紫杉醇包被球囊治疗膝下危及肢体的外周动脉疾病的临床疗效

IF 2.4 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Charlott Fuß, Hans Krankenberg, Pawel Aftanski, P Christian Schulze, Marcus Thieme
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引用次数: 0

摘要

背景:髌下病变占外周动脉疾病(PAD)病例的三分之一;然而,其血管内治疗资料不足。尽管紫杉醇包覆药物包覆球囊(DCBs)可减少股腘动脉再狭窄和再次干预的需要,但其在膝下血管(BTK)中的有效性尚不确定。本研究评估了紫杉醇包被dcb在BTK血管中的实际有效性和安全性。患者和方法:这项回顾性单中心研究纳入了2017年8月至2022年3月期间连续接受紫杉醇涂层Luminor™DCB治疗的BTK动脉患者。随访时间延长至60个月。数据来源于档案、电话访谈和医生询问。结果:79例患者(男性65.5%;平均年龄74.9±9.2岁),接受84次干预,114例dcb。病变总长度为102.1±80.3 mm,治疗后病变长度为117.2±75.5 mm。术前Rutherford评分中位数为5[四分位间距(IQR), 5-5;n = 80)。干预后踝肱指数(ABI, 0.8±0.4-1.0±0.2,P= 0.002)和趾肱指数(TBI, 0.3±0.3-0.6±0.2,P= 0.039)均显著改善。伤口、缺血和足部感染评分成分的中位数从介入前评估到介入后评估均有所下降:伤口评分从1 (IQR, 1-2)降至1 (0-1);缺血,从1 (IQR, 0-2)到0 (0-1);足部感染从1 (IQR, 0-2)到0(0-1)。Kaplan-Meier分析显示5年内25例主要肢体不良事件,17例再干预,15例主要心脏不良事件,8例主要截肢事件。男性无再干预生存率低于女性(P= 0.036)。糖尿病状态或肾功能无显著差异。3年死亡率为46.4%。结论:本研究强调了在现实世界患者中应用apitaxel包被dcb的临床益处。ABI和TBI的改善反映了缺血的缓解。伤口愈合趋势显示缺血和感染在3天内减少,但需要更长时间的随访。高死亡率强调了合并症和多学科护理需求的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical benefits of paclitaxel-coated balloons in the treatment of infrapopliteal limb-threatening peripheral artery disease.

Background: Infrapopliteal lesions account for one-third of peripheral artery disease (PAD) cases; however, its endovascular treatment data are insufficient. Although paclitaxel-coated drug-coated-balloons (DCBs) reduce restenosis and the need for re-interventions in femoropopliteal arteries, their effectiveness in below-the-knee (BTK) vessels is uncertain. This study evaluated the real-world effectiveness and safety of paclitaxel-coated DCBs in BTK vessels. Patients and methods: This retrospective single-centre study included consecutive patients treated with paclitaxel-coated Luminor™ DCB in BTK arteries between August 2017 and March 2022. The follow-up extended to 60 months. Data were retrieved from archives, phone interviews and physician inquiries. Results: Seventy-nine patients (65.5% male; mean age 74.9±9.2 years) underwent 84 interventions with 114 DCBs. The overall and treated lesion lengths averaged 102.1±80.3 and 117.2±75.5 mm, respectively. The median preoperative Rutherford score was 5 [interquartile range (IQR), 5-5; n=80]. The ankle-brachial index (ABI, 0.8±0.4-1.0±0.2, P=.002) and toe-brachial index (TBI, 0.3±0.3-0.6±0.2, P=.039) significantly improved post-intervention. The wound, ischaemia and foot infection score components showed median value reductions from the pre- to the postinterventional assessment: wound, from 1 (IQR, 1-2) to 1 (0-1); ischaemia, from 1 (IQR, 0-2) to 0 (0-1); and foot infection, from 1 (IQR, 0-2) to 0 (0-1). Kaplan-Meier analysis revealed 25 major adverse limb events, 17 re-interventions, 15 major adverse cardiac events, and 8 major amputation events over 5 years. Re-intervention-free survival was lower in men than in women (P=.036). Diabetic status or renal function was not significantly different. The 3-year mortality was 46.4%. Conclusions: This study highlights the clinical benefit of infrapopliteal paclitaxel-coated DCBs in real-world patients. ABI and TBI improvements reflect ischaemia relief. Wound-healing trends suggest reduced ischaemia and infection within 3 days, but requires longer follow-up. High mortality rates emphasise the effect of comorbidities and multidisciplinary care requirements.

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来源期刊
CiteScore
3.90
自引率
11.10%
发文量
61
审稿时长
1 months
期刊介绍: Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology. The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation. Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.
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