Zeller Thomas, Sixt Sebastian, Schwarzwälder Uwe, Schwarz Thomas, Frank Ulrich, Bürgelin Karlheinz, Pochert Volker, Müller Christian, Noory Elias, Krankenberg Hans, Hauswald Kirsten, Neumann Franz-Josef, Rastan Aljoscha
Department of Angiology, Heart Center Bad Krozingen, Germany.
J Endovasc Ther. 2007 Apr;14(2):232-40. doi: 10.1177/152660280701400216.
To report the 12- and 24-month results after directional atherectomy (DA) of below-the-knee (BTK) arterial lesions with the SilverHawk device.
Forty-nine BTK lesions in 36 patients (58% men; mean age 70+/-11 years) with peripheral occlusive disease of the lower limbs were treated with DA; 19 (53%) of the limbs were classified with Rutherford-Becker 4 or 5 ischemia. Target lesions were in the popliteal artery (n = 6, 12%), tibioperoneal trunk (n = 25, 51%), peroneal artery (n = 10, 20%), anterior tibial artery (n = 5, 10%), and posterior tibial artery (n = 3, 6%). Nine (18%) lesions were located in a stent. Twelve lesions extended to 2 artery segments. The average degree of diameter stenosis was 89%+/-10% (range 70%-100%); there were 11 (22%) occlusions. The mean lesion length was 48+/-28 mm.
Sixteen (33%) lesions were treated after predilation; 33 (67%) lesions were treated with primary DA. All but 1 (2%) lesion could be treated with DA. In 19 (39%) lesions, additional balloon angioplasty was performed, and 2 (4%) lesions required stent implantation as a result of dissection. The mean stenosis diameter after DA was 12%+/-18% (range 0%-100%). After additional therapy, the mean stenosis diameter was 8%+/-9% (range 0%-100%). A residual stenosis </ or 30% was achieved in 48 (98%) lesions. The mean ankle-brachial index significantly increased from 0.48+/-0.26 to 0.81+/-0.32 (p<0.05) before discharge and remained improved during follow-up. Primary and secondary patency rates were 67% and 91% after 1 year and 60% and 80% after 24 months. The 12- and 24-month cumulative event-free survival rates (primary patency) by Kaplan-Meier analysis were 58%+/-8% and 46%+/-9%; at the same time intervals, the cumulative survival rates (secondary patency) were 88%+/-6% and 73%+/-9%, respectively.
报告使用SilverHawk装置对膝下（BTK）动脉病变进行定向旋切术（DA）后12个月和24个月的结果。
对36例（男性占58%；平均年龄70±11岁）下肢周围闭塞性疾病患者的49处BTK病变进行DA治疗；其中19例（53%）肢体为Rutherford-Becker 4级或5级缺血。靶病变位于腘动脉（n = 6，12%）、胫腓干（n = 25，51%）、腓动脉（n = 10，20%）、胫前动脉（n = 5，10%）和胫后动脉（n = 3，6%）。9处（18%）病变位于支架内。12处病变累及2个动脉节段。平均直径狭窄程度为89%±10%（范围70%-100%）；有11处（22%）闭塞。平均病变长度为48±28 mm。
16处（33%）病变在预扩张后进行治疗；33处（67%）病变进行了初次DA治疗。除1处（2%）病变外，其余所有病变均可通过DA治疗。19处（39%）病变进行了额外的球囊血管成形术，2处（4%）病变因夹层而需要植入支架。DA后平均狭窄直径为12%±18%（范围0%-100%）。经过额外治疗后，平均狭窄直径为8%±9%（范围0%-100%）。48处（98%）病变实现了残余狭窄≤30%。出院前平均踝肱指数从0.48±0.26显著提高到0.81±0.32（p<0.05），并在随访期间保持改善。1年后的初次和二次通畅率分别为67%和91%，24个月后分别为60%和80%。通过Kaplan-Meier分析，12个月和24个月的累积无事件生存率（初次通畅）分别为58%±8%和46%±9%；在相同时间间隔，累积生存率（二次通畅）分别为88%±6%和73%±9%。
