下肢动脉硬化闭塞症腔内治疗的效果及术后再狭窄的影响因素分析

Effect of endovascular treatment for lower limb arteriosclerosis occlusion and the influencing factors for postoperative restenosis

目的探讨腔内治疗下肢动脉硬化闭塞症(ASO)的效果及术后再狭窄的影响因素。方法病例对照研究。纳入2019年1月—2021年6月蚌埠医科大学第一附属医院血管外科下肢ASO患者182例,其中男126例、女56例,年龄46~93(70.5±10.2)岁。患者术前均行CTA或动脉造影检查,踝肱指数(ABI)为0.15~0.58(0.38±0.18)。182例患者均行腔内治疗。观察指标:(1)观察182例患者腔内治疗的疗效(血管一期通畅率、治疗后1个月ABI等),以及围手术期心脑血管意外、肾功能不全、大截肢等不良事件发生情况。(2)统计182例患者术后12个月动脉再狭窄发生情况。依据患者是否发生动脉再狭窄分为再狭窄组和非再狭窄组,对2组患者性别、年龄、Fontaine分期、内科合并症、吸烟史等临床基线资料,以及下肢ASO病变部位、狭窄程度、病变长度、治疗方式、术后抗血小板治疗时间等指标进行单因素分析,对P<0.01的变量进一步行多因素logistic回归分析。结果(1)182例患者手术均顺利完成,术后临床症状均不同程度缓解,无大截肢、消化道出血及严重心脑血管并发症和死亡病例。术后血管一期通畅率100%,治疗后1个月ABI为0.68±0.25,高于术前,差异有统计学意义(t=15.15,P<0.001)。(2)182例患者术后12个月发生动脉再狭窄100例,发生率54.9%。单因素分析结果显示,2组患者下肢ASO病变长度、抗血小板治疗时间、吸烟史等指标比较,差异均有统计学意义(χ^(2)=8.69、8.43、9.25,P值均<0.01),而性别、年龄、内科合并症及下肢ASO病变部位、狭窄程度等指标比较,差异均无统计学意义(P值均>0.05)。进一步多因素logistic回归分析结果显示,病变长度≥3 cm(OR=2.835,95%CI:1.478~5.438)、吸烟(OR=2.776,95%CI:1.460~5.277)是ASO患者腔内治疗后发生动脉再狭窄的危险因素(P值均<0.001),而抗血小板治疗>6个月(OR=0.220,95%CI:0.084~0.574)是腔内治疗术后预防管腔再狭窄的保护因素。结论采用腔内治疗下肢ASO安全有效,ASO患者病变长度≥3 cm、有吸烟史是影响术后发生动脉再狭窄的危险因素,而术后抗血小板治疗>6个月是预防管腔再狭窄的保护因素。

Objective This study aimed to explore the efficacy of endovascular treatment for lower-limb arteriosclerosis obliterans(ASO)and related the influencing factors of postoperative restenosis.Methods A case-control study was conducted from January 2019 to June 2021.A total of 182 patients with lower-limb ASO in the Vascular Surgery Department of the First Affiliated Hospital of Bengbu Medical University,including 126 males and 56 females,aged 46−93(70.5±10.2)years old,were enrolled in the study.All patients underwent computed tomographic arteriography or arterial angiography and had ankle brachial index(ABI)ranging from 0.15 to 0.58(0.38±0.18).The 182 patients received intracavitary treatment.Observation indicators included the following:(1)efficacy of intracavitary treatment(primary vascular patency rate,ABI of 1 month after treament and other indicators)and incidence of adverse events,such as cardiovascular and cerebrovascular accidents,renal insufficiency,and major amputations during the perioperative period;(2)incidence of arterial restenosis in the 182 patients 12 months after analysis of the operation.All patients were divided into the restenosis and nonrestenosis groups based on whether the patients had arterial restenosis 12 months after surgery.Single-factor analysis involved clinical baseline data,such as gender,age,Fontaine stage,internal medicine comorbidities,smoking history,and lower limb ASO lesion site,stenosis degree,lesion length,treatment method,and postoperative antiplatelet treatment time for two groups of patients.A stepwise multivariate logistic regression analysis was performed on variables with P<0.01.Results(1)Surgery was successful in all 182 patients.The clinical symptoms of the patients improved to varying degrees after surgery,and no major amputations,gastrointestinal bleeding,severe cardiovascular and cerebrovascular complications,or deaths were recorded.The postoperative primary vascular patency rate was 100%,ABI of 1 month after treament was 0.68±0.25,which was higher than that before operation.The difference was statistically significant(t=15.15,P<0.001).Among the 182 patients,100 experienced arterial restenosis 12 months after surgery(restenosis rate:54.9%).(2)Univariate analysis revealed statistically significant differences among indicators,such as lesion length of the lower-limb ASO,antiplatelet treatment time,and smoking history between the two groups of patients(χ^(2)=8.69,8.43,9.25,all P values<0.01).However,no statistically significant differences were detected in indicators,such as gender,age,internal medicine complications,lesions location of lower limb ASO,and degree of stenosis(all P values>0.05).Further multivariate logistic regression analysis unveiled lesion length≥3 cm(OR=2.835,95%CI:1.478−5.438),and smoking(OR=2.776,95%CI:1.460−5.277)as independent risk factors for arterial restenosis in ASO patients after intracavitary treatment(all P values<0.001).Meanwhile,antiplatelet therapy>6 months(OR=0.220,95%CI:0.084−0.574)was a protective factor for preventing luminal restenosis after intracavitary treatment.Conclusion The intraluminal treatment is safe and effective for lower-limb ASO.Patients with lesions whose length≥3 cm and a history of smoking are independent risk factors for postoperative arterial restenosis,and postoperative antiplatelet therapy>6 months is a protective factor for the prevention of luminal restenosis.