),无血管穿孔、死亡等并发症发生。生存分析显示DA+DCB组术后1年通畅率为79%,2年通畅率56%;DA+POB组术后1年通畅率为67%,2年通畅率38%。通过Cox回归矫正,DA+DCB组通畅率优于DA+POB组(P=0.047)。结论DA联合DCB或POB对于股腘动脉病变患者安全有效,联合DCB可能比联合POB具有更好的通畅率。

Objective To compare the efficacy of directional atherectomy(DA)combined with drug coating balloon(DCB)versus plain old balloon(POB)in the treatment of femoropopliteal artery disease.Methods The clinical data of 22 patients with femoropopliteal artery disease admitted to the First Affiliated Hospital of Sun Yat-sen University from August 2015 to April 2022 were analyzed retrospectively,including 11 cases in DA+DCB group and 11 cases in DA+POB group.Improvement of clinical symptoms,changes in ABI were observed,and short-and medium-term patency rates were compared.Results The stenosis and occlusion lesions were successfully opened in all patients,among which 20 cases had improvement in clinical symptoms.The postoperative ABI was significantly higher than that before the operation(P<0.001),and no complications such as arterial perforation or death occurred.Survival analysis showed that the 1-year patency rate of the DA+DCB group was 79%,and the 2-year patency rate was 56%;the 1-year patency rate of the DA+POB group was 67%,and the 2-year patency rate was 38%.Corrected by Cox regression showed that the patency rate of DA+DCB group was higher than that of DA+POB group(P=0.047).Conclusion DA combined with DCB or POB is safe and effective for patients with femoropopliteal artery disease,and combined with DCB may have a better patency rate than combined with POB.