| Objectives To evaluate the safety,effectiveness and difference of directional atherectomy and stent implantation in the treatment of TASC II A/B femorapopliteal arteriosclerosis obliterans,and to explore the reasonable endovascular therapy for TASC II A/B femorapopliteal arteriosclerosis obliterans.Methods A prospective cohort study was conducted in patients with TASC II A/B femorapopliteal arteriosclerosis obliterans admitted to the Department of Vascular Surgery,Nanjing Drum Tower Hospital,from November 2017 to October 2018.Patients were divided into two groups according to treatment intention: directional atherectomy(atherectomy group,Group A)and stent implantation(stent group,Group S).The general data,preoperative baseline data,perioperative data and follow-up data at 3 months and 6months were collected and analyzed combined with t test,chi square test and rank sum test to evaluate the safety,effectiveness and difference of two endovascular therapies.Results A total of 66 patients(Group A: 20)were enrolled in this study.The differences in general data and preoperative baseline data except for the surgical site between the two groups were not significant(P>0.05).In Group A and Group S,the average operation time were(143.25±86.29)minutes and(96.52±60.00)minutes,40.0%(8/20)patients were treated with Spider Fx distal embolic protection in Group A and all the protections intercepted plaque debris.In Group A and Group S,the major adverse events rate were30.0%(6/20)and 6.5%(3/46),the technical success rate were 90.0%(18/20)and 97.8%(45/46),the clinical success rate were 95.0%(19/20)and 95.7%(44/46),the average postoperative Rutherford grade were(1.70±1.03)and(1.96±1.05),the average postoperative ABI were(0.76±0.16)and(0.69±0.19),the average inpatient days were(10.00±5.69)and(8.96±2.88)days,and the average postoperative inpatient days were(4.70±5.53)and(3.15±1.28)days.In Group A,the follow-up rate was 100%(20/20)at 3months and 6 months,the primary patency rate were 95.0%(19/20)and 90.0%(18/20),the clinical-driven target vessel revascularization rate were 5.0%(1/20)and 10.0%(2/20),the limb salvage rate was 95.0%(19/20)and the survival rate was 100%(20/20),the average Rutherford grade were(1.42±0.96)and(1.44±0.92).In Group S,the follow-up rate was 95.7%(44/46)at 3 months and 6 months and 1 patient died unexpectedly,the primary patency rate were 93.2%(41/44)and 88.4%(38/43),the clinical-driven target vessel revascularization rate were 4.5%(2/44)and 11.6%(5/43),the limb salvage rate were 97.7%(43/44)and 97.7%(42/43),the survival rate were 100.0%(44/44)and 97.7%(43/44),the average Rutherford grade were(1.83±0.79)and(1.74±0.80).The differences in technical success rate,clinical success rate,postoperative Rutherford grade,postoperative ABI,inpatient days,postoperative inpatient days and follow-up data between the two groups were not significant(P>0.05),except for operation time(P=0.003)and major adverse events(P=0.030).The differences in preoperative Rutherford grade and postoperative Rutherford grade,preoperative ABI and postoperative ABI between the two groups were significant(P=0).The intergroup differences between Rutherford grade at 3months and 6 months and postoperative Rutherford grade were not significant(P>0.05).Conclusions 1.The difference of short term effectiveness between directional atherectomy and stent implantation in the treatment of TASC II A/B femorapopliteal arteriosclerosis obliterans is not significant,and both of them are effective therapies.Directional atherectomy conforms more to vessel and reduces the use of grafts.The medium-long term effectiveness need be confirmed by randomized multicenter large samples and medium-long term follow-up results.2.Compared with stent implantation,directional atherectomy takes a longer time and lacks safety,and results in more major adverse events during the operation.Surgeon should operate carefully and standardly,and use distal embolic protection properly to reduce adverse events during the operation. |
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