The Clinical Efficacy Of Endovascular Treatment For TASC? C Or D Femoropopliteal Arteriosclerosis

ObjectiveThe objective of this study was to analysis clinical efficacy and complications in endovascular treatment for TASC II C and D femoropopliteal lesions,discuss effectiveness and security in endovascular treatment for TASC II C and D femoropopliteal lesions.MethodsClinical data of 83 patients(90 limbs)with TASC II C and D femoropopliteal lesions from April 2012 to December 2015 in the Second Afiliated Hospital of Guangzhou Medical University were retrospectively analyzed.The patients were 49 to 93 years old,the average age was 73.9 ± 8.9 years old,the length of the lesions was 14.4 to 26.3 cm,and the average length was 19.7 ± 4.4 cm,of which 55 were men,28 were women,58 were hypertension,and 40 were diabetes.One case of uremia.The TASC II classification and Rutherford staging standard were used to score the femoropopliteal arteriosclerosis and clinical manifestations of patients.Among them,56 limbs was TASCII C and 34 limbs was TASCII D,of which 3patients could not open the occlusion segment.Statistics on simple balloon dilation,dosed balloon,stent use,number of stent implants,changes in ABI before and after surgery,symptoms of lower extremity ischemia after surgery,rate of target lesions after surgery,rate of early limb opening,rate of assisted opening,limb retention rate.The remaining patients were treated in the endovascular treatment.This paperdiscusses the factors that cause the occlusion of posterior stenosis after endovascular treatment of femoral popliteal artery.ResultsRetrospective analysis of 83 cases of femoropopliteal lesions with 90 limbs.Among them,there were 56 cases of TASC II-C type,34 cases of TASCII-D type disease,and 90 limbs were treated in the endovascular treatment,The operation failed to 3 limbs,and the technical success rate was 96.6 %.In 87 cases,simple balloon expansion in the affected limbs was 10 cases,7 cases were drug coateing balloon,and balloon expansion + metal bare stent implantation was 68 cases,including 1 case of membrane stent implantation and 1 limb of turbohawk rotation.Surgical complications include: 1 case of arterial spasm,5 cases of endometriosis and mezzanine,1 case of contrast agent spillage,2 cases of distal arterial embolization,2 cases of punctured hematoma and pseudoaneurysm,3 cases of contrast agent nephropathy,1 case of perioperative death,Total incidence rate16.6 %(15/90).The clinical improvement of all affected limbs after endovascular treatment was varied,and the ABI was increased to 0.81 ± 0.14 from 0.32 ± 0.12 before and after endovascular treatment.The difference of ABI after endovascular treatment was statistically significant(P<0.05).After endovascular treatment,the rate of endovascular treatment in 1,3,6,12,18,24 months was 98.8 %,93.1 %,88.0 %,74.6 %,59.1 %,and 43.2 %.The short term efficacy of interventional therapy for TASC II C and D femoropopliteal lesions were mainly affected by smoking,diabetes,severe limb ischemia,TASC II D(VS type C),infrapopliteal arterial outflow tract number(1,2,3),stent implantation(VS PTA).A total of 38 patients were treated with intracavity therapy and then stenosis occlusion,all of them were treated with thrombolysis,mechanical thrombus removal,simple balloon expansion,re-stent implantation,plaque rotation,and coated balloon expansion.After treatment,The rate of second phase ventilation was 74.6 % and 61.1 % in 12 months and 24 months after endovascular treatment.Single-factor analysis showed that hypertension,diabetes,fibrinogen elevation,occlusion,and deactivation of antiplatelet drugs werestatistically significant for postoperative intracavitary stenosis occlusion.The inclusion of logistics analysis of multiple factors showed that occlusion and diabetes were independent risk factors that affected postoperative recurrence.According to multiple linear regression analysis,the number of subknee arterial detachments is the clinical effect of TASCII C/D femoral popliteal artery occlusion patients.Conclusion1.Endovascular treatment is a safe and effective option for the TASC II C and D femoropopliteal lesions as it can improve the limb ischemia symptoms and limb salvage rate significantly.2.The short term efficacy of mterventional therapy for TASC II C and D femoropopliteal lesions were mainly affected by smoking,diabetes,severe limb ischemia,TASC II D(vs type C),infrapopliteal arterial outflow tract number(1,2,3),stent implantation(vs PTA).The first 5 factors could reduce the clinical efficacy,and stent implantation could improve theefficacy.The hige hazard ratio factor were male(to female),TASC II D(to C),current somking and diabetes mellitus.3.The results of this study suggested that endovascular therapy could be the preferred treatment for the patients with non-diabetic,more underlying diseases,and poor runoff artery in TASC II C and D femoropopliteal lesions.