Endovascular Therapy For Type TASC?C/D Lower Extremity Atherosclerotic Occlusive Disease And The Analysis Of The Factors For The Recurrence After Interventional Therapy

ObjectiveEvaluate the feasibility and efficacy of endovascular treatment for type TASC II C/D lower extremity atherosclerotic occlusive disease,and to investigate the risk factors after undergoing operation.MethodsFrom January 2012 to June 2015,52 patients(59 limbs)with TASCII-C/D lower extremity arteriosclerosis obliterans in our hospital were retrospectively analyzed.20 cases were aortoiliac lesions(20 limbs,grade C in 7 and grade D in 13);32 cases were femoral popliteal lesions(39 limbs,grade C in 23 and grade D in 16).The success rate,complication rate,ABI and clinical symptoms were analyzed.Patients were followed up for 18 months to observe the patency rate and limb salvage.The factors including gender,hypertension,smoking,diabetes,hyperlipidemia,cerebrovascular disease,coronary heart disease,renal insufficiency,the increase of CRP and FIB,use of stent,chronic total occlusion and discontinuation of antiplatelet drugs were analyzed by single factor analysis.The binary logistic regression model were performed to determine the factor significantly affected the recurrence.ResultsTotal technical success rate was 93.2%.The success rate in aortoiliac lesion was 90%,2 cases failed,18 patients successed in revascularization,implanting 23 self expandable metal bare stents and 3 covered stents;The success rate in femoral popliteal artery lesions was 94.9%,37 limbs were successful opening of vascular lesion,16 underwent balloon dilatation,21 underwent stent implantation with 49 self expandable metal bare stents.2 limbs of occlusion of superficial femoral failed,and reconstructed the deep femoral artery.The complication rate was 3.8%.Perioperative mortality was 1.9%.ABI of all the patients increased from 0.30±0.13 t0 0.85±0.17(P<0.05).The clinical improvement rate was 94.9%in 58 limbs,the ABI of 2 patients with deep femoral artery reconstruction respectively increased from 0.25,0.33 to 0.39,0.58.In 58 limbs were followed up after operation,limb salvage rate was 98.2%.The limb patency rate for aortoiliac and femoral artery in 6 months?12 months?18 months were 100%?88.9%?72.2%and 91.7%?80.6%?63.7%.A total of 18 cases of patients recurred after operation,univariate analysis showed that hypertension,diabetes,increase of CRP,chronic total occlusion and discontinuation of antiplatelet drugs were statistically significant on postoperative recurrence.The multivariate analysis showed chronic total occlusion was independent risk factors of recurrence after operation.Conclusion1.Endovascular treatment of TASCII-C/D lower extremity arteriosclerosis obliterans is safety and minimally invasive,with less complications and good short-term curative effect.2.When the chronic occlusion of the superficial femoral artery could not be successfully opened,and with the lower level of the knee,the reconstruction of the deep femoral artery blood flow could improve the symptoms of lower limb ischemia and save the limbs.3.chronic total occlusion is the main influencing factors of recurrence of TASCII type C/D lower extremity arterial occlusive disease after surgery,and the blood pressure,blood glucose and the inflammatory reaction should be strictly control after endovascular treatment,as well as take antiplatelet drugs regularly.