Objective: To evaluate the results of excimer laser ablation (ELA) in the treatment of lower limb atherosclerotic obliterans (ASO). Methods: From June 2019 to March 2020, patients who underwent ELA combined with drug-coated balloon (DCB) for lower limb atherosclerotic obliterans (ASO) were enrolled. Demographics, lesion characteristics, procedure-related outcomes and complications were collected and analyzed. Results: Thirty patients were enrolled, including 21 males and 9 females. The mean age was (76.5±10.5) years. The mean lesion length was (11.7±6.4) cm. A total of 41 lesions, including in-stent restenosis (ISR) in 12 (29.3%), chronic totally occlusion (CTO) at initial treatment in 24 (58.5%), and severe stenosis in 5 (12.2%) patients. Sixteen (51.6%) patients were classified as Peripheral Arterial Calcium Scoring System (PACSS) category 4. The technical success rate was 93.5%. Incidence of distal embolization and bailout stenting was 12.9% and 6.5%, respectively. The mean follow-up time was (6.6±3.0) months. Ankle-brachial index (ABI) was significantly increased from 0.43(0.32,0.55) preoperatively to 0.91(0.87,1.01) postoperatively (Z=-5.43, P<0.01) and 0.82(0.73,1.02) (Z=-3.99, P<0.01) three months after surgery. The 3-month major-amputation free survival rate was 96.7%, primary patency rate was 100%, the target lesion reintervention (TLR) rate was 0 and ulcer healing rate was 76.9%. Conclusion: Debulking of ELA is feasible and effective for both ISR and CTO at initial treatment, providing a new option for DCB preparation and reducing stent implantation.
目的： 评价准分子激光消蚀在下肢动脉硬化闭塞腔内治疗中的应用与价值。 方法： 回顾性分析2019年6月至2020年3月在复旦大学中山医院接受准分子激光消蚀联合药物涂层球囊（DCB）治疗30例下肢动脉硬化闭塞患者的（31条肢体）基本信息、病变特点、手术疗效和相关并发症。 结果： 30例患者中，男21例，女9例。年龄（76.5±10.5）岁，病变长度（11.7±6.4） cm。共41处病变，其中支架内再狭窄（ISR）12 例（29.3%）、初次治疗的慢性闭塞性病变（CTO）24例（58.5%）、重度狭窄病变5例（12.2%）。51.6%的患者钙化分级（PACSS）为4级。技术成功率为93.5%，并发远端栓塞4例（12.9%），补救性支架植入2例（6.5%）。随访（6.6±3.0）个月，踝肱指数（ABI）由术前的0.43（0.32，0.55）提升至术后即时0.91（0.87，1.01）（Z=-5.43，P<0.01）和术后3个月的0.82（0.73，1.02）（Z=-3.99，P<0.01）。3个月的无截肢生存率为96.7%，一期通畅率为100%，病变血管再干预率（TLR）为0，溃疡愈合率为76.9%。 结论： 准分子激光消蚀减容对于ISR和初次治疗的CTO均可行、有效，为DCB管腔准备、减少支架植入提供了新的选择。.