药物涂层球囊治疗下肢动脉硬化闭塞症

Treatment of atherosclerosis obliterans in lower extremity with drug-coated balloon

目的 探索药物涂层球囊治疗下肢动脉硬化闭塞症的疗效及特点.方法 对28例经药物球囊治疗并完成6～13个月随访的患者的临床资料进行回顾性分析.结果 28例患者均诊断为下肢动脉硬化闭塞症并成功进行腔内介入治疗.患者病变主要位于股浅动脉,根据病变程度按泛大西洋协会间共识(TASC)Ⅱ分级分为A、B、C、D组.术后6、9、12个月的血管通畅率分别为100％、86.4％及76.9％.术后12个月,A、B组合并通畅率92.8％,C、D两组合并的通畅率为66.7％(P<0.05);术后9个月,药物球囊扩张加支架植入的血管通畅率为85.7％,单纯药物球囊扩张的通畅率为86.7％(P>0.05);5例斑块减容加药物球囊成形患者靶血管通畅率达100％;10例单纯药物球囊成形(不含支架内病变)患者,靶血管通畅率为80％(P<0.05).结论 药物涂层球囊用于下肢动脉硬化闭塞症的介入治疗具有明显优势,而减容联合药物涂层球囊成形可能是目前最理想的介入治疗方式.

Objective To investigate the clinical outcome of drug-coated balloon ( DCB) treated atherosclerosis obliterans ( ASO) in lower extremity. Methods Data of 28 patients were retrospectively an-alyzed to determine the effectiveness and characteristics of DCB treatment. Results All the 28 patients were successfully treated with endovascular intervention therapy. Lesions mainly located in the superficial femoral arteries were divided into Groups A, B, C, and D according to TransAtlantic InterSociety Consensus (TASC) Ⅱ classification. Follow-up at 6, 9, and 12 months showed 100％, 84. 6％ and 76. 9％ patency rate in treated artery. After 9 months of endovascular intervention therapy, the combined artery patency rates in Groups A and B was 92. 8％, which was significantly better than 66. 7％ in Groups C and D ( P <0. 05 ) . DCB angioplasty had an artery patency rate of 86. 7％, while DCB angioplasty plus stenting had the patency rate of 85. 7％ (P>0. 05). Artery patency rate of Simple DCB angioplasty in ten patients (Exclu-ding patients with in-stent restenosis ) was 80％ and of Atherectomy plus DCB angioplasty in 5 patients was 100％ (P<0. 05). Conclusions DCB angioplasty has superiority over conventional intervention therapy. Combined debulky and DCB angioplasty appear to be the best choice in current treatment of ASO in lower extremity.