Viabahn覆膜支架与裸支架治疗股腘动脉硬化闭塞症疗效分析
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摘要
目的分析Viabahn覆膜支架与裸支架治疗股腘动脉硬化闭塞症的临床疗效。方法回顾性分析2016-01~2017-01采用腔内手术治疗的75例(75条患肢)股腘动脉硬化闭塞症患者的临床资料。Viabahn覆膜支架治疗组患者35例,裸支架治疗组患者40例,比较两组患者血管再通情况并分析影响一期通畅率的因素。结果 75例患者(75条患肢)手术均获得成功,随访时间24个月。Viabahn支架组术后3、6、12、24个月一期通畅率分别为97. 14%、91. 43%、80. 00%、68. 57%,二期通畅率分别为100. 00%、97. 14%、91. 43%、85. 71%;裸支架组术后3、6、12、24个月一期通畅率分别为90. 00%、75. 00%、52. 50%、42. 50%,二期通畅率分别为97. 50%、92. 50%、87. 50%、80. 00%。Log-rank检验提示两组一期通畅率差异有统计学意义(χ2=5. 318,P=0. 021),二期通畅率差异无统计学意义(χ2=0. 536,P=0. 464)。吸烟、高血脂、糖尿病是影响一期通畅率的独立危险因素(P=0. 007、0. 003、0. 063)。结论 Viabahn覆膜支架相较裸支架治疗股腘动脉硬化闭塞症疗效更确切。
Objective To analyze the clinical effects of Viabahn covered stents and bare metal stents in treatment of femoral and popliteal arteriosclerosis. Methods The clinical data of 75 patients( 75 limbs) with femoral and popliteal arteriosclerosis obliterans receiving endovascular surgery from January 2016 to January 2017 were retrospectively analyzed. There were 35 patients in the Viabahn covered stents group and 40 in the bare metal stents group. The condition of vascular recanalization was compared between the two groups and the factors which affected the primary patency rate were also analyzed. Results All the patients( 75 limbs in 75 cases) were operated successfully. The follow-up time was 24 months. In the Viabahn covered stents group,the primary patency rates were97. 14%,91. 43%,80. 00% and 68. 57% 3,6,12 and 24 months after surgery,and the secondary patency rates were 100. 00%,97. 14%,91. 43% and 85. 71% respectively. In the bare metal stents group,the primary patency rates were 90. 00%,75. 00%,52. 50% and 42. 50% 3,6,12 and 24 months after surgery,and the secondary patency rates was 97. 50%,92. 50%,87. 50% and 80. 00% respectively. Log-rank test showed that there were a significant differences in the primary patency rates between the two groups( χ2= 5. 318,P = 0. 021),but there were no significant difference in the secondary patency rates( χ2= 0. 536,P = 0. 464). Smoking,hyperlipidemia and diabetes were the independent risk factors of primary patency rates( P = 0. 007,0. 003,0. 063). Conclusion Viabahn covered stent is more effective than bare metal stent in the treatment of femoral popliteal arteriosclerosis.
Objective To analyze the clinical effects of Viabahn covered stents and bare metal stents in treatment of femoral and popliteal arteriosclerosis. Methods The clinical data of 75 patients( 75 limbs) with femoral and popliteal arteriosclerosis obliterans receiving endovascular surgery from January 2016 to January 2017 were retrospectively analyzed. There were 35 patients in the Viabahn covered stents group and 40 in the bare metal stents group. The condition of vascular recanalization was compared between the two groups and the factors which affected the primary patency rate were also analyzed. Results All the patients( 75 limbs in 75 cases) were operated successfully. The follow-up time was 24 months. In the Viabahn covered stents group,the primary patency rates were97. 14%,91. 43%,80. 00% and 68. 57% 3,6,12 and 24 months after surgery,and the secondary patency rates were 100. 00%,97. 14%,91. 43% and 85. 71% respectively. In the bare metal stents group,the primary patency rates were 90. 00%,75. 00%,52. 50% and 42. 50% 3,6,12 and 24 months after surgery,and the secondary patency rates was 97. 50%,92. 50%,87. 50% and 80. 00% respectively. Log-rank test showed that there were a significant differences in the primary patency rates between the two groups( χ2= 5. 318,P = 0. 021),but there were no significant difference in the secondary patency rates( χ2= 0. 536,P = 0. 464). Smoking,hyperlipidemia and diabetes were the independent risk factors of primary patency rates( P = 0. 007,0. 003,0. 063). Conclusion Viabahn covered stent is more effective than bare metal stent in the treatment of femoral popliteal arteriosclerosis.
引文
1陈孝平,汪建平.外科学[M].第8版.北京:人民卫生出版社,2013:501-503.
2 Madassery S,Turba UC,Arslan B.Role of Stent Grafts and HelicalWoven Bare-Metal Stents in the Superficial Femoral and Popliteal Arteries[J].Tech Vasc Interv Radiol,2016,19(2):153-162.
3王洛波,王兵,王颖,等.Viabahn覆膜支架治疗下肢动脉硬化闭塞症的效果分析[J].中国普通外科杂志,2015,24(6):813-817.
4 Mohr PJ,Oyama JK,Luu JT,et al.Clinical outcomes of endovascular treatment of TASC-ⅡC and D femoropopliteal lesions with the Viabahn endoprosthesis[J].Cardiovasc Revasc Med,2015,16(8):465-468.
5吴斐,刘俊超,王洛波,等.复合技术治疗下肢动脉硬化疗效分析[J].实用医学杂志,2016,32(8):1308-1310.
6 van de Weijer MA,Kruse RR,Schamp K,et al.Morbidity of femoropopliteal bypass surgery[J].Semin Vasc Surg,2015,28(2):112-121.
7 Zeller T,Peeters P,Bosiers M,et al.Heparin-bonded stent-graft for the treatment of TASCⅡC and D femoropopliteal lesions:the Viabahn-25 cm trial[J].J Endovasc Ther,2014,21(6):765-774.
8 Davaine JM,Quérat J,Guyomarch B,et al.Incidence and the clinical impact of stent fractures after primary stenting for TASC C and Dfemoropopliteal lesions at 1 year[J].Eur J Vasc Endovasc Surg,2013,46(2):201-212.
9 Lammer J,Zeller T,Hausegger KA,et al.Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions:the randomized VIASTAR trial(Viabahn endoprosthesis with PROPATEN bioactive surface[VIA]versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease)[J].J Am Coll Cardiol,2013,62(15):1320-1327.
10 Lammer J,Zeller T,Hausegger KA,et al.Sustained benefit at 2years for covered stents versus bare-metal stents in long SFA lesions:the VIASTAR trial[J].Cardiovasc Intervent Radiol,2015,38(1):25-32.
11 Golchehr B,Kruse R,van Walraven LA,et al.Three-year outcome of the heparin-bonded Viabahn for superficial femoral artery occlusive disease[J].J Vasc Surg,2015,62(4):984-989.
12宋庆宏,李阳春,赵奇,等.VIABAHN支架治疗下肢动脉闭塞的效果分析[J].天津医药,2014,42(8):825-827.
13叶宁,张冠石.GORE VIABAHN支架及GORE VIABAHN肝素生物活性表面支架[J].中国医疗设备,2014,29(1):169.
14 Lindholt JS,Gottschalksen B,Johannesen N,et al.The Scandinavian Propaten()trial-1-year patency of PTFE vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PT-FE vascular prostheses-a randomised clinical controlled multi-centre trial[J].Eur J Vasc Endovasc Surg,2011,41(5):668-673.
15王帅,Sean X.LUO,孙思翘,等.Viabahn腔内人工血管治疗髂股动脉长段闭塞性病变的疗效评价[J].吉林大学学报(医学版),2016,42(3):577-581.
16 Al Shammeri O,Bitar F,Ghitelman J,et al.Viabahn for femoropopliteal in-stent restenosis[J].Ann Saudi Med,2012,32(6):572-582.
17纪东华,刘剑飞,张涛,等.Viabahn支架在处理股浅动脉支架内再狭窄中的初期应用经验[J].中国临床医学影像杂志,2014,25(1):40-42.
18 Shackles C,Rundback JH,Herman K,et al.Above and below knee femoropopliteal VIABAHN[J].Catheter Cardiovasc Interv,2015,85(5):859-867.
19 Johnston PC,Vartanian SM,Runge SJ,et al.Risk factors for clinical failure after stent graft treatment for femoropopliteal occlusive disease[J].J Vasc Surg,2012,56(4):998-1006.
20李志勇,周栋.Viabahn覆膜支架在复杂股浅动脉闭塞性疾病中的应用[J].中华老年多器官疾病杂志,2017,16(10):792-796.
2 Madassery S,Turba UC,Arslan B.Role of Stent Grafts and HelicalWoven Bare-Metal Stents in the Superficial Femoral and Popliteal Arteries[J].Tech Vasc Interv Radiol,2016,19(2):153-162.
3王洛波,王兵,王颖,等.Viabahn覆膜支架治疗下肢动脉硬化闭塞症的效果分析[J].中国普通外科杂志,2015,24(6):813-817.
4 Mohr PJ,Oyama JK,Luu JT,et al.Clinical outcomes of endovascular treatment of TASC-ⅡC and D femoropopliteal lesions with the Viabahn endoprosthesis[J].Cardiovasc Revasc Med,2015,16(8):465-468.
5吴斐,刘俊超,王洛波,等.复合技术治疗下肢动脉硬化疗效分析[J].实用医学杂志,2016,32(8):1308-1310.
6 van de Weijer MA,Kruse RR,Schamp K,et al.Morbidity of femoropopliteal bypass surgery[J].Semin Vasc Surg,2015,28(2):112-121.
7 Zeller T,Peeters P,Bosiers M,et al.Heparin-bonded stent-graft for the treatment of TASCⅡC and D femoropopliteal lesions:the Viabahn-25 cm trial[J].J Endovasc Ther,2014,21(6):765-774.
8 Davaine JM,Quérat J,Guyomarch B,et al.Incidence and the clinical impact of stent fractures after primary stenting for TASC C and Dfemoropopliteal lesions at 1 year[J].Eur J Vasc Endovasc Surg,2013,46(2):201-212.
9 Lammer J,Zeller T,Hausegger KA,et al.Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions:the randomized VIASTAR trial(Viabahn endoprosthesis with PROPATEN bioactive surface[VIA]versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease)[J].J Am Coll Cardiol,2013,62(15):1320-1327.
10 Lammer J,Zeller T,Hausegger KA,et al.Sustained benefit at 2years for covered stents versus bare-metal stents in long SFA lesions:the VIASTAR trial[J].Cardiovasc Intervent Radiol,2015,38(1):25-32.
11 Golchehr B,Kruse R,van Walraven LA,et al.Three-year outcome of the heparin-bonded Viabahn for superficial femoral artery occlusive disease[J].J Vasc Surg,2015,62(4):984-989.
12宋庆宏,李阳春,赵奇,等.VIABAHN支架治疗下肢动脉闭塞的效果分析[J].天津医药,2014,42(8):825-827.
13叶宁,张冠石.GORE VIABAHN支架及GORE VIABAHN肝素生物活性表面支架[J].中国医疗设备,2014,29(1):169.
14 Lindholt JS,Gottschalksen B,Johannesen N,et al.The Scandinavian Propaten()trial-1-year patency of PTFE vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PT-FE vascular prostheses-a randomised clinical controlled multi-centre trial[J].Eur J Vasc Endovasc Surg,2011,41(5):668-673.
15王帅,Sean X.LUO,孙思翘,等.Viabahn腔内人工血管治疗髂股动脉长段闭塞性病变的疗效评价[J].吉林大学学报(医学版),2016,42(3):577-581.
16 Al Shammeri O,Bitar F,Ghitelman J,et al.Viabahn for femoropopliteal in-stent restenosis[J].Ann Saudi Med,2012,32(6):572-582.
17纪东华,刘剑飞,张涛,等.Viabahn支架在处理股浅动脉支架内再狭窄中的初期应用经验[J].中国临床医学影像杂志,2014,25(1):40-42.
18 Shackles C,Rundback JH,Herman K,et al.Above and below knee femoropopliteal VIABAHN[J].Catheter Cardiovasc Interv,2015,85(5):859-867.
19 Johnston PC,Vartanian SM,Runge SJ,et al.Risk factors for clinical failure after stent graft treatment for femoropopliteal occlusive disease[J].J Vasc Surg,2012,56(4):998-1006.
20李志勇,周栋.Viabahn覆膜支架在复杂股浅动脉闭塞性疾病中的应用[J].中华老年多器官疾病杂志,2017,16(10):792-796.