准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症的短期疗效_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

祖力凯尔·艾尼瓦 , 杨建平 , 唐加热克 ,  管圣

1. ;

Corresponding author：

管圣, Email: Jyh610@sina.cn

Keywords：

准分子激光消蚀; 药物涂层球囊; 下肢动脉硬化闭塞症; 临床疗效

DOI：

10.7507/1007-9424.202308068

Video：

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目的评估准分子激光消蚀术（excimer laser ablation，ELA）联合药物涂层球囊（drug-coated balloon，DCB）治疗下肢动脉硬化闭塞症的疗效及安全性。方法回顾性收集2021年9月至2022年4月期间新疆维吾尔自治区人民医院血管外科收治且采用ELA联合DCB治疗的下肢动脉硬化闭塞症患者的临床病理资料，观察手术成功率，术后第3天、第3、6、12个月时的踝肱指数、一期通畅率和保趾（肢）率。结果本研究共收集到40例患者，均为单下肢病变，男30例、女10例，年龄（71.9±10.9）岁。40例患者（40条肢体）手术成功率为100%，均未出现严重的术中并发症。术后第3天、第3、6、12个月时的踝肱指数分别为0.87±0.09、0.82±0.12、0.78±0.10、0.76±0.15，较术前（0.34±0.13）均有明显提高［均数差（95%可信区间）分别为 0.011（–0.549，–0.502）、0.013（–0.502，–0.447）、0.017（–0.473，–0.404）、0.016（–0.454，–0.385），t值分别为–46.70、–34.94、–25.55、–24.86，P值分别为<0.001、<0.001、0.035、0.048］。术后第3天、第3、6、12个月时的一期通畅率分别为100%（40/40）、97.5%（39/40）、90.0%（36/40）和82.5%（33/40），保肢（趾）率分别为95.0%（38/40）、92.5%（37/40）、92.5%（37/40）和87.5%（35/40）。结论从本组有限病例分析的结果提示，ELA联合DCB治疗下肢动脉硬化闭塞症具有较好的安全性和良好的近期疗效。

Citation： 祖力凯尔·艾尼瓦, 杨建平, 唐加热克, 管圣. 准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症的短期疗效. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(1): 85-88. doi: 10.7507/1007-9424.202308068 Copy

1.	Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ, 2018, 27(4): 427-432.
2.	Dake MD, Ansel GM, Jaff MR, et al. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv, 2011, 4(5): 495-504.
3.	Jiang X, Ju S, Chen B, et al. Safety and effectiveness of excimer laser ablation combined with drug-coated balloon for atherosclerotic obliterans in the lower extremity. J Endovasc Ther, 2023, 30(5): 721-729.
4.	Stival LR, Figueiredo MN, Santhiago MR. Presbyopic excimer laser ablation: a review. J Refract Surg, 2018, 34(10): 698-710.
5.	Jongsma H, Bekken JA, de Vries JP, et al. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty in patients with femoropopliteal arterial occlusive disease. J Vasc Surg, 2016, 64(5): 1503-1514.
6.	蒋小浪, 董智慧, 符伟国. 准分子激光消蚀在下肢动脉硬化闭塞症治疗中的应用及前景. 中华外科杂志, 2022, 60(12): 1041-1044.
7.	刁永鹏, 谭树平, 兰勇, 等. 准分子激光斑块消蚀联合药物涂层球囊处理下肢动脉硬化闭塞症. 中华普通外科杂志, 2019, 34(8): 663-666.
8.	乔冠宇, 蒋小浪, 陈斌, 等. 血管内超声在准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症中的应用价值. 中华外科杂志, 2023, 61(2): 150-155.
9.	Alfonso F, Rivero F, Cortese B. Excimer laser prior to drug-coated balloon treatment of in-stent restenosis. Int J Cardiol, 2022, 348: 47-49.
10.	Shammas NW, Shammas GA, Arikat L, et al. Five-year freedom from target-lesion revascularization using excimer laser ablation therapy in the treatment of in-stent restenosis of femoropopliteal arteries. J Invasive Cardiol, 2017, 29(6): 207-208.
11.	Dippel EJ, Makam P, Kovach R, et al. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv, 2015, 8(1 Pt A): 92-101.
12.	李杨, 黄莹, 郭连瑞, 等. 准分子激光消蚀联合药物涂层球囊治疗股腘动脉支架内再狭窄的临床疗效. 中华老年心脑血管病杂志, 2019, 21(9): 934-938.
13.	Paulino Geisel P, Pantuso Monteiro D, de Oliveira Nascimento I, et al. Evaluation of functional capacity and muscle metabolism in individuals with peripheral arterial disease with and without diabetes. J Vasc Surg, 2022, 75(2): 671-679.
14.	Catrina SB, Zheng X. Disturbed hypoxic responses as a pathogenic mechanism of diabetic foot ulcers. Diabetes Metab Res Rev, 2016, 32 Suppl 1: 179-185.
15.	Peeters P, Keirse K, Verbist J, et al. Other endovascular methods of treating the diabetic foot. J Cardiovasc Surg (Torino), 2009, 50(3): 313-321.
16.	唐加热克, 张传阳, 杨建平, 等. 准分子激光销蚀术治疗糖尿病足膝下动脉病变的临床疗效分析. 中国医师杂志, 2022, 24(12): 1776-1779.
17.	周思远, 蒋小浪, 鞠帅, 等. 准分子激光消蚀治疗糖尿病足膝下动脉病变效果分析. 中华外科杂志, 2022, 60(6): 599-605.

1. Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ, 2018, 27(4): 427-432.
2. Dake MD, Ansel GM, Jaff MR, et al. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv, 2011, 4(5): 495-504.
3. Jiang X, Ju S, Chen B, et al. Safety and effectiveness of excimer laser ablation combined with drug-coated balloon for atherosclerotic obliterans in the lower extremity. J Endovasc Ther, 2023, 30(5): 721-729.
4. Stival LR, Figueiredo MN, Santhiago MR. Presbyopic excimer laser ablation: a review. J Refract Surg, 2018, 34(10): 698-710.
5. Jongsma H, Bekken JA, de Vries JP, et al. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty in patients with femoropopliteal arterial occlusive disease. J Vasc Surg, 2016, 64(5): 1503-1514.
6. 蒋小浪, 董智慧, 符伟国. 准分子激光消蚀在下肢动脉硬化闭塞症治疗中的应用及前景. 中华外科杂志, 2022, 60(12): 1041-1044.
7. 刁永鹏, 谭树平, 兰勇, 等. 准分子激光斑块消蚀联合药物涂层球囊处理下肢动脉硬化闭塞症. 中华普通外科杂志, 2019, 34(8): 663-666.
8. 乔冠宇, 蒋小浪, 陈斌, 等. 血管内超声在准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症中的应用价值. 中华外科杂志, 2023, 61(2): 150-155.
9. Alfonso F, Rivero F, Cortese B. Excimer laser prior to drug-coated balloon treatment of in-stent restenosis. Int J Cardiol, 2022, 348: 47-49.
10. Shammas NW, Shammas GA, Arikat L, et al. Five-year freedom from target-lesion revascularization using excimer laser ablation therapy in the treatment of in-stent restenosis of femoropopliteal arteries. J Invasive Cardiol, 2017, 29(6): 207-208.
11. Dippel EJ, Makam P, Kovach R, et al. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv, 2015, 8(1 Pt A): 92-101.
12. 李杨, 黄莹, 郭连瑞, 等. 准分子激光消蚀联合药物涂层球囊治疗股腘动脉支架内再狭窄的临床疗效. 中华老年心脑血管病杂志, 2019, 21(9): 934-938.
13. Paulino Geisel P, Pantuso Monteiro D, de Oliveira Nascimento I, et al. Evaluation of functional capacity and muscle metabolism in individuals with peripheral arterial disease with and without diabetes. J Vasc Surg, 2022, 75(2): 671-679.
14. Catrina SB, Zheng X. Disturbed hypoxic responses as a pathogenic mechanism of diabetic foot ulcers. Diabetes Metab Res Rev, 2016, 32 Suppl 1: 179-185.
15. Peeters P, Keirse K, Verbist J, et al. Other endovascular methods of treating the diabetic foot. J Cardiovasc Surg (Torino), 2009, 50(3): 313-321.
16. 唐加热克, 张传阳, 杨建平, 等. 准分子激光销蚀术治疗糖尿病足膝下动脉病变的临床疗效分析. 中国医师杂志, 2022, 24(12): 1776-1779.
17. 周思远, 蒋小浪, 鞠帅, 等. 准分子激光消蚀治疗糖尿病足膝下动脉病变效果分析. 中华外科杂志, 2022, 60(6): 599-605.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞症的短期疗效

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