Analysis On The Effect Of Percutaneous Sequential PTA And PTAS On The Lower Extremity Arteriosclerosis Obliterans

Objective:This study was designed to objectively observe the effect of percutaneous sequential PTA and PTAS(PTA+Stent)on the treatment of lower limb arteriosclerosis occlusion with simple femoral popliteal arteriosclerosis obliterans.Methods:The clinical trials of the thoracic cardiovascular surgical ward of the Huaihe Hospital affiliated to Henan University from January 2016 to January 2018 of 33 patients who have been diagnosed as lower limb ASO and successfully treated by percutaneous sequential PTA or PTA+Stent surgery were selected and analyzed retrospectively according to Fontain stage as following: Fontain Ⅱb stage: moderately or severe intermittent claudication;Fontain Ⅲ stage: rest pain;Fontain Ⅳ stage: the patients with Limb ulcers and gangrene.In addition to that,the CTA and DSA showed only simple femoral popliteal arteriosclerosis obliterans,and TASCII type was A,B,C types and at least one of the three infrapopliteal arteries including Anterior tibial artery,posterior tibial artery and peroneal artery remained abundant blood supply to the plantar arch.The improved conditions of the patients and long-term unobstructed situation of the occluded artery were observed postoperatively,including intermittent claudication distance preoperatively and 2 weeks after surgery,the ABI values pre-and postoperatively measured by CDFI,and the unobstructed situation of the occluded artery at 3,6 and 12 months postoperatively using CTA or DSA.The results were analyzed by chi-square test and t-test.Results:Among the 33 patients who were successfully treated with ET(Endovascular Therapy),the ABI value of the patients before sequential PTA operation was 0.42 ± 0.09 while the value after operation was 0.87 ± 0.08(p <0.05).The ABI value of the patients before PTAS operation was 0.36 ± 0.07 while the value after operation was 0.93±0.07(p < 0.05).Furthermore,the differences of the ABI values between sequential PTA and PTAS have statistical significance(p < 0.05),indicating that ABI values after PTAS were significantly improved than that of sequential PTA.the Intermittent claudication distance(NIC distance)of the patients before sequential PTA operation was 107.89 ± 34.99 m and that value after operation was 440.84 ± 75.96 m,the Intermittent claudication distance after operation was significantly increased compared with that before operation(p <0.05).While the Intermittent claudication distance before PTAS operation was 122.36 ± 35.25 m and the Intermittent claudication distance after operation was 526.86 ± 69.94 m,suggesting that the Intermittent claudication distance after operation was significantly increased compared with that before operation(p <0.05).The differences of Intermittent claudication distance between the two groups have statistical significance(p <0.05),indicating that Intermittent claudication distance after PTAS were significantly improved than that of sequential PTA.,the vascular patency rate at 3,6 and 12 months of follow-up are 94.74%,89.47% and 84.21% for the 19 patients after sequential PTA surgery respectively,while the rate for the 14 patients after PTAS surgery are 100%,92.86% and 92.86% respectively,with no significant difference(p > 0.05).Conclusion:(1)the ABI value and Intermittent claudication distance after operation were both significantly increased compared with that before operation in the patients treated with the two kinds of surgeries,indicating that both of the two kinds of surgeries for ASO can produce good clinical results,moreover,the ABI value and Intermittent claudication distance of PTAS was significantly improved compared with that of sequential PTA.Although PTAS produce a higher artery patency rate than that of sequential PTA in 3,6,12 months postoperatively,there is no statistical significance,partly due to the small sample size involved in this trial.(2)ET has a high success rate,less complications,and satisfactory postoperative patency rate.In 2007,the traditional surgery was recommend for TASCII D type by trans-atlantic cooperation organization(Trans Atlantic system-Society Consensus),but many case analysis shows that Endovascular Therapy can achieve good treatment effect for TASCII type D patients,therefore,on the premise of conforming to the indications of endovascular treatment for lower limb atherosclerosis,ET can be used as the recommended treatment scheme.(3)previous studies were mainly based on simple PTA and PTAS are abundant,few studies on the sequential PTA and PTAS have been reported,Sequential PTA can make atherosclerotic plaques disperse relatively evenly along the intima with slightly rebound and intima damage,thus,decrease the reoccurrence of postoperative stenosis.Although the long-term patency rate of sequential PTA was lower than that of PTAS,there is no statistical significance between them.Therefore,sequential PTA has certain advantages in the long term,and it is more economically acceptable to patients.