Correlation Between Preoperative Inflammatory Markers And Restenosis After Endovascular Treatment Of Lower Extremity Arteriosclerosis Obliterans

Objective:By analyzing the relationship between preoperative inflammatory markers and restenosis(ISR)after endovascular treatment in patients with lower limb arteriosclerosis obliterans(LEASO),to explore the influencing factors of ISR,and to explore the predictive ability of preoperative inflammatory markers for ISR after LEASO endovascular treatment.Methods:According to the inclusion and exclusion criteria,496 patients with lower limb arteriosclerosis obliterans admitted to the Department of Vascular Surgery,Bethune Hospital,Shanxi Province from January 2016 to June 2021 were followed up and retrospectively analyzed,including 50 patients with ISR,as the observation group.A total of 104 patients without ISR were selected as the control group by 1:2 matching with stent length and the same surgical type,and a total of 154 LEASO patients were finally included in this study.General data,inflammation-related laboratory parameters,such as neutrophil lymphocyte ratio(NLR),monocyte lymphocyte ratio(MLR),platelet lymphocyte ratio(PLR),and C-reactive protein(CRP),were collected from patients,as well as other laboratory parameters such as blood lipid levels,liver and kidney function,homocysteine(Hcy),and blood glucose.Statistical analysis was performed using SPSS26.0 software.Indicators with statistically significant differences in univariate analysis were used as independent variables,and whether ISR occurred after LEASO surgery in LEASO patients was used as dependent variable.Binary logistic regression was included to analyze the independent risk factors for ISR after LEASO surgery,and receiver operating characteristic(ROC)curves were plotted to evaluate the predictive ability of the model for ISR after LEASO endovascular treatment,and P < 0.05 was considered statistically significant.Results:A total of 154 patients were included,including 50 in the ISR group and 104 in the non-ISR group.Patients in both ISR and non-ISR groups underwent PTA combined with stenting,and the procedural success rate was 100% in all patients.Univariate analysis showed significant differences in BMI(23.7 ± 3.2 kg/m2 vs 22.6 ± 2.4 kg/m2,P =0.046),NLR(4.5 ± 2.8 vs 3.2 ± 2.9,P < 0.001),MLR(0.8 ± 0.6 vs 0.4 ± 0.8,P= 0.003),CRP(12.9 ± 3.1 mg/L vs 4.4 ± 9.7 mg/L,P < 0.001),Hcy(19.6 ± 8.5μmol/L vs 15.8 ± 10.9 μmol/L,P = 0.030),TG(1.4 ± 0.6 mmol/L vs 1.8 ± 0.9mmol/L,P < 0.001),and blood glucose(5.6 ± 1.4 mmol/L vs 6.5 ± 2.3 mmol/L,P =0.002)between the two groups(P < 0.05).Multivariate logistic regression analysis was performed with the presence or absence of ISR as the dependent variable and BMI,NLR,MLR,CRP,Hcy,TG,and blood glucose that were significant in univariate analysis as independent variables(original continuous variables),and the results showed that BMI,NLR,CRP,and TG were all independent risk factors leading to the development of ISR(P < 0.05).Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive ability of the model for ISR after endovascular LEASO treatment.Among the independent risk factors,CRP had the highest accuracy in predicting ISR,with an area under the curve of 0.949 [95% CI:(0.912,0.986)];followed by NLR,with an area under the curve of 0.811 [95% CI:(0.726,0.896)];BMI [AUC = 0.615,95% CI(0.524,0.706)]and TG [AUC = 0.654,95% CI(0.563,0.746)] had some predictive value for postoperative ISR..Conclusion:Preoperative inflammatory markers NLR and CRP levels were independent risk factors for ISR after endovascular treatment in LEASO patients,and NLR > 3.97 and CRP > 6.2 mg/L had a high predictive value for ISR after endovascular treatment in LEASO patients.Through the analysis of preoperative inflammatory markers(NLR,CRP),the high-risk group of LEASO patients who developed ISR after surgery was selected,so as to strengthen the follow-up of such patients to obtain a better prognosis.In addition,this study showed that BMI and TG levels were also independent risk factors for ISR after endovascular treatment in LEASO patients,suggesting that the importance of lipid-lowering and strengthening lower limb functional exercise should be emphasized for LEASO patients after endovascular treatment.