Analysis Of The Related Factors Of In-stent Restenosis In The Superficial Femoral Artery Stents Of Lower Limb Arteriosclerosis Occlusion

Objective:To evaluate the incidence of stent restenosis(ISR)in patients with arteriosclerosis obliterans(ASO)after operation,to analyze the risk factors related to the occurrence of ISR.Aim to find out the factors,methods and markers to predict the occurrence of ISR,and to provide the basis for the clinical treatment and prevention of ISR.Methods:This is a retrospective study based on the Second Affiliated Hospital of Nanchang University.We conducted enrolling patients with lower extremity angiography and lower extremity angiography confirmed the occurrence of lower extremity arteriosclerosis form Jan 2015 to Jan 2018.Patients with ASO stent implantation were collected and divided into restenosis group and non restenosis group according to the results of CTA or DSA examination.Exclusion of endovascular treatment,postoperative residual stenosis rate > 30%,intraoperative drug coated balloon,postoperative amputation,death and other patients.A total of 381 patients with lower extremity arteriosclerosis obliterans were collected,and 331 patients with complete clinical data were included in the study.The general data including age,sex,smoking history,hypertension history,diabetes history,and restenosis time were recorded and collected in detail,and the blood routine,blood lipid,fibrinogen concentration and other biochemical indexes were collected to record the total stent length after stent implantation for patients with lower extremity arteriosclerosis closure.The number of stents,the number of stent implantation,stenosis degree,stenosis or occlusion length before and after operation,and during follow-up were determined to determine whether in stent restenosis existed.The results were analyzed and the restenosis rate was evaluated,and the stenosis of the stent was taken as a variable.Single factor analysis and multiple regression analysis were used to compare the gender,age,hypertension history,diabetes history,smoking history,fibrinogen concentration,blood cells,blood lipid levels,the number of stents,length etc and the correlation of stent restenosis.Results:1.There was a total of 331 patients including 280 men and 51 women.All the patients underwent lower limb artery stenting and there were 340 superficial femoral arteries.According to the CTA or lower extremity arteriography of the lower extremities,92 patients were diagnosed as ISR including 74 men and 18 women,with a total of 98 superficial femoral arteries.The rate of restenosis was about 28.82%(98/340)after stent implantation in ASO patients.The maximum age was 92 years,with a minimum age of 45 years,with an average age of(71.14 ±9.32)years.The difference between compared the ISR group and non ISR group,there showed no significant difference in the age,sex,hypertension history(P > 0.05),while showed statistically significant(P < 0.05)in the history of diabetes,smoking history and the rule of after operation.2.The difference of blood routine and biochemical indexes between the ISR group and non ISR group was compared by single factor ANOVA analysis.There was no statistical difference between the two groups on the concentration of hemoglobin count,platelet count,triglyceride,low density lipoprotein and high density lipoprotein(P > 0.05),And there were statistically significant differences between the two groups in the total cholesterol,fibrinogen concentration,and erythrocyte meter(P < 0.05).3.The difference of the number of stent implantation and the total length of the stent between the ISR group and the non ISR group was compared by single factor ANOVA analysis.And there showed statistically significant differences in the number of stent implantation and the total length of the stent between the two groups(P < 0.05).4.We analysised other risk factors by the multiple factor regression analysis.And the result shoed that the diabetes history,smoking history,fibrinogen concentration,stent implantation and total stent length were the risk factors for the stent restenosis,and the law of taking medicine after operation was the protective factor of ISR(P < 0.05).Conclusion:1.The stenosis rate of the stent was about 28.82% within 3 years after the implantation of superficial artery stent implantation in all patients with lower limb arteriosclerosis occlusion.2.The occurrence of early ISR is related to the formation of stent thrombosis.3.Diabetes,smoking and fibrinogen concentration are the risk factors for in the stent restenosis.4.The patients who taking the oral medication according to the doctor's order decrease the occurrence rate of ISR.5.To reduce the number of stents or the length of the stents,the ISR can be reduced while the stent is covered.