Kim Hyeon Ju, Hwang Deokbi, Yun Woo-Sung, Huh Seung, Kim Hyung-Kee
Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea.
Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Vasc Specialist Int. 2024 Sep 30;40:34. doi: 10.5758/vsi.240071.
Atherectomy has been reintroduced for debulking calcified atheroma to enhance the efficacy of drug-coated balloons (DCBs); however, its efficacy in severe calcification and related outcomes have not been fully evaluated. This study aimed to evaluate the outcomes of atherectomy and DCB angioplasty for treating femoropopliteal occlusive disease (FPOD).
From 2014 to July 2022, 85 limbs in 76 patients with FPOD underwent atherectomy with DCB angioplasty. We evaluated the efficacy of this procedure using primary patency (PP) and clinically driven target lesion revascularization (CD-TLR)-free survival. PP was defined as the duration of uninterrupted patency without occlusion or a peak systolic velocity ratio more than 2.5 at the target lesion. Lesion calcification was evaluated according to Peripheral Arterial Calcium Scoring System, and Grade 4 was classified as severe.
Seventy-one (84%) cases were male, and 56 limbs (66%) were treated for claudication. Rotational and directional atherectomies were performed in 62 (73%) and 23 limbs, respectively. The improvement in the median ankle-brachial index was 0.36 (interquartile range, 0.25-0.48). Median follow-up duration was 19.4 months. The overall PP and CD-TLR-free survival rates were 77% and 93% at 1 year and 64% and 83% at 2 years, respectively. On multivariable analysis, female sex (adjusted hazard ratio [aHR], 3.77; 95% confidence interval (CI), 1.30-10.87, P=0.014), dialysis (aHR, 4.35; 95% CI, 1.33-13.22, P=0.015), and severe calcification (aHR, 2.42; 95% CI, 1.07-5.46, P=0.033) were independent risk factors for poor PP. Dialysis (aHR, 11.07; 95% CI, 3.72-32.92, P<0.001) and severe calcification (aHR, 3.19; 95% CI, 1.15-8.84, P=0.026) were identified as independent risk factors for CD-TLR.
Atherectomy with DCB angioplasty for FPOD did not work well in female patients, patients with lesions with severe calcification, and patients undergoing dialysis. Therefore, careful monitoring of these patients is crucial for patency loss and the requirement for revascularization. Additionally, for these patients requiring revascularization, surgical bypass may be appropriate for suitable candidates; whereas more proactive conservative management may be justified for claudicants.
再次引入斑块旋切术以去除钙化动脉粥样硬化斑块，提高药物涂层球囊（DCB）的疗效；然而，其在严重钙化中的疗效及相关结果尚未得到充分评估。本研究旨在评估斑块旋切术和DCB血管成形术治疗股腘动脉闭塞性疾病（FPOD）的结果。
2014年至2022年7月，76例FPOD患者的85条肢体接受了斑块旋切术联合DCB血管成形术。我们使用原发性通畅率（PP）和无临床驱动的靶病变血运重建（CD-TLR）生存率评估该手术的疗效。PP定义为无闭塞的通畅持续时间或靶病变处收缩期峰值流速比大于2.5。根据外周动脉钙化评分系统评估病变钙化情况，4级被归类为严重钙化。
71例（84%）为男性，56条肢体（66%）因间歇性跛行接受治疗。分别对62条（73%）和23条肢体进行了旋磨术和定向斑块旋切术。踝肱指数中位数改善了0.36（四分位间距，0.25 - 0.48）。中位随访时间为19.4个月。1年时总体PP和无CD-TLR生存率分别为77%和93%，2年时分别为64%和83%。多变量分析显示，女性（调整后风险比[aHR]，3.77；95%置信区间[CI]，1.30 - 10.87，P = 0.014）、透析（aHR，4.35；95% CI，1.33 - 13.22，P = 0.015）和严重钙化（aHR，2.42；95% CI，1.07 - 5.46，P = 0.033）是PP不良的独立危险因素。透析（aHR，11.07；95% CI，3.72 - 32.92，P < 0.001）和严重钙化（aHR，3.19；95% CI，1.15 - 8.84，P = 0.026）被确定为CD-TLR的独立危险因素。
斑块旋切术联合DCB血管成形术治疗FPOD对女性患者、严重钙化病变患者和接受透析的患者效果不佳。因此，对这些患者进行仔细监测对于通畅性丧失和血运重建需求至关重要。此外，对于这些需要血运重建的患者，手术旁路移植术可能适合合适的候选人；而对于间歇性跛行患者，更积极的保守治疗可能是合理的。
