Clinical Application And Curative Effect Analysis Of Endovascular Treatment For Restenosis Of Lower Extremity Artery Stent

Objective:To explore the short-term curative effect of different endovenous treatment methods in lower extremity arterial stent restenosis,analyze their safety and effectiveness,and summarize the clinical experience.Method:The project was a retrospective,non-random,single-center study.The selected subjects were 17 hospitalized patients(17 limbs)treated by vascular surgery at Jinan Central Hospital of Shandong University from January 2016 to January 2018.Among them,11 were males and 6 females,with an average age of 71.82±8.85 years.The patient came to hospital for the pain of lower limbs and cooling.The color Doppler ultrasound,CT angiography or lower extremity angiography showed that the lower extremity artery stent was restricted or occluded.Treatment of blood vessel dilation,antiplatelet,lipids and anticoagulation were given during hospitalization.Different intraoperative methods were used according to individual conditions,such as Catheter-directed thrombolysis(CDT),Percutaneous mechanical thrombolytic(PMT),Percutaneous transluminal angioplasty(PTA)and Stent implantation(SI).After discharge,they were followed up once 3 months,6 months and 12 months after operation,and once every six months thereafter.We define patients with mechanical thrombolytic systems(combined or uncombined balloon dilation and stent implantation)as group A(PMT group),of which Al:Angiojet group,A2:Straub group.Patients with catheter-directed thrombolysis(combined or uncombined balloon dilation and stent implantation)were defined as group B(CDT group).Patients treated with balloon dilatation combined with or without stent implantation were defined as group C(control group).The symptoms,signs,ankle and brachial index(ABI),technical success rate,surgical complications,primary patency rate,amputation rate and mortality rate of all patients were analyzed before and after operation.Results:In 17 patients,the ISR in 16 patients(94%)occurred in superficial femoral artery.The average length of lesions was 13.81±6.32 cm.Their Tosaka typing was dominated by Type Ⅱ and Ⅲ(88%).In group A,balloon dilatation was followed up,and in group A2,a stent was implanted due to flow limiting sandwich.In group B,2 cases were successfully treated with catheter-directed thrombolysis and 3 cases were treated with balloon dilation and stent implantation.Group C had 3 cases of PTA and 3 cases of PTA and SI.Group A1 and group A2 each showed 1 case of subknee artery balloon dilation due to distal outflow tract problem,and the rest group had sufficient blood supply.All patients had 100%immediate technical success rate(17/17).The primary clearance rate was 100%and 94.4%in 3 and 6 months.The auxiliary primary clearance rate was 100%and 100%respectively.The analysis of Fontaine stage,symptom scoring system and pulsation of dorsum artery showed that the symptoms and signs of all the patients improved obviously after treatment in different groups,but there was a tendency to slow deterioration at 3 and 6 months.According to the analysis of ABI,the three groups of A,B and C showed significant improvement after treatment(P<0.05),but there was no significant difference in the therapeutic effect among them(P>0.05).For surgical complications,1 case(16.7%)of vascular dissection and 1 cases(16.7%)of hematuria in group A,1 case(20.0%)of inguinal hematoma in group B.However,there was no significant difference between the incidence of complications and the choice of surgical methods(P>0.05).In follow-up,1 case(20.0%)of stent occlusion in group B,1 case(16.7%)of stent restenosis in group C,1 case(16.7%)of death in group A and 1 case(20.0%)of high position amputation in group B.Conclusion:In-stent restenosis is a common problem after stent implantation in lower limbs.It often occurs in superficial femoral artery.The pathogenesis is complicated,the risk factors are numerous and the treatment methods are varied.The treatment of ISR with mechanical thrombolysis,catheter-directed thrombolysis,balloon dilatation combined with or without stent implantation has good short-term clinical effect.For most ISR,percutaneous mechanic thrombectomy combined with drug-coated balloon dilatation may achieve the best surgical results.