Objective: To examine the effective and safe outcomes of drug-coated balloon (DCB) angioplasty for the treatment of femoropopliteal long lesions in mid-term and long-term follow-up. Methods: The clinical data of 114 patients with symptomatic (Rutherford 2 to 6) femoropopliteal long lesions who underwent angioplasty with DCB between June 2016 and May 2021 at Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital were retrospectively analyzed. A total of 75 males and 39 females were enrolled, aged (71.9±8.4)years (range: 49 to 89 years). Among 138 lesions in 114 patients, there were 111 de nove lesions (80.4%, 111/138). Total occlusions were recanalized in 116 limbs (84.1%, 116/138). The lesion length was (280.9±78.7)mm (range: 150 to 520 mm). DCB angioplasty combined with debulking devices was used in 59 lesions (42.8%, 59/138).The bail-out stent implantation was performed in 27 limbs (19.6%, 27/138). The Kaplan-Meier method was used to evaluate cumulative primary patency rate, freedom from the clinically driven target lesion revascularization (CD-TLR) rate and accumulate survival rate. Univariate and multivariate analyses with Cox proportional hazards models were performed to determine the significant prognostic factors for primary patency. Results: DCB angioplasty was completed in 114 patients. The technical success rate was 98.2%(112/114). The mean follow-up time was 18 months (range: 3 to 54 months).The results showed that primary patency rates at 12, 24 and 36 months postoperatively were 87.5%, 75.2% and 55.1%, respectively. Freedom from CD-TLR rate at 12, 24 and 36 months postoperatively were 92.4%, 81.8% and 68.7%, respectively. Accumulate survival rate at 12, 24 and 36 months postoperatively were 96.2%, 94.0% and 80.2%. Multivariate Cox's regression analyses showed that chronic limb-threatening ischemia(CLTI) (HR=2.629, 95%CI:1.519 to 4.547, P<0.01) and hyperlipidemia (HR=2.228, 95%CI: 1.004 to 4.948, P=0.026) were independent prognosis factors for primary patency in DCB treatment of femoropopliteal long lesions. Conclusions: DCB provided favorable outcomes for the treatment of femoropopliteal long lesions. CLTI and hyperlipidemia are independent prognosis factors for restenosis after DCB angioplasty.
目的： 探讨药物涂层球囊（DCB）治疗股腘动脉长段病变的中远期结果及其预后因素。 方法： 回顾性分析2016年6月至2021年5月于清华大学附属北京清华长庚医院血管外科接受DCB治疗的114例股腘动脉长段病变（卢瑟福分级2~6级）患者的临床资料。男性75例，女性39例，年龄（71.9±8.4）岁（范围：49~89岁）。114例患者共有138处股腘动脉长段病变，其中初次病变111处（80.4%，111/138），闭塞病变116处（84.1%，116/138），病变长度（280.9±78.7）mm（范围：150~520 mm）；联合减容治疗59处（42.8%，59/138），植入补救支架27处（19.6%，27/138）。通过Kaplan-Meier生存曲线分别计算患者的累积初始通畅率、免于临床驱动的靶病变再次干预率、累积总体生存率。通过Cox比例风险模型进行单因素及多因素分析，筛选影响股腘动脉长段病变通畅率的相关因素。 结果： 114例患者均完成DCB治疗，技术成功率为98.2%（112/114）。术后平均随访18个月（范围：3~54个月）。术后12、24和36个月累积初始通畅率分别为87.5%、75.2%和55.1%，免于临床驱动的靶病变再次干预率分别为92.4%、81.8%和68.7%，累积总体生存率分别为96.2%、94.0%和80.2%。单因素及多因素分析结果显示，慢性肢体威胁性缺血（HR=2.629，95%CI：1.519~4.547，P<0.01）、合并高脂血症（HR=2.228，95%CI：1.004~4.948，P=0.026）是影响股腘动脉长段病变DCB术后通畅率的独立预后因素。 结论： DCB治疗股腘动脉长段病变的中远期效果满意，慢性肢体威胁性缺血、合并高脂血症是影响股腘动脉长段病变DCB治疗后通畅率的独立预后因素。.