药物涂层球囊治疗老年患者下肢动脉硬化闭塞症长段病变的疗效观察

Efficacy of drug-coated balloon in long-term lesions of lower extremity arteriosclerosis obliterans in elderly patients

摘要:

目的 观察药物涂层球囊(DCB)治疗老年下肢动脉硬化闭塞症(ASO)长段闭塞或狭窄的疗效。方法 选取2018年8月至2019年8月内蒙古自治区人民医院血管外科接受介入治疗的老年下肢ASO患者21例,共32条患肢(病变长度≥10 cm)。每条患肢在选择合适的手术入路后使用普通球囊预扩张,然后选取符合靶病变的DCB或金属裸支架(BMS)植入,其中接受DCB治疗的有12条患肢(DCB组),接受BMS治疗的有20条患肢(BMS组)。观察术后6、12个月患肢主要症状的改善情况(皮温、肤色、患肢疼痛和患者的自我感觉,后两者为患者口述)、骑行距离及卢瑟福血管外科学Rutherford分级,以及12个月后患肢的血运重建率。采用SPSS 22.0软件进行统计分析。根据数据类型,组间比较采用t检验或χ² 检验。结果 32条患肢均获得技术成功,且随访率为100%。随访期间患者均未进行再次手术治疗,未发生与手术或器械相关的出血、死亡、截肢等不良临床事件。术后6及12个月,2组患肢主要症状改善情况、骑行距离及Rutherford分级比较差异无统计学意义(P>0.05)。与DCB组比较,BMS组术后12个月血运重建率显著降低,差异有统计学意义[35.0%(7/20)和58.3%(7/12)；P<0.05]。结论 DCB在治疗老年下肢ASO长段病变中的近、中期疗效不劣于BMS,前者血运重建率更低。

Abstract:

Objective To observe efficacy of drug-coated balloon (DCB) in the treatment of long-term occlusion or stenosis of lower limb arteriosclerosis obliterans (ASO) in the elderly patients. Methods A total of 21 elderly patients (32 limbs of lower limb ASO ≥10 cm) were selected from Department of Vascular Surgery of Inner Mongolia People′s Hospital, who received interventional therapy form August 2018 to August 2019. After an appropriate surgical approach was decided, each limb was pre-expanded with a common balloon, and depending on the target lesion, DCB (n=12) or bare metal stent (BMS; n=20) was implanted. At 6 and 12 months after intervention, the patients were assessed for the alleviation in the main symptoms (skin temperature, skin color, and oral report of pain in the affected limb and the patients′ self-feeling), riding distance, and Rutherford classification. The rate of blood reconstruction of the affected limb was observed at 12 months after intervention. SPSS statistics 22.0 was used for data analysis. Depending on the data type, t-test or χ² test was used for the comparison between groups. Results The intervention in all affected limbs was successful with a follow-up rate of 100%. During the follow-up period, no reoperation was performed, and no bleeding, death, amputation and other adverse clinical events occurred. There was no significant difference in the alleviation of main symptoms, riding distance and Rutherford grade between the two groups (P>0.05 for all). The revascularization rate of BMS group was significantly lower than that of DCB group [35.0%(7/20) vs 58.3%(7/12); P＜0.05)]. Conclusion DCB is as effective as BMS in the treatment of ASO in the elderly in the near and medium term, the former having a lower revascularization rate.