The Appropriate Application Of Endovascular Treatment (EVT) Of The Lower Extremity Arterial Occlusive Disease (ASO)

Objective:To investigate the appropriate and normative application of endovascular treatment (EVT) of the lower extremity arterial occlusive disease (ASO).Methods:From 2012 to 2015,184 limbs in 137 patients with the lower extremity arterial occlusive disease (ASO) underwent 180 endovascular treatments in Guangdong Provincial Hospital of Traditional Chinese Medicine. We retrospectivly analysed and studied the clinical data. At the same time, we combined with the latest advances of the treatment of lower extremity arterial occlusive disease(ASO) to investigate the appropriate and normative application of endovascular treatment (EVT).Results:In this study,35.8% of the patients had a history of smoking,75.9% of the patients with hypertension,58.4% of the patients with diabetes,43.8% of the patients with hyperlipoidemia,36.5%of the patients with chronic renal insufficiency,68.6% of the patients with hyperfibrinogenemia.In this study, the patients combined with coronary heart disease accounted for33.6%, the patients combined with cerevascular disease accounted f or36.5%.184 limbs according to the lesion site classification,19(10.3%) limbs in the aortoiliac disease group,39(21.2%)limbs in the femoralpopliteal disease group,54(29.3%)limbs in the infrapopliteal disease group,72(39.1%) limbs in the multiple segment disease group. According to the classification of symptom,28(15.2%)limbs in the severe claudication(Rutherford 3)group,89(48.4%)limbs in the resting pain (Rutherford 4) group,47(25.5%)limbs in the minor tissue loss group,20(10.9%)limbs in the major tissue loss group.According to the SCAI Expert Consensus Statement for Peripheral arterial Intervention, treatment recommendation level were classified into Appropriate Care (AC), May Be Appropriate Care (MBAC) and Rarely Appropriate Care (RAC).In the aortoiliac disease group,19 endovascular treatments were Appropriate Care (AC).In the femoralpopliteal disease group,38 endovascular treatments were Appropriate Care (AC),1 endovascular treatment was May Be Appropriate Care (MBAC). In the infrapopliteal diseasegroup,33 endovascular treatments were Appropriate Care (AC),17 endovascular treatments were May Be Appropriate Care (MBAC),4 endovascular treatments were Rarely Appropriate Care (RAC).According to the general technical evaluation criteria, in the aortoiliac group the technical success rate was 100%(19/19). In the femoralpopliteal group 37 limbs were successful in 39 limbs (2 cases underwent deep femoral artery reconstruction), the technical success rate was 94.9%(37/39). In the infrapopliteal group the technical success rate was 94.4%(51/54).There were 72 limbs in the multiple segment group, which including 29 patients with ASO of lower extremities showing no patent crural artery, the technical success rate was 80.6%(58/72).According to the technical evaluation criteria of this study, TS was achieved in 80.6%(42/54)of treated limbs, whereas PS and CF were achieved in 16.7%(9/54) and 5.6%(3/54)of the limbs in the infrapopliteal group. TS was achieved in 63.9%(46/72)of treated limbs, whereas PF was achieved in 36.1%(26/72) of the limbs in the multiple segment group. The complication incidence rate was 8.9%(16/180) in this study, major complications rate was 3.3%(6/180). The perioperative mortality was 2.2%(4/180). In this study,5 patients underwent deep femoral artery reconstruction, mean follow-up period was 13.6 months(range,4-20 months). During the follow-up period, patients limb salvage successfully.Conelusion:1、 Controling risk factors of ASO and treating systemic comorbidities should continue throughout the treatment process.2、 Patient clinical symptoms, desired treatment outcome, lesion anatomy, and systemic comorbidities should be taken into consideration when making therapeutic decisions. The appropriate application of endovascular treatment of the infrapopliteal artery is the difficult point. There are limitations in the treatment decisions based only on the clinical symptoms of the patient. SCAI Expert Consensus Statement for Peripheral arterial Intervention has a good guiding values.The Lower Extremity Grading System(LEGS) score also has reference value for the treatment decisions. Jenali Tibial Runoff Classification and Intervention Protocol, Jenali Collateral Scoring System have some value for the reconstruction of the infrapopliteal artery.3、Collateral circulation has important significance in the reconstruction, when the superficial femoral artery reconstruction is difficult, the reconstruction of deep femoral artery to improve lower limb ischemia is a feasible choice.4、 Endovascular treatment of ASO with high success rate, high safety, but there are still some complications. Controling risk factors and treating systemic comorbidities before the operation, standardized operation and closely monitoring the disease variety after the operation are effective measures to prevent the complications.