The efficacy and influencing factors analysis of excimer laser combined with drug-coated balloon in the treatment of femoropopliteal arteriosclerosis obliterans
The efficacy and influencing factors analysis of excimer laser combined with drug-coated balloon in the treatment of femoropopliteal arteriosclerosis obliterans
李攀峰 1李晓健 1王国权 1牛浩 1翟水亭 1张琳琳 王春杰
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作者信息
1. 阜外华中心血管病医院血管外科 河南省人民医院心脏中心，郑州 450018
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摘要
目的 探讨准分子激光消蚀术（ELA）联合药物涂层球囊（DCB）治疗股腘动脉硬化闭塞症的疗效及其影响因素。 方法 回顾性分析2019年7月至2022年3月应用ELA联合DCB治疗股腘动脉硬化闭塞症82例患者的临床资料，包括技术成功率、踝肱指数（ABI）、一期通畅率、免于靶病变血运重建（TLR）率等指标，应用Cox回归分析影响一期通畅率和免于TLR率下降的危险因素。 结果 82例患者均完成了ELA+DCB治疗，技术成功率为91.5%，术后ABI（0.73±0.13）较术前（0.39±0.11）明显提高（t=35.26，P<0.001）。术后24个月的累积一期通畅率和免于TLR率分别为64.1%和76.8%。病变长度>15 cm（HR=2.57，P=0.047）、病变重度钙化（HR=3.26，P=0.021）与一期通畅率的下降相关，患糖尿病（HR=5.24，P=0.010）、术后单一流出道（HR=4.18，P=0.008）与免于TLR率的下降相关。 结论 ELA联合DCB治疗股腘动脉硬化闭塞症的安全性高，中期疗效良好。病变长度>15 cm和重度钙化是一期通畅率的独立危险因素，糖尿病和术后单一流出道是免于TLR率的独立危险因素。 Objective To investigate the efficacy of excimer laser atherectomy (ELA) combined with drug-coated balloon (DCB) in the treatment of femoropopliteal arteriosclerosis obliterans (ASO) and its influencing factors. Methods The clinical data of patients with femoropopliteal ASO treated by ELA combined with DCB from July 2019 to March 2022 were retrospectively analyzed, including technical success rate, ankle-brachial index(ABI), primary patency rate and freedom from target lesion revascularization (TLR) rate. Cox regression was applied to analyze the risk factors affecting the decline in the rate of primary patency and freedom from TLR. Results All 82 patients were treated with ELA+DCB. The technical success was 91.5%. The post-operative ABI (0.73±0.13) was significantly higher than preoperative ABI (0.39±0.11) (t=35.26, P<0.001). The 24-month cumulative primary patency and TLR-free rates were 64.1% and 76.8%, respectively. Lesion length>15 cm (HR=2.57, P=0.047) and severe calcification (HR=3.26, P=0.021) were associated with loss of primary patency. Having diabetes (HR=5.24, P=0.010) and a single postoperative outflow tract (HR=4.18, P=0.008) were associated with a decrease in TLR-free rates. Conclusions ELA combined with DCB for femoropopliteal ASO is safe and has good intermediate efficacy. Lesion length>15 cm and severe calcification were independent risk factors for primary patency rate, and diabetes and a single postoperative outflow tract were independent risk factors for TLR-free rate.
Abstract
Objective To investigate the efficacy of excimer laser atherectomy (ELA) combined with drug-coated balloon (DCB) in the treatment of femoropopliteal arteriosclerosis obliterans (ASO) and its influencing factors. Methods The clinical data of patients with femoropopliteal ASO treated by ELA combined with DCB from July 2019 to March 2022 were retrospectively analyzed, including technical success rate, ankle-brachial index(ABI), primary patency rate and freedom from target lesion revascularization (TLR) rate. Cox regression was applied to analyze the risk factors affecting the decline in the rate of primary patency and freedom from TLR. Results All 82 patients were treated with ELA+DCB. The technical success was 91.5%. The post-operative ABI (0.73±0.13) was significantly higher than preoperative ABI (0.39±0.11) (t=35.26, P<0.001). The 24-month cumulative primary patency and TLR-free rates were 64.1% and 76.8%, respectively. Lesion length>15 cm (HR=2.57, P=0.047) and severe calcification (HR=3.26, P=0.021) were associated with loss of primary patency. Having diabetes (HR=5.24, P=0.010) and a single postoperative outflow tract (HR=4.18, P=0.008) were associated with a decrease in TLR-free rates. Conclusions ELA combined with DCB for femoropopliteal ASO is safe and has good intermediate efficacy. Lesion length>15 cm and severe calcification were independent risk factors for primary patency rate, and diabetes and a single postoperative outflow tract were independent risk factors for TLR-free rate.
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