Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011.
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011.
J Vasc Interv Radiol. 2021 Apr;32(4):593-601. doi: 10.1016/j.jvir.2020.12.024. Epub 2021 Jan 30.
To assess the 12-month safety and effectiveness of paclitaxel drug-coated balloon (DCB) for the treatment of patients with isolated chronic occlusions in popliteal arteries and evaluate the risk factors of lesion reocclusion.
From January 2018 to December 2019, DCB angioplasty was performed in 54 limbs with isolated chronic popliteal artery occlusion of 48 patients (32 men) with a mean age of 71.5 ± 12.1 (range, 50-97) years, mean occlusive length of 6.3 ± 3.0 (range, 1-15) cm, and mean preoperative ankle-brachial index (ABI) of 0.42 ± 0.12 (range, 0.19-0.58). A total of 18.5% (10/54) of lesions were long-segment occlusions involving the entire popliteal artery from P1 to P3. Twenty seven of 54 limbs presented with critical limb ischemia (CLI) with a mean ABI of 0.33 ± 0.10 (range, 0.19-0.51). The primary endpoint was primary patency rate at 12 months. The secondary endpoints included technical success rate, 1-year secondary patency rate, limb salvage rate, and improvement in clinical symptoms. Univariate Cox regression analysis was used to determine the predictors of lesion reocclusion.
The technical success rate was 85.2% (46/54), and bailout stenting was performed in 14.8% (8/54) of lesions. The 12-month primary and secondary patency rates by the Kaplan-Meier estimate were 72.6% and 88.3%, respectively. Two thirds of the reocclusions occurred within 6 months after intervention. No 30-day mortality was observed. The limb salvage rate was 100% during a mean follow-up period of 13 months, and all minor amputations occurred in the limbs presented with CLI. The mean ABI increased from 0.42 before the procedure to 0.73 after the procedure. Patients younger than 60 years and the lesions exhibiting long-segment occlusions present as trending risk factors for lesion reocclusion.
Paclitaxel DCB angioplasty is safe and effective in managing isolated chronic occlusion of popliteal arteries. Younger patients and long-segment occlusions of the popliteal artery are associated with a relatively higher reocclusion rate after the procedure.
评估紫杉醇药物涂层球囊（DCB）治疗孤立性慢性腘动脉闭塞患者的 12 个月安全性和有效性，并评估病变再闭塞的危险因素。
2018 年 1 月至 2019 年 12 月，对 48 例（32 例男性）患者的 54 条孤立性慢性腘动脉闭塞的病变行 DCB 血管成形术治疗，患者平均年龄为 71.5±12.1（50-97）岁，平均闭塞长度为 6.3±3.0（1-15）cm，平均术前踝肱指数（ABI）为 0.42±0.12（0.19-0.58）。18.5%（10/54）的病变为长段闭塞，累及 P1 至 P3 整个腘动脉。54 条肢体中有 27 条存在严重肢体缺血（CLI），平均 ABI 为 0.33±0.10（0.19-0.51）。主要终点为 12 个月时的一期通畅率。次要终点包括技术成功率、1 年二期通畅率、肢体保肢率和临床症状改善。采用单因素 Cox 回归分析确定病变再闭塞的预测因素。
技术成功率为 85.2%（46/54），14.8%（8/54）的病变需要挽救性支架置入。Kaplan-Meier 估计的 12 个月一期和二期通畅率分别为 72.6%和 88.3%。三分之二的再闭塞发生在介入治疗后 6 个月内。无 30 天死亡率。平均随访 13 个月时，肢体保肢率为 100%，所有小截肢均发生在 CLI 肢体。ABI 从术前的 0.42 增加到术后的 0.73。年龄小于 60 岁和腘动脉长段闭塞的患者是病变再闭塞的潜在危险因素。
紫杉醇药物涂层球囊血管成形术治疗孤立性慢性腘动脉闭塞安全有效。年轻患者和腘动脉长段闭塞与术后再闭塞率较高相关。
