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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (03) : 204 -208. doi: 10.3877/cma.j.issn.1672-6448.2016.03.008

所属专题： 文献；

外周血管超声影像学

彩色多普勒超声对股腘动脉TASCⅡA、B型病变支架治疗有效性的评估研究
赵新宇1, 华扬1,†(), 高明杰1, 凌晨1, 段春1, 夏明钰1   
  1. 1. 100053　北京，首都医科大学宣武医院血管超声科
  • 收稿日期:2015-10-15 出版日期:2016-03-01
  • 通信作者: 华扬

Evaluation of stenting therapy for patients with femoro-popliteal artery TASCⅡA, B lesions by color duplex ultrasound

Xinyu Zhao1, Yang Hua1,†(), Mingjie Gao1, Chen Ling1, Chun Duan1, Mingyu Xia1   

  1. 1. Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2015-10-15 Published:2016-03-01
  • Corresponding author: Yang Hua
  • About author:
    Corresponding author: Hua Yang, Email:
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赵新宇, 华扬, 高明杰, 凌晨, 段春, 夏明钰. 彩色多普勒超声对股腘动脉TASCⅡA、B型病变支架治疗有效性的评估研究[J/OL]. 中华医学超声杂志（电子版）, 2016, 13(03): 204-208.

Xinyu Zhao, Yang Hua, Mingjie Gao, Chen Ling, Chun Duan, Mingyu Xia. Evaluation of stenting therapy for patients with femoro-popliteal artery TASCⅡA, B lesions by color duplex ultrasound[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(03): 204-208.

目的

探讨彩色多普勒超声（CDU）评估股腘动脉TASCⅡA、B型病变支架治疗的有效性、支架通畅率及再狭窄相关影响因素。

方法

回顾性纳入2012年4月至2015年4月在首都医科大学宣武医院血管外科接受股-腘动脉（femoro-popliteal artery，FPA）支架成形术治疗，并进行超声术前评估及术后规律随访的股腘动脉TASCⅡA、B型病变患者。通过CDU观察支架术后血流动力学变化特征，计算术后3、6、12、24个月的支架通畅率，分析支架术后再狭窄影响因素。

结果

本研究入组患者139例（191个支架），平均支架总长度（12.34±5.71）cm。随访时间3~24个月（中位时间12个月），术后3、6、12、24个月的支架累及通畅率分别为97.0%（130/134）、88.3%（106/120）、73.6%（78/106）、61.1%（55/90），TASCⅡB型患者各时期通畅率均低于TASCⅡA型患者（χ2=12.396，P<0.01）。Cox多因素回归分析证实，TASCⅡ分级、糖尿病、性别及术前病变类型是支架术后再狭窄的独立危险因素。

结论

股腘动脉TASCⅡA、B型病变支架治疗效果较好，CDU可用于FPA支架术后通畅性的评估；TASCⅡ分级、糖尿病、性别及术前病变类型是支架术后再狭窄的独立危险因素。

关键词: 支架, 超声检查，多普勒，彩色, 股动脉, 腘动脉
Objective

To retrospectively analyze the femoro-popliteal artery TASC Ⅱ A and B lesions stenting treatment effectiveness, patency and in-stent restenosis (ISR) related influencing factors by color duplex ultrasound (CDU).

Methods

Patients with femoro-popliteal artery TASC Ⅱ A and B lesions after stent treatment at our institution from April 2012 to April 2015 were enrolled into our study. These patients underwent preoperative evaluation and regular follow-up by CDU. Hemodynamic changes and patency was observed after stenting. Predictors for ISR were assessed using a Cox proportional hazards model.

Results

A total of 191 stents were implanted in 139 cases, cumulative median length of the stent was (12.34±5.71) cm. Median follow-up was 12 months (range 3 to 24 months). The patency at 3, 6, 12, 24 months post-procedure was 97.0% (130/134), 88.3% (106/120), 73.6% (78/106), 61.1% (55/90), respectively. TASC Ⅱ B was associated with lower patency compared with TASC Ⅱ A in each period. Cox regression analysis indicated that the TASC Ⅱ class, diabetes mellitus, gender and lesion types were significant risk factors for ISR in TASC Ⅱ A and B lesions.

Conclusions

The result was satisfying for femoro-popliteal artery TASC Ⅱ A and B lesions stenting. TASC Ⅱ class, diabetes mellitus, gender and lesion types were significant risk factors for ISR. CDU is a reliable method for monitoring patients with femoro-popliteal stenting.

Key words: Stents, Ultrasonography, Doppler, color, Femoral artery, Popliteal artery
图1~6 患者，男性，右侧股浅动脉重度狭窄支架术前、后超声检查结果。图1　右侧股浅动脉管径局限性变细，呈花彩血流信号；图2　狭窄段动脉流速明显升高，收缩期峰值流速（PSV）高达235 cm/s，舒张末期流速（EDV）50.1 cm/s，收缩与与舒张血流同向，频谱形态改变；图3　狭窄远段腘动脉流速减低，PSV4 5.3 cm/s，EDV 11.5 cm/s，呈低搏动性血流频谱改变；图4　支架术后，原狭窄段管径恢复正常（三相波），支架内血流充盈完全；图5　支架内流速PSV -75.6 cm/s，EDV ＋15.6 cm/s，频谱形态恢复正常；图6　支架远段腘动脉血流速度PSV -90.3 cm/s，EDV ＋10.6 cm/s，频谱形态恢复正常
表1 股浅动脉病变患者支架置入术前、术后3个月血管内径及血流速度比较（±s）
时间 管径（mm） PSV1（cm/s） PSV2（cm/s）
狭窄病变处 闭塞病变处
术前 0.80±0.65 358.94±106.35 0 38.04±11.62
术后3个月 3.99±1.17 131.41±81.95 139.25±97.51 69.82±20.91
检验值 Z=-28.062 Z=16.256 Z=-10.298 t=-15.855
P值 <0.01 <0.01 <0.01 <0.01
图2 股腘动脉TASCⅡA、B型病变患者各随访时间点通畅率比较
表2 股腘动脉TASCⅡA、B型病变患者支架置入术后累及通畅率比较（%，例/例）
分组 3个月 6个月 12个月 24个月
TASCⅡA组 100.0（57/57） 97.8（45/46） 92.6（38/41） 76.6（23/30）
TASCⅡB组 94.8（73/77） 82.4（61/74） 61.5（40/65） 53.3（32/60）
χ2值 12.396
P值 0.001
表3 股浅动脉支架再狭窄危险因素Cox回归分析
危险因素 B SE Wald值 df P值 HR 95%CI
TASCⅡ分级 1.137 0.475 5.738 1 0.017 3.116 1.205-10.469
糖尿病 0.064 0.020 10.333 1 0.001 1.066 1.026-1.117
性别 1.188 0.352 11.363 1 0.001 3.279 1.673-6.716
病变类型 1.024 0.390 6.886 1 0.009 2.784 1.265-6.143
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