Experience sharing of ultrasound<b>-</b>guided endovascular treatment for femoropopliteal arteriosclerosis obliteran: clinical analysis of 112 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CUI Fengqiang ,  YUAN Shifang , CHEN Jianghao , YAN Changjiao , WANG Hui , SHI Wenlong , ZHANG Dai

Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital of Air Force Military Medical University, Xi’an 710032, P. R. China;

Corresponding author：

YUAN Shifang, Email: shifangy@fmmu.edu.cn

Keywords：

arteriosclerosis obliteran; ultrasound-guided; endovascular treatment; Rutherford grade; ankle-brachial index

DOI：

10.7507/1007-9424.202305058

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Objective To analyze the safety and effectiveness of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran (ASO). Methods The clinical data of patients with femoropopliteal ASO were collected and analyzed. The patients were treated by ultrasound-guided endovascular intervention in the Xijing Hospital of Air Force Military Medical University, from March 2015 to June 2021. The endovascular intervention methods included the arterial balloon dilation (ABD) alone, stent implantation (SI), Rotarex mechanical thrombus removal (Abbreviationas: Rotarex), and thrombolytic catheter implantation (CDT), etc. Results All 112 patients (121 affected extremities) who met the research criteria were collected. Among them, there were 13, 68, and 40 affected extremities by the Rutherford classification of 2, 3, and 4, respectively, while 41, 39, and 41 affected extremities by the Trans-Atlantic Inter-SocietyConsensus Ⅱ classification of A, B, and C, respectively. Among 121 affected extremities, 61 underwent the ABD alone, 27 underwent ABD plus Rotarex, 12 underwent ABD plus SI, 6 underwent ABD plus SI plus Rotarex, 3 underwent ABD plus SI plus CDT, 7 underwent ABD plus CDT plus Rotarex, and 5 underwent ABD plus CDT. The ultrasound-guided endovascular treatments were completed successfully in 118 affected extremities (the success rate was 97.5%), and 3 affected extremities were not completely completed by ultrasound guidance. After operation, 5 affected extremities had pseudoaneurysm and 7 affected extremities had hematoma at the puncture site, which were cured after conservative management. The ankle-brachial index (ABI) of the affected extremities immediately after surgery was statistically higher than that before surgery [0.89±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.36 (0.34, 0.38), paired t-test (t=–25.17), P<0.001]. After a follow-up of 12 months, one patient had a metatarsal amputation and one patient died (acute myocardial infarction). The restenosis rate and reintervention rate of the target lesions were 25.0% (30/120) and 15.0% (18/120) at 12 months postoperatively, and the late loss of diameter was (0.88±0.25) mm. The ABI was still higher than before surgery [0.78±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.25 (0.22, 0.27), paired t-test, t=–17.61, P<0.001]. Conclusion From analysis results of this data, it can be seen that, ultrasound-guided endovascular intervention is a safe and effective treatment for selective femoropopliteal ASO.

Citation： CUI Fengqiang, YUAN Shifang, CHEN Jianghao, YAN Changjiao, WANG Hui, SHI Wenlong, ZHANG Dai. Experience sharing of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran: clinical analysis of 112 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(9): 1093-1097. doi: 10.7507/1007-9424.202305058 Copy

1.	Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J, 2018, 39(9): 763-816.
2.	张恺欣, 张明, 陈军, 等. 药物涂层球囊扩张与经皮腔内球囊扩张合并支架植入术对下肢动脉硬化闭塞病变患者治疗的各项临床指标的影响. 河北医学, 2022, 28(6): 960-964.
3.	魏立春, 侯培勇, 谷涌泉. 股腘动脉钙化病变腔内治疗技术新进展. 实用医学杂志, 2021, 37(1): 115-120.
4.	Bausback Y, Willfort-Ehringer A, Sievert H, et al. Six-month results from the initial randomized study of the ranger paclitaxel-coated balloon in the femoropopliteal segment. J Endovasc Ther, 2017, 24(4): 459-467.
5.	Malik A. Prevention of contrast-induced acute kidney injury. Br J Hosp Med (Lond), 2015, 76(12): 685-689.
6.	Deek H, Newton P, Sheerin N, et al. Contrast media induced nephropathy: a literature review of the available evidence and recommendations for practice. Aust Crit Care, 2014, 27(4): 166-171.
7.	Wakabayashi M, Hanada S, Nakano H, et al. Ultrasound-guided endovascular treatment for vascular access malfunction: results in 4 896 cases. J Vasc Access, 2013, 14(3): 225-230.
8.	中国医院协会血液净化中心管理分会血液净化通路学组. 中国血液透析用血管通路专家共识. 中国血液净化, 2014, 13(8): 549-558.
9.	Ascher E, Marks NA, Hingorani AP, et al. Duplex-guided endovascular treatment for occlusive and stenotic lesions of the femoral-popliteal arterial segment: a comparative study in the first 253 cases. J Vasc Surg, 2006, 44(6): 1230-1237.
10.	戴贻权, 庄勇, 陈宏宇, 等. 彩色多普勒超声引导下腔内治疗股腘动脉硬化闭塞症. 中国介入影像与治疗学, 2016, 13(4): 226-229.
11.	张杰, 赵亮, 周静, 等. 多普勒超声引导对股浅动脉闭塞合并肾功能不全患者行腔内介入治疗6例临床分析. 心肺血管病杂志, 2013, 32(3): 343-346.
12.	廖智杰, 郭思恩. 彩色多普勒超声引导球囊扩张治疗下肢动脉硬化性闭塞症2例报道. 广西医科大学学报, 2014, 31(2): 318.
13.	吴中俭, 崔世军, 郭连瑞, 等. 超声引导介入治疗外周动脉硬化闭塞症. 中国微创外科杂志, 2022, 22(5): 425-430.
14.	陈忠, 杨耀国. 下肢动脉硬化闭塞症腔内治疗进展. 中国普外基础与临床杂志, 2018, 25(1): 3-9.
15.	单海丰, 周密, 康春博. 外周血miRNA-4463表达水平对药物涂层球囊治疗下肢闭塞性动脉硬化后复发的影响因素分析. 血管与腔内血管外科杂志, 2020, 6(6): 487-491.
16.	Tian J, Tang YD, Qiao S, et al. Two-year follow-up of a randomized multicenter study comparing a drug-coated balloon with a drug-eluting stent in native small coronary vessels: The RESTORE Small Vessel Disease China trial. Catheter Cardiovasc Interv, 2020, 95 Suppl 1: 587-597.
17.	安鹏, 尹家保, 杨浩, 等. 床旁彩色多普勒超声引导腘静脉置管溶栓疗法在下肢深静脉血栓治疗中的应用. 中国介入影像与治疗学, 2018, 15(3): 144-147.
18.	Ascher E, Gopal K, Marks N, et al. Duplex-guided endovascular repair of popliteal artery aneurysms (PAAs): a new approach to avert the use of contrast material and radiation exposure. Eur J Vasc Endovasc Surg, 2010, 39(6): 769-773.
19.	Sato DT, Robinson KD, Gregory RT, et al. Duplex directed caval filter insertion in multi-trauma and critically ill patients. Ann Vasc Surg, 1999, 13(4): 365-371.
20.	姚佐懿, 罗菲菲, 周翔宇, 等. 超声引导下经皮凝血酶注射对医源性股动脉复杂假性动脉瘤的应用研究. 重庆医学, 2017, 46(4): 450-452.

1. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J, 2018, 39(9): 763-816.
2. 张恺欣, 张明, 陈军, 等. 药物涂层球囊扩张与经皮腔内球囊扩张合并支架植入术对下肢动脉硬化闭塞病变患者治疗的各项临床指标的影响. 河北医学, 2022, 28(6): 960-964.
3. 魏立春, 侯培勇, 谷涌泉. 股腘动脉钙化病变腔内治疗技术新进展. 实用医学杂志, 2021, 37(1): 115-120.
4. Bausback Y, Willfort-Ehringer A, Sievert H, et al. Six-month results from the initial randomized study of the ranger paclitaxel-coated balloon in the femoropopliteal segment. J Endovasc Ther, 2017, 24(4): 459-467.
5. Malik A. Prevention of contrast-induced acute kidney injury. Br J Hosp Med (Lond), 2015, 76(12): 685-689.
6. Deek H, Newton P, Sheerin N, et al. Contrast media induced nephropathy: a literature review of the available evidence and recommendations for practice. Aust Crit Care, 2014, 27(4): 166-171.
7. Wakabayashi M, Hanada S, Nakano H, et al. Ultrasound-guided endovascular treatment for vascular access malfunction: results in 4 896 cases. J Vasc Access, 2013, 14(3): 225-230.
8. 中国医院协会血液净化中心管理分会血液净化通路学组. 中国血液透析用血管通路专家共识. 中国血液净化, 2014, 13(8): 549-558.
9. Ascher E, Marks NA, Hingorani AP, et al. Duplex-guided endovascular treatment for occlusive and stenotic lesions of the femoral-popliteal arterial segment: a comparative study in the first 253 cases. J Vasc Surg, 2006, 44(6): 1230-1237.
10. 戴贻权, 庄勇, 陈宏宇, 等. 彩色多普勒超声引导下腔内治疗股腘动脉硬化闭塞症. 中国介入影像与治疗学, 2016, 13(4): 226-229.
11. 张杰, 赵亮, 周静, 等. 多普勒超声引导对股浅动脉闭塞合并肾功能不全患者行腔内介入治疗6例临床分析. 心肺血管病杂志, 2013, 32(3): 343-346.
12. 廖智杰, 郭思恩. 彩色多普勒超声引导球囊扩张治疗下肢动脉硬化性闭塞症2例报道. 广西医科大学学报, 2014, 31(2): 318.
13. 吴中俭, 崔世军, 郭连瑞, 等. 超声引导介入治疗外周动脉硬化闭塞症. 中国微创外科杂志, 2022, 22(5): 425-430.
14. 陈忠, 杨耀国. 下肢动脉硬化闭塞症腔内治疗进展. 中国普外基础与临床杂志, 2018, 25(1): 3-9.
15. 单海丰, 周密, 康春博. 外周血miRNA-4463表达水平对药物涂层球囊治疗下肢闭塞性动脉硬化后复发的影响因素分析. 血管与腔内血管外科杂志, 2020, 6(6): 487-491.
16. Tian J, Tang YD, Qiao S, et al. Two-year follow-up of a randomized multicenter study comparing a drug-coated balloon with a drug-eluting stent in native small coronary vessels: The RESTORE Small Vessel Disease China trial. Catheter Cardiovasc Interv, 2020, 95 Suppl 1: 587-597.
17. 安鹏, 尹家保, 杨浩, 等. 床旁彩色多普勒超声引导腘静脉置管溶栓疗法在下肢深静脉血栓治疗中的应用. 中国介入影像与治疗学, 2018, 15(3): 144-147.
18. Ascher E, Gopal K, Marks N, et al. Duplex-guided endovascular repair of popliteal artery aneurysms (PAAs): a new approach to avert the use of contrast material and radiation exposure. Eur J Vasc Endovasc Surg, 2010, 39(6): 769-773.
19. Sato DT, Robinson KD, Gregory RT, et al. Duplex directed caval filter insertion in multi-trauma and critically ill patients. Ann Vasc Surg, 1999, 13(4): 365-371.
20. 姚佐懿, 罗菲菲, 周翔宇, 等. 超声引导下经皮凝血酶注射对医源性股动脉复杂假性动脉瘤的应用研究. 重庆医学, 2017, 46(4): 450-452.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience sharing of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran: clinical analysis of 112 cases

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