流出道对糖尿病患者股腘动脉腔内成形术预后的影响

摘要

目的 应用北美血管外科协会(Society for Vascular Surgery,SVS)流出道评分标准,研究流出道病变评分对糖尿病合并下肢动脉硬化闭塞症患者行股腘动脉腔内成形术后一期通畅率的影响.方法 回顾性分析进行股腘动脉腔内介入治疗的糖尿病性下肢动脉硬化闭塞症患者41条患肢,记录内科疾病、股腘动脉病变、泛大西洋学会联盟(Trans-Atlantic Inter-Society Consensus,TASC)Ⅱ分级情况、介入治疗完成时的流出道SVS评分以及术后30 d合并症.随访并通过Kplan-Meier方法计算一期通畅率,应用Cox回归模型分析影响预后的危险因素.结果 22条患肢股腘动脉一期植入金属裸支架,成功进行膝下流出道血管球囊扩张.本组病例术后流出道评分及分布:1～3分3条,3.5 ～5分7条,5.5 ～7分15条,7.5 ～10分16条,术后流出道评分中位数为7分.随访时间最短1个月,最长48个月,中位随访时间12个月,随访率为95.1％.股腘动脉腔内成形术后一期通畅率在1、3、6个月,1、2、3年分别为:95.0％,92.5％,92.5％,77.4％,65.3％和45.5％.术后流出道评分的分值高低对术后一期通畅率具有显著影响(RR=1.857,P=0.003,95％ CI:1.230 ～2.806).结论 股腘动脉流出道条件差是影响其腔内成形术预后的主要危险因素,术后流出道SVS评分的分值越高,一期通畅率越低.%Objective To evaluate the implication of runoff score on the primary patency of femoropopliteal angioplasty in patients with type 2 diabetes mellitus, using the Society for Vascular Surgery ( SVS) criteria. Methods A retrospective review of a database of 37 patients with type 2 diabetes mellitus (41 legs) undergoing femoropopliteal angioplasty between 2006 January and December 2010 was made. Demographic characteristics and possible related diseases were recorded. Procedural angiograms were classified according to TASCII criteria. SVS runoff scores were determined after the completion of the intervention and the primary patency were calculated. Cox proportional hazard model was used to determine if runoff score and other factors affected the outcome. Results Thirty seven patients(41 legs) were included. Among the 41 legs, 22 underwent bare metal stent implantation. Twenty two legs underwent tibial angioplasty successfully. According to TASC II , the lesion severity scores were; TASC II A 22 legs, TASC II B 19 legs. Post-procedural runoff score; 1 ~3, 3 legs; 3. 5 ~5, 7 legs; 5.5 ~ 7, 15 legs; 7.5~ 10, 16 legs. The median runoff score was 7 ( ranged from 1 to 9. 5). Follow-up time ranged from 1 month to 48 months (median 12 months). 95. 1% patients were fully followed. Two patients were lost. The total primary patency rates at the 1, 3, 6 months and 1, 2, 3 years were 95. 0% ,92. 5% , 92. 5% ,77. 4% ,65. 3% and 45. 5% respectively. By Cox regression analysis, post-procedural runoff score according to SVS criteria affected primary patency significantly ( RR= 1.857, P = 0. 003, 95% CI- 1. 230 ~ 2. 806). Conclusion Compromised runoff negatively affected the primary patency of femoropopliteal angioplasty. High post - procedural runoff score is a main risk factor related to loss of primary patency.