CAJ | 학술논문

目的评价股浅动脉、近端腘动脉慢性完全闭塞性病变(CTO)腔内治疗的效果及预后.方法回顾性分析北京协和医院血管外科2009年1月1日至2012年12月31日期间,股动脉、近端腘动脉闭塞性病变患者148例(156条肢体),患者均接受腔内治疗.病变长度0.5～41.0 cm,平均(14±11) cm;按泛大西洋协作组织共识Ⅱ(TASC Ⅱ)分级划分,A级47条,B级40条,C级26条,D级43条.评估技术成功率、临床症状缓解率、围手术期保肢率及并发症发生率.Kaplan-Meier方法计算一期通畅率、二期通畅率、保肢率、生存率.Cox回归分析计算影响一期通畅率的危险因素.结果腔内治疗技术成功率98.7%,临床成功率96.2%,围手术期保肢率99.4%,局部并发症发生率4.5%,系统并发症发生率1.9%.术后3、6、12、24、36个月的一期通畅率分别为 95.1%±1.8%,80.2%±3.4%,65.6%±4.3%,60.9%±4.6%,53.7%±5.8%;二期通畅率分别为 97.9%±1.2%,94.2%±2.0%,89.6%±2.8%,81.4%±3.9%,78.0%±5.0%;保肢率分别为99.4%±0.6%,99.4%±0.6%,97.8%±1.2%,97.8%±1.2%,97.8%±1.2%;生存率分别为99.2%±0.8%,98.4%±1.1%,97.5%±1.5%,94.9%±2.3%,91.2%±4.2%.Cox回归分析发现TASC Ⅱ C、D级病变(OR=1.776,95%CI 1.013~3.116)、流出道评分(OR=1.138,95%CI 1.016~1.275 )是影响一期通畅率的危险因素.结论股浅动脉、近端腘动脉慢性完全闭塞性病变的腔内治疗安全、可靠.术后再狭窄发生率高,但通过再次干预仍可达到满意的保肢效果.TASC Ⅱ C、D级病变与流出道评分是导致再狭窄的相关危险因素.
목적 평개고천동맥、근단객동맥만성완전폐새성병변(CTO)강내치료적효과급예후.방법 회고성분석북경협화의원혈관외과2009년1월1일지2012년12월31일기간,고동맥、근단객동맥폐새성병변환자148례(156조지체),환자균접수강내치료.병변장도0.5～41.0 cm,평균(14±11) cm;안범대서양협작조직공식Ⅱ(TASC Ⅱ)분급화분,A급47조,B급40조,C급26조,D급43조.평고기술성공솔、림상증상완해솔、위수술기보지솔급병발증발생솔.Kaplan-Meier방법계산일기통창솔、이기통창솔、보지솔、생존솔.Cox회귀분석계산영향일기통창솔적위험인소.결과 강내치료기술성공솔98.7%,림상성공솔96.2%,위수술기보지솔99.4%,국부병발증발생솔4.5%,계통병발증발생솔1.9%.술후3、6、12、24、36개월적일기통창솔분별위 95.1%±1.8%,80.2%±3.4%,65.6%±4.3%,60.9%±4.6%,53.7%±5.8%;이기통창솔분별위 97.9%±1.2%,94.2%±2.0%,89.6%±2.8%,81.4%±3.9%,78.0%±5.0%;보지솔분별위99.4%±0.6%,99.4%±0.6%,97.8%±1.2%,97.8%±1.2%,97.8%±1.2%;생존솔분별위99.2%±0.8%,98.4%±1.1%,97.5%±1.5%,94.9%±2.3%,91.2%±4.2%.Cox회귀분석발현TASC Ⅱ C、D급병변(OR=1.776,95%CI 1.013~3.116)、류출도평분(OR=1.138,95%CI 1.016~1.275 )시영향일기통창솔적위험인소.결론 고천동맥、근단객동맥만성완전폐새성병변적강내치료안전、가고.술후재협착발생솔고,단통과재차간예잉가체도만의적보지효과.TASC Ⅱ C、D급병변여류출도평분시도치재협착적상관위험인소.
Objectives To evaluate the efficacy and prognosis of endoluminal treatment of superficial femoral artery and proximal popliteal artery chronic total occlusions.Methods A prospectively collected database of 148 patients (156 limbs) between January 1, 2009 and December 31, 2012 was retrospectively analysed.All the patients were treated with endoluminal interventions.The mean lesion length was (14±11) cm (0.5-41.0 cm).According to Trans-Atlantic Inter-Society Consensus Ⅱ (TASC Ⅱ), 47 lesions were type A, 40 were type B, 26 were type C and 43 were type D.Technical success rate, clinical success rate, perioperative limb salvage rate and complication rate were evaluated.Primary patency rate, secondary patency rate, limb salvage rate and survival rate were calculated with Kaplan-Meier analysis.Cox-regression analysis was used to evaluate risk factors associated with loss of primary patency.Results Technical success rate was 98.7%, clinical success rate was 96.2%, perioperative limb salvage rate was 99.4%, local complication rate was 4.5% and systemic complication rate was 1.9%.At 3, 6, 12, 24 and 36 months after surgery, the primary patency rates were 95.1%±1.8%,80.2%±3.4%, 65.6%±4.3%,60.9%±4.6% and 53.7%±5.8%, respectively.The secondary patency rates were 97.9%±1.2%,94.2%±2.0%,89.6%±2.8%,81.4%±3.9% and 78.0%±5.0%, respectively.The limb salvage rates were 99.4%±0.6%,99.4%±0.6%, 97.8%±1.2%, 97.8%±1.2%, and 97.8%±1.2%, respectively.The survival rates were 99.2%±0.8%,98.4%±1.1%,97.5%±1.5%,94.9%±2.3% and 91.2%±4.2%, respectively.TASC Ⅱ C/D lesions (OR=1.776, 95%CI 1.013~3.116) and runoff score (OR=1.138, 95%CI 1.016-1.275) were found to be associated with loss of primary patency.Conclusion Endoluminal intervention was a safe and efficacious method for treating femopopliteal artery chronic total occlusions.Satisfactory limb salvage rate can be reached despite of the high restenosis rate.TASC Ⅱ C/D lesions and runoff score were found to be risk factors associated with restenosis.