Efficacy Analysis Of Drug-coated Balloon For Femoropopliteal In-stent Restenosis

Objective:The femoropopliteal in-stent restenosis(ISR)is the common clinical problem of vascular surgery,which is also the current therapeutic difficulty and hot spot.By analyzing the clinical datas of 31 femoropopliteal ISR patients,the research compared the clinical results of drug-coated balloon(DCB)angioplasty and plain old balloon angioplasty(POBA),and analyzed the related risk factors affecting target vessel patency rate,so that it can provide certain theoretical basis for the treatment of ISR.Method:The clinical datas of 31 patients with femoropopliteal ISR treated from January 2016 to September 2016 in the fifth affiliated hospital of Zheng Zhou university was analyzed.There were 15 patients in the drug-coated balloon group(DCB group),and 16 patients in the plain old balloon angioplasty group(POBA group).The mean follow-up time was 10 months.The target vessels were examined by conventional color doppler ultrasound and CT angiography(CTA).The results of complication,ankle brachial index(ABI),Rutherford classification,minimum lumen diameter(MLD)and late lumen loss(LLL)were recorded.And SPSS 21.0 was used to compare ABI,MLD,LLL and target vessel patency rate in the two groups.Meanwhile the related risk factors affecting target vessel patency rate were analyzed.Result:All 31 patients undregone percutaneous transluminal angioplasty successfully.The average follow-up was 10 months,without loss patients.1.Complication,ABI and changes of Rutherford class: the hematoma appeared on the puncture point in 1 patient of the DCB group,while in the POBA group,1 case had distal artery embolization,1 case with lung infection.There was no significant difference between preoperative ABI and 1 week postoperative ABI in both groups.The ABI increase of 6,10 months postoperatively in DCB group,compared with preoperative ABI,were higher than ABI increase in POBA group(both P <0.05).All the patients had reached the level of mild intermittent claudication,except 1 patient in DCB group and POBA group respectively.The changes of Rutherford class in 6 months and 10 months after operation were both not significant(both P >0.05).2.MLD changes and LLL: The MLD of before and after surgery immediately,was not statistically significant between the two groups.At 10 months after operation,MLD of DCB group was higher than POBA group(P=0.022).At 6 months after operation,there was no significant difference in MLD between the two groups(P =0.305).At 10 months after surgery,LLL in DCB group was significantly lower than the POBA group(P =0.010).3.Target vessel primary patency rate and recurrent intervention rate: During the follow-up period,no amputation or death occurred in both groups.The target vessel primary patency rate at 3,6 and 10 months after operation in DCB group and POBA group were 93.3%,86.7%,80% and 81.3%,56.3% and 43.8% respectively.Intentionality statistical analysis showed that the target vessel primary patency rate of DCB group was higher than that of POBA group(P=0.043).In the POBA group,there were 9 patients with target vessel stenosis >50%,3 patients were treated conservatively,6 patients were treated with PTA again,and the intervention rate was 37.5%.While in the DCB group,only 3 patients had target vessel stenosis >50%,1 case of conservative treatment of drugs,2 cases of intervention again,and the intervention rate was 13.3%.4,Factors affecting target vessel primary patency rate: Cox regression analysis showed that Class ? type was the risk factor for primary patency rate(RR=10.618,P=0.016),while DCB treatment was the protective factor for primary patency rate(RR=0.122,P =0.025).Conclusion:DCB is the safe and effective method to treat femoropopliteal ISR,which has better short and mid-term efficacy than POBA,and total occlusion within stent has more risks for re-stenosis.