Kavala Ali Aycan, Kuserli Yusuf, Turkyilmaz Gulsum, Yesiltas Mehmet Ali, Turkyilmaz Saygin
Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Ann Vasc Surg. 2023 Mar;90:162-171. doi: 10.1016/j.avsg.2022.10.007. Epub 2022 Oct 28.
The objective of the study was to compare drug-coated balloon (DCB) angioplasty alone and directional atherectomy (DA) combined with DCB angioplasty in patients with lower extremity peripheral arterial disease (LE-PAD).
Subjects treated with DCB angioplasty alone (group A) and DA combined with DCB angioplasty (group B) were enrolled in the study. A retrospective chart review was performed between the 4 years. Subjects with severe and occluded LE-PAD were included. Demographic data, atherosclerotic vessel properties, and procedural data were recorded. For both groups, success rates (technical, procedural, and clinical) were presented.
In total, 226 patients were evaluated. For baseline characteristics, only tobacco use and hyperlipidemia were higher in group B (P = 0.001 and P = 0.010, respectively). For the ankle-brachial index, no significant difference existed at the first, third, sixth, 12th or 24th month follow-ups. No significant difference existed for the Rutherford class at the first, third, sixth, or 12th months according to the groups. A significant difference was found at 24-month Rutherford levels. The incidence of severe claudication in group A was significantly higher than that in group B (13 [12.4%] for group A and 3 [2.8%] for group B, P = 0.035). The stenosis rate after predilatation in group B was significantly higher than that in group A (54.56 ± 5.36 for group A and 59.20 ± 6.21 for group B, P = 0.012). The distribution of full patency in the 12th month in group B was significantly higher than that in group A. The rate of 70-100% stenosis in the 12th month was significantly higher in group A than in group B. According to the groups, the distribution of the patients who were lost to follow-up and died during the follow-up and secondary results, primary patency rates, and 2-year disease-free survival rates were also similar.
Atherectomy combined with DCB is superior for the long-term treatment of LE-PAD.
本研究的目的是比较单纯药物涂层球囊（DCB）血管成形术与定向斑块旋切术（DA）联合DCB血管成形术治疗下肢外周动脉疾病（LE-PAD）患者的效果。
纳入单纯接受DCB血管成形术治疗的患者（A组）和接受DA联合DCB血管成形术治疗的患者（B组）。对4年间的病历进行回顾性分析。纳入患有严重闭塞性LE-PAD的患者。记录人口统计学数据、动脉粥样硬化血管特性和手术数据。呈现两组的成功率（技术成功率、手术成功率和临床成功率）。
共评估了226例患者。就基线特征而言，仅B组的吸烟率和高脂血症发生率更高（分别为P = 0.001和P = 0.010）。在第1个月､第3个月､第6个月､第12个月或第24个月的随访中，踝肱指数无显著差异。根据分组，在第1个月､第3个月､第6个月或第12个月时，Rutherford分级无显著差异。在24个月时的Rutherford分级水平存在显著差异。A组严重跛行的发生率显著高于B组（A组为13例[12.4%]，B组为3例[2.8%]，P = 0.035）。B组预扩张后的狭窄率显著高于A组（A组为54.56±5.36，B组为59.20±6.21，P = 0.012）。B组在第12个月时完全通畅的分布显著高于A组。A组在第12个月时70%-100%狭窄的发生率显著高于B组。根据分组，随访期间失访和死亡患者的分布以及次要结果、原发性通畅率和2年无病生存率也相似。
斑块旋切术联合DCB在LE-PAD的长期治疗中更具优势。
