| Objective:Comparative analysis of safety and effectiveness of extravascular ultrasound(EVUS)-guided excimer laser and digital subtraction angiography(DSA)-guided guidewire catheter for chronic total occlusive lesions(CTOs)in the superficial femoral artery(SFA),an evaluation feasibility and technical advantages of ultrasound-guided excimer laser opening of superficial femoral CTOs.Method:A total of 66 patients with superficial femoral artery CTOs lesions in our department from November2020 to November 2021 were analyzed.Among them,31 cases were operated by excimer laser guided by ultrasound,the average age was 65.5 ±12.9 years,20 cases were male(64.5%),and the lesion length was17(5)cm.Among them,35 cases were operated with DSA-guided guidewire catheter,the average age was72.1±8.9 years,23 cases were male(65.7%),and the lesion length was 15(5)cm.After successful opening,the diameter 2～6mm balloon was used for post-dilatation,if residual stenosis was greater than 30% or flow-limiting dissection,the salvage stent implantation was given.Retrograde recanalization(through popliteal artery,tibiofibular trunk artery)was performed in patients with antegrade crossing failure.The success rate of operation was compared between the two groups,The intraoperative complications and the incidence of severe adverse events(SAE)1 month after operation were recorded.The improvement of ABI and Rutherford were recorded after 6 months of follow-up.The free of clinical-driven target lesion revascularization(CD-TLR),free amputation rate and patency rate were compared between two groups at6 months after procedure.Measurement data two groups of samples t-test or nonparametric test(Mann-Whitney U test),counting data two groups of samples chi-square test,Kaplan-Meier curve analysis follow-up patency rate.Results:The success rates of ultrasound-guided excimer laser and DSA-guided guidewire catheter group were100% and 91.4%(P=0.282).The initial success rate and second-stage success rate of the two groups were(80.6 vs.57.1%,P=0.041)and(19.4% vs.34.3%,P=0.111),and the true cavity opening rates of the two groups were 83.9% and 54.3%(P=0.010).Compared with the DSA guided guidewire catheter group,the excimer laser group had higher initial success rate and true cavity opening rate(P<0.05).The mean procedural time and radiation time of(124.4±18.4)min and 30(5)min in the ultrasound-guided excimer laser group were shorter than of(152.8±66.0)min and 55(15)min in the guidewire catheter group,and the mean amount of contrast of 45(35)ml in the ultrasound-guided excimer laser group was less than of 150(70)ml in the guidewire catheter group(P<0.05).Compared with the guidewire catheter opening group,the excimer laser group had significantly smaller stent implantation rate(16.1% vs.42.9%,P<0.05)and shorter average stent implantation length(106.0±34.4 cm vs.198.7±56.4 cm,P<0.05).Two groups of patients There was no significant difference in the incidence of surgical complications and SAE 1 month after surgery(P>0.05).The ABI at 1 week and 6 months after procedure was lower than that before procedure between both groups(0.84±0.09 and 0.72±0.08 vs.0.51±0.18;0.81±0.08 and 0.73 ±0.08 vs.0.45 ±0.20,P<0.001),but no significant difference between two groups(P>0.05).The Rutherford grade at 1 month and6 months after procedure was lower than that before procedure between both groups [0(2)and 1(2)vs.5(2);1(1)and 1(2)vs.4(1),P<0.001],but no significant difference between two groups(P>0.05).The CD-TLR and unplanned major amputation between both groups at 6 months after surgery were(90.3% vs.84.4%)and(96.8% vs.90.6%),but no significant difference between two groups(P>0.05).There was no significant difference of primary patency rate at 12-months and second patency between two groups(83.9%vs.81.3%,P=0.780;93.5% vs.87.5%,P=0.436).Conclusion:1.ELA can effectively remove plaques by excimer laser ablation,which can not only pass through the lesions but also reduce volume.Lumen preparation is of great significance for the treatment of complex femoral and popliteal artery lesions.2.Ultrasound guidance overcomes the defect of lack of direction controllable at the tip of laser catheter and provides better intraoperative imaging guidance,improves the ability of laser catheter to open superficial CTOs lesions in the true cavity of laser catheter,and optimizes the treatment process of arterial CTO lesions of lower extremities.3.Ultrasound-guided excimer laser catheterization of superficial femoral artery CTOs disease has a higher initial pass rate and true cavity opening rate,which can effectively reduce radiation exposure and the use of contrast medium,reduce the intraoperative stent implantation rate and the incidence of operation-related complications,ensure the whole process of endovascular recanalization,and improve the success rate of operation and long-term postoperative effect.To provide a safe and feasible strategy for the treatment of complex long-segment occlusive disease of lower extremity arteries. |
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