| ObjectiveTo compare the efficacy of drug coated balloon(DCB)and bare mental stent(BMS)in the treatment of long segment femoral popliteal artery occlusion.MethodFrom December 2016 to June 2019,73 affected limbs(all femoral popliteal artery lesions,lesion length ≥ 20 cm)were selected from patients with arteriosclerotic obliterans(ASO)of lower limbs who received interventional treatment in vascular surgery of our hospital.The patients showed severe intermittent claudication or resting pain(Rutherford grade was 2 ～ 4).All patients had no surgical treatment before hospitalization,and the diseased vessels were completely occluded;Preoperative CTA of lower extremity artery showed(lesion length ≥ 20 cm).After selecting the appropriate surgical approach,each affected limb is first subject to vascular preparation(VP),that is,ordinary balloon angioplasty(poba)is used to pre dilate for 2-3 minutes to break the plaque on the tube wall,so as to open the lumen to the greatest extent and improve the compliance of blood tube.Then,drug coated balloon(DCB)or bare metal stent(BMS)implantation meeting the target lesions were selected,in which 36 affected limbs received DCB(simple DCB or DCB combined with remedial short segment BMS implantation),and 37 affected limbs in BMS group were implanted with BMS.In DCB group,there were 32 males(88.9%)and 4 females(11.1%),with an average age of 71 years and an average lesion length of247 mm.Preoperative Rutherford grade: moderate intermittent claudication(Rutherford grade 2)in 7 cases(19%),severe intermittent claudication(Rutherford grade 3)in 12cases(33%),and ischemic resting pain(Rutherford grade 4)in 17 cases(47%).In BMS group,there were 35 males(94.6%)and 2 females(5.4%),with an average age of 71 years and an average lesion length of 297 mm.Preoperative Rutherford grade: moderate intermittent claudication(Rutherford grade 2)in 4 cases(10%),severe intermittent claudication(Rutherford grade 3)in 19 cases(51%),and ischemic resting pain(Rutherford grade 4)in 14 cases(38%).The outpatient follow-up was conducted at 1month,3 months,6 months,9 months and 12 months after operation.The vascular blood supply of the lower limbs was judged whether it was unobstructed by rechecking the vascular ultrasound or CTA of the lower limbs.The preoperative / postoperative claudication distance,ankle / brachial index,amputation rate,mortality and target lesion reconstruction rate were recorded.SPSS 22.0 software was used for statistical analysis.According to the data type,t-test or χ 2 inspection.Result73 affected limbs were technically successful without serious adverse events.The difference of preoperative / postoperative ABI was 0.54 ± 0.12 in DCB group and 0.51 ±0.09 in BMS group(P > 0.05).The difference of claudication distance before and after operation was 1465 ± 26 m in DCB group and 1390 ± 31 m in BMS group(P > 0.05).The patency rate of target lesions in DCB group was 86.1% and that in BMS group was 86.4%,with no significant difference(P > 0.05).The target lesion reconstruction rate(cd-tlr)in DCB group was lower than that in BMS group(11.1% vs 48.6%)(P < 0.05).ConclusionCompared with BMS,DCB treatment of long segment lesions of femoral artery occlusion(≥ 20cm)had no significant difference in patency rate,ankle brachial index and claudication distance 12 months after operation,but the reconstruction rate of DCB target lesions was low.The long-term effect of DCB in the treatment of long segment lesions of femoral popliteal artery needs to be further studied,but the advent of drug coated balloon provides a new treatment method for patients,reduces the utilization rate of stent in the short term,improves the quality of life of patients,and provides more possibilities for follow-up treatment.Therefore,as a new treatment method,DCB will play a more and more important role in endovascular treatment of lower extremity in the future. |
PDF Full Text Request