股腘动脉长段闭塞腔内治疗临床疗效及再狭窄处理

Clinic effects and re-stenosis management of endovascular treatment for patients with TASC Ⅱ D femoropopliteal occlusive disease

目的评估股腘动脉长段闭塞(trans atlantic inter-society consensusⅡclass D,TASCⅡD)腔内治疗临床疗效及再狭窄处理。方法总结2012-01至2014-01收治的股腘动脉长段闭塞(TASCⅡD)腔内治疗病例64例71条肢体,绘制Ⅰ期、辅助、Ⅱ期通畅率Kaplan-Meier曲线。单因素方差分析再狭窄的危险因素。结果 64例患者的年龄范围在53~91岁,平均年龄为(73.6±8.7)岁;病变长度范围在200~500 mm,平均长度为(309.0±58.2)mm,支架平均数目为2.4枚(1~4枚);随访时间范围在7~39个月,平均随访时间为(12.1±6.2)个月。所植支架均为裸支架。1、2、3年的Ⅰ期通畅率分别为68%、15%和15%;1、2、3年的辅助通畅率分别为82%、37%和37%;1、2、3年的Ⅱ期通畅率分别为96%、68%和68%。1年的随访中,无大截肢发生。单因素方差分析显示,流出道的数目与支架内再狭窄程度是再狭窄的危险因素。结论腔内治疗股腘动脉长段闭塞(TASCⅡD)中短期临床疗效可以接受,长期随访欠满意;再次腔内治疗可作为再狭窄处理的较好选择。

Objective To evaluate the outcomes of endovascular treatment for TASCⅡ D(Trans Atlantic InterSociety ConsensusⅡ class D) femoropopliteal lesions and re-stenosis management.Methods Endovascular intervention with bare nitinol stent implantation was performed on 71 limbs(64 patients in Ren Ji hospital) with TASCⅡ D femoropopliteal lesions from January 2012 to January 2014.Kaplan-Meier curves of primary patency,assisted patency and second patency were performed.Predictive factors of re-stenosis/occlusion were evaluated by univariate methods.Results Total 64 patients with mean age of 73.6±8.7(range,53.0~91.0 years) and mean lesion length of 309±58.2 mm(200~500 mm) were enrolled.The mean follow-up time was 12.1±6.2 month(7~39 ms).Revascularization was successfully on 95% lesions by bare nitinol stent implantation.Primary patency rates at 1,2 and 3 years were 68%,15% and 15%,respectively.Assisted primary patency rates at 1,2 and 3 years were 82%,37%and 37%,respectively.Secondary patency rates at 1,2 and 3 years were 96%,68% and 68%.During one-year followup,no major amputation was occurred.Univariate analysis revealed that number of run-off vessels and degree of restenosis were potential predictors of re-stenosis/occlusion.Conclusion The short and mid-term outcomes of endovascular treatment of TASCⅡ D femoropopliteal artery occlusion are accepted,but the long-term is not satisfactory.Reendovascular intervention could be a good alternative for patients of re-stenosis/occlusion.