Clinical Observation Of Drug-coated Balloon In The Treatment Of Lower Extremity Arterial Long Segment Lesions

Objective:Atherosclerosis obliteration of lower limbs is a common clinical problem in vascular surgery,especially in the femoral popliteal artery segment.Due to the complex and often complex vascular conditions,both occlusion and stenosis,how to treat the lesions is the current treatment difficulties and hot spots.This study through the analysis of 80 cases of femoral popliteal artery stenosis block the clinical data of patients with lesions,comparison of drug-coated balloons(drug-coated balloon,DCB)angioplasty with bare metal stents implantation therapy(bare metal stent,BMS)in lower extremity long narrow femoral popliteal artery occlusion lesions in clinical curative effect,and analyze the risk factors affecting target vascular patency rate,for lower limb of femoral popliteal arterial lesions in patients and provide certain theoretical basis for clinical treatment.Methods: 80 cases of lower limb atherosclerosis patients admitted to the department of vascular and thyroid surgery of the first affiliated hospital of China medical university from February 2017 to January 2018 were retrospectively analyzed,among which 60 cases received drug-coated balloon therapy(DCB group)and 20 cases received metal bare stent implantation therapy(BMS group).The ratio of male to female in the DCB group was: male: female =41:19,with an average age of 65.52 10.99.The ratio of male to female in the BMS group was: male: female =13:7,with an average age of 67.229.57.The clinical data of 80 patients with lower extremity femoral popliteal artery stenosis were collected.The primary unhurt rate,ankle brachialindex(ABI),Rutherford grade,amputation rate,clinical symptoms and changes in the quality of life of the two groups of patients before and after surgery were compared.Results: After preoperative risk assessment,60 patients with lower extremity femoral popliteal artery stenosis planned to receive drug coated balloon surgery,and 21 patients planned to receive stent implantation.Drug-coated balloon treatment of 58 cases treated with drug coated balloon and stent restenosis in 3 cases,1 case of using ordinary balloon art(UCB)after a period of time delay estimate expansion lesions imaging showed the degree of stenosis greater than 50%,1 case of art with a common balloon pre expansion lesions appear afterangiography showed current-limiting interlayer,after stent implantation in remedial operation,the operation have succeeded at last.Among the 21 patients to be treated with stent implantation,20 were successfully operated,and 1 patient failed to open the diseased blood vessel with guidewire,which was followed by conservative treatment.Ankle-brachial index(ABI),color ultrasound or CTA were reviewed 6 and 12 months after surgery,with a follow-up rate of 91.25%.The patency rate of DCB group was 83.33% and 75.00% at 6 and 12 months after operation.The patency rate was85.00% and 65.00% in the BMS group at 6 and 12 months after surgery.ABI,walking distance,Rutherford grade and clinical symptoms were significantly improved immediately after surgery,6 months after surgery and 12 months after surgery,compared with that before surgery.During the follow-up period of 6-12 months,there were no patients requiring further surgical intervention,and no bleeding,death,amputation and other clinical events related to surgery or instruments occurred.Conclusion:Drug balloon therapy for long segment stenosis of lower limb artery can obtain better near and middle term effect.Result: All patients included in this study required preoperative risk assessment,and ABI,vascular color and CTA examinations confirmed the presence of lesions in the outpatient setting.Among the 80 patients with lower extremity femoral popliteal artery stenosis and occlusion(lesion length >10cm),60 patients planned to receive drug-coated balloon surgery,and 21 patients planned to receive metal bare stent implantation.Receive drug-coated balloon in the treatment of patients with the treatment of 58 cases of successful use of drug-coated balloon,3 cases of patients with stent restenosis,1 case of using ordinary balloon art(UCB)delay after the preliminary period of blood vessels expanding lesions imaging showed stenosis degree is still greater than 50%,1 case of technique used in ordinary balloon pre expansion lesions appear after vascular imaging display current limiting the interlining,bare metal stents in remedy,after operation or the final was a technical success.Among the 21 patients to be treated with bare metal stent implantation,20 patients achieved technical success in the operation,and 1 patient failed to open the diseased blood vessel after repeated attempts of the guidewire,and was subsequently treated with conservative treatment in the safe return ward.Ankle-brachial index(ABI),vascular color ultrasound or CTA of the affected limb were reviewed in theoutpatient department 6 and 12 months after surgery,respectively,with a follow-up rate of 100%.The patency rates of patients in the DCB group at 6 and 12 months after surgery were 83.33% and 75.00%,respectively.The patency rate of patients in the BMS group at6 and 12 months after surgery was 85.00% and 65.00%,respectively.ABI was significantly improved immediately after surgery(generally within 1 week after surgery),6 months and 12 months after surgery,and walking distance was significantly increased compared with that before surgery.Rutherford classification,clinical symptoms and quality of life were significantly improved compared with that before surgery.During the follow-up period of 6-12 months,there were no patients requiring further surgical intervention,and no bleeding,death,amputation and other clinical events related to surgery or instruments occurred.Conclusion: Drug-coated balloon is safe and effective in the treatment of lower extremity femoral popliteal artery stenosis and occlusion.In addition,a better first-stage patency rate can be obtained,in which the short-term efficacy is not statistically different from the implantation of bare metal stents,and the second-stage patency rate of drug-coated balloon is due to bare metal stents.After statistical analysis(COX hazard factor analysis),diabetes mellitus is a risk factor for target vessel patency after surgery,and drug-coated balloon surgery is a protective factor for target vessel patency after surgery.