Efficacy Of Paclitaxel Drug-coated Balloon Combined With TurboHawk Atherectomy Device And Stenting In Treatment Of Superficial Femoral Artery Occlusive Diseases

Objective : For the treatment of lower extremity arteriosclerosis obliterans,traditional surgical methods(such as artificial graft bypass)often have problems such as poor therapeutic effect,many complications and trauma.With the development of interventional techniques and surgical equipment and the efficacy has been confirmed,endovascular treatment has become the first line for the treatment of lower extremity arteriosclerosis obliterans.However,for the occlusive disease of the superficial femoral artery segment,endovascular treatment has not achieved satisfactory results,the main problem is the higher incidence of postoperative restenosis.The current theory is to replace the stent implantation with a volume-reducing surgery combined with a drugcoated balloon to inhibit intimal hyperplasia.In this 6 months of follow-up study,the efficacy of paclitaxel drug-coated balloon combined with TurboHawk atherectomy in the treatment of superficial femoral arteriosclerosis obliterans and simple stent implantation was compared.Methods:We retrospectively analyzed the clinical data of 69 patients(69 limbs)who use endovascular treatment of superficial femoral artery disease from September 2016 to June 2018 and completed follow-up.39 patients with stent implantation,30 patients with paclitaxel drug-coated balloon combined with TurboHawk atherectomy.Criteria: one or more superficial femoral artery lesions on the same side,Rutherford grade 3 to 5,with or without other diseases.All patients had significant chronic ischemia of the lower limbs,including weakness of the affected limb,intermittent claudication,paralysis,pain,weakened or disappeared pulsation of the dorsal artery,decreased skin temperature,paller or cyanosis.Patients have ankle brachial index,ultrasound,and CTA before surgery to confirm the presence of superficial femoral arteriosclerosis occlusion.Exclusion criteria:in-stent restenosis,acute thrombosis,radial artery,radial artery and sub-knee vascular disease.The efficacy of the two methods in the treatment of superficial femoral arteriosclerosis obliterans was compared by the improvement of Rutherford grade,improvement of the ankle brachial index,late lumen loss,incidence of restenosis and amputation rate at 6 months after treatment.Results:All 69 patients had successful diseased vessels.Late luminal loss at 6 months after surgery: 0.80 ± 0.39 mm in the combination group and 1.29 ± 0.52 mm in the stent group(P<0.05).The ankle brachial index of the two groups was significantly improved compared with that before surgery.The combination group was 0.84±0.12(0.47±0.14 before operation)and the stent group was 0.73±0.11(0.49±0.18 before operation).The difference between the two is statistically significant(P <0.05).For the improvement of Rutherford classification at 6 months after surgery,patients in the combination group were more pronounced than those in the stent group.But there was no statistically significant difference in comparing between amputation rate(P>0.05).No adverse events such as distal embolization,dissection,arterial perforation,and contrast material-induced nephropathy occurred during and after surgery.Conclusions : The method of paclitaxel drug-coated balloon combined with TurboHawk atherectomy for the treatment of superficial femoral arteriosclerosis occlusive disease is safe,and the recent treatment effect is significant,it is worth trying and promoting.