Comparative Study Of Directional Atherectomy And Percutaneous Transluminal Angioplasty With Stenting For The Treatment Of Femoropopliteal Arteriosclerosis Obliterans

Objective:The aim of this study was to compare the recent and medium term clinical outcomes of two different endovascular,comparative directional atherectomy and percutaneous transluminal angioplasty with stenting interventions,in the treatment of femoropopliteal arteriosclerosis obliterans.Methods:We retrospectively collect and analyze the outcomes and complications of patients underwent endovascular interventional treatment with directional atherectomy(DA group)or percutaneous transluminal angioplasty with stenting(PTAS group)in our hospital from June 2015 to September 2018.There were 102 patients with femoropopliteal arteriosclerosis obliterans,including 44 patients in the DA group and 58 patients in the PTAS group.The preoperative and postoperative ABI were compared between the two groups.The follow-up clinical symptoms,postoperative complications,vascular patency rates,target lesion revascularization rates,limb salvage rates,survival rates,etc.were compared between the two groups during follow-up at 6 months,12 months,24 months,and 36 months after surgery.The difference in the efficacy of two different endovascular interventions in the treatment of femoropopliteal arteriosclerosis obliterans was obtained from the collected data.Results:A total of 102 patients met the inclusion criteria was included in this study.Technique success was achieved in all 102 patients,and there was no death during hospitalization.The technical success rates of DA group and PTAS group were both 100%and the treatment success rate was 95.5%(42/44)or 94.8%(55/58),respectively.The surgery-related complication rate was 9.1%(4/44)or 6.9%(4/58),respectively.During hospitalization,the clinical symptoms of limb pain,intermittent claudication,and ulcer were improved to some extent.The postoperative ankle brachial indexes(ABI)were as fllows:DA group(Preoperative 0.46±0.20/postoperative 0.88 ± 0.10/improvement 0.42±0.18),PTAS group(Preoperative 0.44±0.17/postoperative 0.87±0.11/improvement 0.44±0.15).There was no significant difference between the two groups(P>0.05).The vascular patency rates of the DA group and the PTAS group were 90.9%vs 94.8%,82.5%vs 78.4%,76.7%vs 70.4%,64.3%vs 62.5%at 6 months,12 months,24 months,36 months after surgery.Target lesion revascularization rates were 4.5%vs 3.4%,15.9%vs 17.2%,22.7%vs 25.9%,29.5%vs 32.8%at different time-point during follow-up.Limb salvage rates were 100%vs 100%,100%vs 96.6%,97.7%vs 94.8%,97.7%vs 94.8%.Survival rates were 100%vs 100%,100%vs 100%,97.7%vs 98.3%,97.7%vs 96.6%.There was no significant difference in vascular patency rates,target lesion revascularization rates,limb salvage rates and survival rates between the two groups(P>0.05).Conclusions:There was no significant difference in vascular patency rates,target lesion revascularization rates,limb salvage rates and survival rates between the DA group and the PTAS group in the treatment of femoropopliteal arteriosclerosis obliterans during the three-year follow-up period.The total hospitalization cost and operation time of the DA group were higher than those of the PTAS group.Considering the absence of prosthesis,the flexibility in operation,DA is the better way of endovascular interventional therapy.