关键词: 下肢动脉长段闭塞；经皮腔内血管成形术；药物涂层球囊；普通球囊；预后

Abstract: Objective To investigate the effect of drug-coated balloon(DCB) percutaneous transluminal angioplasty(PTA) on clinical indicators and prognosis of patients with long-segment occlusion of lower extremity arteries.Methods A total of 91 patients with long-segment occlusion of lower extremity arteries admitted to the hospital from October 2020 to October 2022 were selected and divided into DCB group(n=46) and ordinary balloon(POB) group(n=45) according to different treatment methods.POB group underwent POB-PTA,DCB group underwent DCB-PTA.The vascular endothelial function indexes [ nitric oxide(NO),endothelin-1(ET-1),P-selectin ] were compared between the two groups before operation,6 h and 2 weeks after operation.The patients were followed up for 1 year.The primary patency rate,restenosis rate,target lesion revascularization rate,incidence of postoperative complications and the degree of target vessel stenosis,minimum lumen diameter(MLD),ankle brachial index(ABI),Rutherford vascular surgery(Rutherford) classification were measured before operation,6 months,12 months after operation were compared between the two groups.Results The serum NO levels at 6 h and 2 weeks after operation in the DCB group were(30.83±3.95) pg/ml and(33.62±4.20) pg/ml,which were higher than(26.70±3.58) pg/ml and(29.96±3.82) pg/ml in the POB group.The levels of ET-1 and P-selectin were(70.25±7.24) pg/ml,(67.29±7.05) pg/ml,(30.12±3.68) μg/L and(25.61±3.32) μg/L,which were lower than(75.98±7.63) pg/ml,(70.73±7.31) pg/ml,(37.03±3.90) μg/L and(27.29±3.50)(P< 0.05).The primary patency rate of the DCB group(82.61 %) was higher than that of the POB group(55.56 %),and the restenosis rate(10.87 %) was lower than that of the POB group(31.11 %)(P<0.05).There was no difference in the rate of target lesion revascularization between the two groups(P> 0.05).The degree of target vessel stenosis and Rutherford grade in DCB group were(18.07±5.25) %,(25.68±4.35) %,(2.05±0.64) grade and(2.24±0.81) grade at 6 months and 12 months after operation,which were lower than those in POB group (41.20±5.86) %,(57.36±5.18) %,(2.60±0.72) grade and(2.75±0.94) grade.MLD and ABI were(3.37±0.68) mm,(3.02±0.59) mm,(0.85±0.19) grade,(0.82±0.15) grade,which were higher than those in POB group(1.59±0.41) mm,(1.46±0.38) mm,(0.65±0.15) grade,(0.62±0.11) grade(P< 0.05).There was no difference in postoperative complications between the two groups(P> 0.05).Conclusion The application of DCB-PTA can significantly reduce vascular endothelial injury,improve primary patency rate,increase vascular diameter,relieve lower limb ischemia symptoms,reduce restenosis rate,and has good safety.

Key words: long-segment occlusion of lower extremity arteries；percutaneous transluminal angioplasty；drug-coated balloon；ordinary balloon；prognosis