权建军,卢翔,蔺宇浩,杨林.腔内治疗股腘动脉闭塞症效果及一期通畅率影响因素[J].中国介入影像与治疗学,2023,20(11):670-674
腔内治疗股腘动脉闭塞症效果及一期通畅率影响因素
Efficacy of endovascular therapy for femoral-popliteal arterial occlusive and impact factors of primary patency rate
投稿时间:2023-06-13  修订日期:2023-08-27
DOI:10.13929/j.issn.1672-8475.2023.11.007
中文关键词:  股动脉  腘动脉  闭塞性动脉硬化  血管成形术,球囊
英文关键词:femoral artery  popliteal artery  arteriosclerosis obliterans  angioplasty, balloon
基金项目:汉中市中心医院院级科研基金(YK2307)。
作者单位E-mail
权建军 西安交通大学医学部第一附属医院血管外科, 陕西 西安 710061
汉中市中心医院介入与血管外科, 陕西 汉中 723000 
 
卢翔 汉中市中心医院介入与血管外科, 陕西 汉中 723000  
蔺宇浩 西安交通大学医学部第一附属医院血管外科, 陕西 西安 710061  
杨林 西安交通大学医学部第一附属医院血管外科, 陕西 西安 710061 jdvascs@163.com 
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中文摘要:
      目的 观察腔内治疗股腘动脉闭塞症效果及影响治疗后24个月一期通畅率的因素。方法 收集87例接受腔内治疗的股腘动脉闭塞症患者,观察腔内治疗技术成功率、术后并发症及恢复情况;以Kaplan-Meier生存曲线分析治疗后6、12及24个月靶血管一期通畅率、一期辅助通畅率及二期通畅率,以COX回归模型筛选术后24个月一期通畅率的影响因素。结果 对87例共92侧下肢病变成功完成腔内治疗,技术成功率100%(92/92)。围手术期5例(5/87,5.75%)出现并发症;随访期间3例(3/87,3.45%)截肢、6例(6/87,6.90%)死亡。治疗前日与治疗后1个月,踝肱指数、间歇性跛行距离、Rutherford分级及数字评定量表疼痛评分差异均有统计学意义(P均<0.001)。治疗后6、12及24个月,一期通畅率分别为89.13%(82/92)、78.26%(72/92)及47.83%(44/92),一期辅助通畅率分别为91.30%(84/92)、80.43%(74/92)及55.43%(51/92),二期通畅率分别为93.48%(86/92)、84.78%(78/92)及58.70%(54/92)。定向旋切斑块[HR=0.35,95%CI(0.18,0.66),P<0.05]及治疗后≥2支膝下动脉通畅[HR=0.36,95%CI(0.15,0.86),P<0.05]为腔内治疗股腘动脉闭塞症24个月内一期通畅率的保护因素;股浅动脉(SFA)及腘动脉全程受累[HR=2.23,95%CI(1.07,4.65),P<0.05]与血管病变段长度≥15 cm[HR=2.40,95%CI(1.12,5.12),P<0.05]为其独立危险因素。结论 腔内治疗股腘动脉闭塞症效果较好,定向旋切斑块及治疗后≥2支膝下动脉通畅是腔内治疗股腘动脉闭塞症后24个月内一期通畅率的保护因素,SFA及腘动脉全程受累与靶血管病变段长度≥15 cm则为其独立危险因素。
英文摘要:
      Objective To observe the efficacy of endovascular therapy for femoral-popliteal artery occlusion and the impact factors of primary patency rate 24 months after treatment. Methods Data of 87 patients with femoral-popliteal artery occlusion who underwent endovascular therapy were retrospectively analyzed. The technical success rate of endovascular therapy, postoperative complications and recovery were observed. Kaplan-Meier survival curve was used to calculate the primary patency rate, primary auxiliary patency rate and the secondary patency rate 6, 12 and 24 months after treatment. COX regression model was used to screen the impact factors of primary patency rate 24 months after treatment. Results Totally 92 lower limbs with femoral-popliteal artery occlusion in 87 patients were successfully treated, and the technical success rate was 100% (92/92). Perioperative complications were observed in 5 cases (5/87, 5.75%), while amputation or death occurred in 3 (3/87, 3.45%) and 6 (6/87, 6.90%) cases during follow-up period, respectively. Significant differences of ankle brachial index, intermittent claudication, Rutherford classification and pain score of numeric rating scale were found between the day before and 1 month after endovascular therapy (all P<0.001). The primary patency rate at 6, 12 and 24 months after endovascular therapy was 89.13% (82/92), 78.26% (72/92) and 47.83% (44/92), the primary auxiliary patency rate was 91.30% (84/92), 80.43% (74/92) and 55.43% (51/92), while the secondary patency rate was 93.48% (86/92), 84.78% (78/92) and 58.70% (54/92), respectively. Directional atherectomy (HR=0.35, 95%CI [0.18,0.66], P<0.05) and runoff-subknee-vessels≥2 (HR=0.36, 95%CI [0.15,0.86], P<0.05) were protective factors, whereas superficial femoral artery (SFA), whole popliteal artery involvement (HR=2.23, 95%CI [1.07,4.65], P<0.05) and occlusion lesion length ≥15 cm (HR=2.40, 95%CI [1.12,5.12], P<0.05) were all independent risk factors of primary patency rate within 24 months after endovascular therapy of femoral-popliteal artery occlusion. Conclusion Endovascular therapy of femoral-popliteal artery occlusion was effective. Directional atherectomy and runoff-subknee-vessels≥2 were protective factors, whereas SFA and popliteal artery involvement as well as occlusion lesion length ≥15 cm were independent risk factors of primary patency rate within 24 months.
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