| Objective: With the advent of an aging society,the incidence of arteriosclerosis obliterans has grown exponentially.Most of the arteriosclerosis obliterans are elderly patients,often with hypertension,diabetes,coronary heart disease,hyperlipidemia and other diseases,poor tolerance to surgery.Traditional surgery has trauma,high risk and complications and ET has the advantages of less trauma,quick recovery,and fewer complications;therefore,patients or physicians are more likely to receive minimally invasive treatment in the lumen.However,due to its special biomechanical properties(curl,extension,compression,kinking,etc.),the treatment of femoropopliteal lesions is controversial.In recent years,with the continuous development of interventional techniques,some physicians have adopted endovascular treatment for TASC II-D femoropopliteal lesions and achieved satisfactory results.The purpose of this study was to analyze the clinical data of patients with TASC II-D femoropopliteal lesions treated by the Department of Vascular Surgery in the Second Hospital of Tianjin Medical University,and to explore the therapeutic effect and safety of endovascular treatment of TASC II-D femoropopliteal lesions.Methods: This study retrospectively analyzed the clinical data of patients with TASC II-D femoropopliteal lesions who underwent endovascular interventional therapy in the Department of Vascular Surgery,Second Hospital of Tianjin Medical University from November 2014 to November 2018.A total of 49 patients(50 limbs),38 males and 11 females,aged 52~88 years,mean(71.0±7.9)years old,lesion length between 20.0~38.0cm.,average(24.5±4.1)cm.All 50 limbs received endovascular treatment.Puncture approach: 47 patients(48 limbs)were treated with retrograde puncture of the contralateral common femoral artery,and 2 patients(2 limbs)underwent retrograde puncture under the direct view of the common femoral artery.Both were applied to the technique of “turning the mountain” and placed the long sheath of the vessel to the opening of the superficial femoral artery for interventional treatment.Treatment: simple balloon dilatation for the treatment of two limbs,general balloon dilatation + stent implantation for the treatment of 36 limbs.By analyzing the technical success rate,ABI changes before and 3 days after surgery,Rutherford grading changes,perioperative complications,postoperative patency rate,second patency rate,limb salvage rate,etc.for evaluating the clinical efficacy and safety of TASC II-D femoropopliteal lesions.This study used t-test to analyze the clinical efficacy of endovascular treatment and analyzed the data by IBM SPSS 20.0 software,P <0.05 was considered statistically significant.Results: Among the 50 limbs,the two limb arteries were severely calcified,and the guide wire could not return to the distal artery through the vascular occlusion segment,resulting in a surgical failure.The technical success rate was 96%,and 48 limb diseased arteries were opened.All patients had different degrees of symptom improvement after operation.The preoperative ABI was(0.35±0.25),and the postoperative ABI was(0.84±0.20).The difference was statistically significant(t=-14.70,P<0.05).The total incidence of perioperative complications was 12%(6/50),including: local hematoma in the inguinal region,pseudoaneurysm of the puncture,acute arterial thrombosis,pneumonia,etc.,no surgery-related deaths and critical complications.The follow-up period was 3 to 24 months,with an average of 19.7 months.During the follow-up,25 limbs were found in the stent and the proximal and distal stents,and the target lesions were restenosis or occlusion.14 limbs were treated again,including suction bolt,thrombolysis,balloon expansion in the stent and stent implantation.The patency rates of follow-up at 12 months and 24 months were 62.7% and 32.4%,respectively.The patency rates of the second phase were 69.8% and 59.5%,respectively.The rate of limb salvage was 93.0% and 83.8%,respectively.Conclusion: Endovascular treatment of TASC II-D femoropopliteal occlusive disease is effective,safe and reliable,especially for elderly patients with more systemic diseases.We believe that endovascular treatment can be the treatment of choice for elderly patients with TASC II-D femoropopliteal lesions. |
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