Objective: To evaluate the effect of mechanical debulking in treating arteriosclerosis occlusive disease of lower extremity. Methods: The clinical data of 52 arteriosclerosis occlusive disease of lower extremity cases treated with Rotarex mechanical debulking system from June 2017 to June 2020 at Department of Intervention Vascular Surgery,Peking University Third Hospital were retrospectively analyzed. There were 37 males and 15 females,aged(69.4±10.1)years(range:47 to 89 years).Lesion length was (21.6±12.9)cm(range:4 to 45 cm),occlusion length was (18.5±11.8)cm(range:4 to 45 cm).The lesion was located in iliac artery(IA) in 6 cases,femoral-popliteal artery(FPA) in 42 cases,and both IA and FPA in 4 cases. All the cases were treated with Rotarex mechanical debulking system. Residual stenosis more than 50% were treated with percutaneous transluminal angioplasty(PTA).Drug coated balloon was used in part of them,and stent was used only when it was necessary. The patient's operation, complications, postoperative target vessel restenosis and reoperation were collected. The paired sample t test and rank sum test was used for data comparison and the postoperative target vessel patency rate was analyzed by Kaplan-Meier survival curve. Results: All the 52 cases obtained technical success. Percutaneous transluminal angioplasty was used in all cases,and drug coated balloon were used in 11 cases. Twenty-six stents were implanted in 24 cases (2 cases implanted 2 stents).Nine stents were implanted in IA and 15 in FPA. The length of stents was (11.3±3.3)cm(range:6 to 23 cm).There were 3 procedure related complications: one of them was acute occlusion in an iliac lesion,and thrombectomy was applied urgently,and the result was good. And the other two were distal embolism. The thrombus were took out with guiding catheter. The hospital stay was (4.8±1.9)days. The ankle brachial index increased from 0.34±0.16 to 0.81±0.16 after treatment(t=-25.160,P<0.01).The Rutherford stages decreased from (M(IQR)) 3(1) to 1(1(Z=-6.825,P<0.01).The median followed up time was 19 months(range:6 to 42 months).Two cases stopped antiplatelet agents during follow-up and which result in acute thrombosis 2 weeks and 2 months later respectively. One of them was treated with percutaneous mechanical thrombectomy and the other one was not for gastrointestinal hemorrhage. Four cases died during follow-up,one case died of lung cancer,one died of abdominal infection,and the other 2 cases died of cardiovascular disease,and no amputation was observed. Target lesion restenosis(TLR) more than 50% occurred in 13 cases during the follow-up. All TLR were observed in FPA,and target lesion revascularization was taken in 3 of them. According to Kaplan-Meier survival curve analysis,half-year,1-year and 2-year cumulative patency rates of target vessels in this group was 94.2%,87.4% and 51.4%, respectively. And half-year and 1-year cumulative patency rates just in FPA cases was 92.9% and 84.3%, respectively. Conclusions: Percutaneous mechanical debulking using Rotarex catheter combining PTA can reduce the use of stents in femoral-popliteal artery. It is safe and effective in treating with arteriosclerosis obliterans of lower extremity.
目的： 探讨机械减容技术在治疗下肢动脉硬化闭塞性病变中的应用效果。 方法： 回顾性分析2017年6月至2020年6月北京大学第三医院介入血管外科应用Rotarex机械减容治疗的52例下肢动脉硬化闭塞患者的临床资料。男性37例，女性15例，年龄（69.4±10.1）岁（范围：47~89岁）。病变位于髂动脉6例，股腘动脉42例，同时累及髂动脉和股腘动脉4例。所有患者应用Rotarex机械减容，残余狭窄>50%的患者同期行腔内血管成形术，部分患者应用药物涂层球囊，必要时植入支架。收集患者手术情况、并发症情况、术后靶血管再狭窄、再次手术情况等。数据比较采用配对样本t检验和秩和检验，并应用Kaplan-Meier生存曲线分析术后靶血管通畅率。 结果： 52例患者均成功行血运重建，技术成功率100%。所有患者行动脉腔内血管成形术，11例应用药物涂层球囊扩张；24例患者植入支架共26枚（2例植入2枚支架），其中9例为髂动脉支架，15例为股腘动脉支架，支架长度为（11.3±3.3）cm（范围：6~23 cm）。术中发生远端栓塞2例，均以大腔导管抽吸方法取出栓子。1例髂动脉病变患者术后发生靶病变急性闭塞，急诊行股动脉切开取栓术，术后恢复良好。患者住院时间（4.8±1.9）d（范围：2~9 d），出院时踝肱指数为0.81±0.16，较术前的0.34±0.16明显改善（t=-25.160，P<0.01），卢瑟福分级为［M（IQR）］1（1），较术前的3（1）明显降低（Z=-6.825，P<0.01）。中位随访时间19个月（范围：6~42个月）。随访期间，2例患者因停用抗血小板药物，分别于术后2周和2个月时发现靶血管急性血栓形成，其中1例因静息痛明显再次行血运重建，另1例因消化道出血，不能行抗凝治疗，未再次手术；4例患者死亡，死亡原因为腹腔感染1例，肺癌1例，冠心病2例；13例患者超声提示靶血管病变再狭窄>50%，均位于股腘动脉，其中3例再次行腔内治疗。本组患者术后半年、1年和2年的靶血管累积通畅率分别为94.2%、87.4%和51.4%，股腘动脉病变术后半年和1年的靶血管累积通畅率分别为92.9%和84.3%。 结论： 对于下肢动脉硬化闭塞性病变，采用Rotarex机械减容安全有效，与动脉腔内血管成形术联合应用可减少股腘动脉支架的应用。.