定向斑块旋切联合药物涂层球囊血管成形术治疗缺血性糖尿病下肢病变的临床观察

Clinical observation of directional plaque rotation combined with drug-coated balloon in the treatment of ischemic diabetic lower extremity lesions

目的:研究定向斑块旋切术联合药物涂层球囊血管成形术治疗缺血性糖尿病下肢病变的安全性及有效性。方法:回顾性分析2022年5月—2023年5月中国中医科学院广安门医院连续收治的应用定向斑块旋切治疗的缺血性糖尿病下肢病变患者30例,平均年龄(68.6±13.2)岁,Rutherford分级逸3级,平均病变长度(15.13±9.56)mm,慢性完全性闭塞病变9例(30%),均行定向斑块旋切术联合药物涂层球囊血管成形术治疗。主要观察指标为一期通畅率和二期通畅率。次要观察指标包括技术成功率、截肢率和免于靶病变血管重建率(TLR)。结果:30例患者均应用定向斑块旋切术联合药物涂层球囊血管成形术治疗,技术成功率为100%,术后平均随访7~20(10.7±1.8)个月,随访期间,2例患者因趾端坏死行坏死趾骨截趾术,无大截肢或死亡等重大事件发生。一期通畅率为80.0%(26/30),二期通畅率为93.3%(28/30)。所有患者未行补救性支架植入。围手术期发生并发症5例,其中血管穿孔3例(10.0%),远端栓塞2例(6.7%),术中均及时通过腔内治疗缓解。结论:定向斑块旋切术联合药物涂层球囊扩张成形术治疗缺血性糖尿病下肢病变安全有效,可避免或减少支架置入。

Objective To study the safety and efficacy of targeted plaque spatulectomy combined with drug-coated balloon angioplasty in the treatment of ischemic diabetic lower extremity lesions.Methods A retrospective analysis was performed on 30 patients with ischemic diabetic lower extremity lesions admitted to Guang'anmen Hospital of Chinese Academy of Traditional Chinese Medicine from May 2022 to May 2023.The mean age was(68.63±13.2)years old,the Rutherford grade was≥3,and the mean length of lesions was(15.13±9.56)mm.9 cases(30%)of chronic complete occlusive lesions were treated by directional plaque gyrotomy combined with drug-coated balloon angioplasty.The main outcome measures were primary patency rate and secondary patency rate.Secondary outcome measures included technical success rate,amputation rate,and target-free vascular remodeling(TLR).Results A total of 30 patients were enrolled,and the technical success rate was 100%.The average postoperative follow-up was 7-20(10.7±1.8)months.During the follow-up,2 patients underwent necrophalangic toe amputation due to toe end necrosis,and no major amputation or death occurred.The patency rate of the first stage was 80.0%(26/30)and that of the second stage was 93.3%(28/30).None of the patients underwent remedial stent implantation.Perioperative complications were observed in 5 cases,including vascular perforation in 3 cases(10.0%)and distal embolization in 2 cases(6.7%).Conclusion Targeted plaque spatulectomy combined with drug-coated balloon dilatation is safe and effective in the treatment of ischemic diabetic lower extremity lesions,which can avoid or reduce stent placement.