2型糖尿病患者和非2型糖尿病患者股腘动脉经皮旋磨和抽吸斑块切除术的1年随访结果

One-year outcome after percutaneous rotational and aspiration atherectomy in infrainguinal arteries in patient with and without type 2 diabetes mellitus.

作者信息

Sixt Sebastian, Scheinert Dierk, Rastan Aljoscha, Krankenberg Hans, Steinkamp Hermann, Schmidt Andrej, Sievert Horst, Minar Erich, Bosiers Marc, Peeters Patrick, Balzer Jörn O, Tübler Thilo, Wissgott Christian, Nielsen Christopher, Schwarzwälder Uwe, Zeller Thomas

机构信息

Department of Angiology, Heart-Centre Bad Krozingen, Bad Krozingen, Germany.

出版信息

Ann Vasc Surg. 2011 May;25(4):520-9. doi: 10.1016/j.avsg.2010.10.007.

DOI:10.1016/j.avsg.2010.10.007

PMID:21549922

Abstract

BACKGROUND

To compare the safety and efficacy of a rotational aspiration atherectomy system (Jetstream) for the treatment of infrainguinal arteries in diabetic versus nondiabetic patients.

METHODS

A total of 172 patients with Rutherford stage 1-5 lower limb ischemia were treated with rotational aspiration atherectomy between February 2006 and February 2007. Of these, 80 patients with type 2 diabetes mellitus (DM: 46.5%) were compared with 92 nonDM (53.5%) patients. Overall, 210 target lesions (99 DM; 111 nonDM) were treated, located in the superficial femoral (67% DM; 61% nonDM), popliteal (25% DM; 30% nonDM), and tibial (8% DM; 9% nonDM) arteries. Lesion characteristics were comparable in both groups, mean lesion length was 28.5 mm (DM) and 26.2 mm (nonDM); total occlusions were present in 29% (DM) and 32% (nonDM), and 15% (DM) and 14% (nonDM) were restenotic.

RESULTS

In the entire cohort, device success was 99% (all but two lesions). The major adverse event (MAE) rate (death, index limb amputation, myocardial infarction, target lesion revascularization [TLR] and target vessel revascularization) in DM at 30 days was 2.5% (n = 2 planned amputations) and 0% in nonDM. At 6 and 12 months, MAE in DM was seen in 13.8% (11/80) and 25% (20/80) compared with 21.7% (20/92) and 31.5% (29/92) in nonDM, respectively. TLR rate through 12 months was 20% (16/80) in DM and 28% in nonDM (26/92). Overall, 1 year restenosis rate was 38.2% based on duplex. The ankle-brachial index, mean Rutherford categories, and walking impairment questionnaire did not differ between groups at baseline and were increased significantly in both study cohorts at 12 months.

CONCLUSION

Jetstream-assisted atherectomy in infrainguinal arteries is safe and effective in DM compared with nonDM patients. In this short-lesion cohort, vessel patency in diabetics was as good as for non-DM at 1 year. TLR and MAE were higher by trend in nonDM, although planned amputations were seen only in DM. The clinical benefit was similar in both groups.

摘要

背景

比较旋转消斑血管成形术系统（Jetstream）治疗糖尿病和非糖尿病患者下肢动脉的安全性和有效性。

方法

2006年2月至2007年2月期间，共有172例卢瑟福1 - 5期下肢缺血患者接受了旋转消斑血管成形术治疗。其中，80例2型糖尿病（DM：46.5%）患者与92例非糖尿病（53.5%）患者进行比较。总体上，共治疗了210个靶病变（99个DM病变；111个非DM病变），病变位于股浅动脉（DM组67%；非DM组61%）、腘动脉（DM组25%；非DM组30%）和胫动脉（DM组8%；非DM组9%）。两组病变特征具有可比性，平均病变长度DM组为28.5 mm，非DM组为26.2 mm；完全闭塞病变分别占29%（DM组）和32%（非DM组），再狭窄病变分别占15%（DM组）和14%（非DM组）。

结果

在整个队列中，器械成功率为99%（除两个病变外）。DM组30天时的主要不良事件（MAE）发生率（死亡、靶肢体截肢、心肌梗死、靶病变血管重建[TLR]和靶血管血管重建）为2.5%（n = 2例计划截肢），非DM组为0%。在6个月和12个月时，DM组MAE发生率分别为13.8%（11/80）和25%（20/80），非DM组分别为21.7%（20/92）和31.5%（29/92）。至12个月时，DM组TLR发生率为20%（16/80），非DM组为28%（26/92）。总体而言，可以通过双功超声检查得出1年再狭窄率为38.2%。两组患者在基线时的踝肱指数、平均卢瑟福分级和步行障碍问卷评分无差异，且在12个月时两个研究队列均显著改善。