Comparison Of The Efficacy Of Stent Graft And Bare Stent In The Treatment Of Aortic Occlusion

Background: The pathogenesis of aortoiliac occlusive disease(AIOD)is similar to that of femoral popliteal arteriosclerosis,Atherosclerosis is the main cause.The main clinical manifestations of patients are iliac artery and / or infrarenal abdominal aortic occlusion or atherosclerosis narrow.At present,there are many clinical AIOD therapies,including hybrid surgery,symptomatic drug treatment,intraluminal intervention,and traditional surgical open treatment.Open treatment includes extra-anatomical vascular bypass grafting,anatomical vascular bypass grafting,and intima Exfoliation,etc,the patient's curative effect was definitely regarded as the classic method of AIOD treatment,but the patient's postoperative complications and surgical risk were higher.In recent years,intraoperative interventional procedures have been rapidly developed,with advantages such as quick postoperative recovery,less complications,and less invasive patients,which have been widely used in clinical practice.Compared with bypass surgery,traditional ankle stents are prone to diffuse endometrial hyperplasia causing restenosis of stents.Compared with ankle stents,stent grafts can effectively reduce diffuse intimal hyperplasia and increase the long-term patency rate of patients after surgery.At present,there are many studies on the application of Viabahn stent grafts in femoral popliteal artery lesions,but few studies on the use of Viabahn stent grafts in AIOD patients.Objective: In order to provide a reference for intraluminal interventional treatment of AIOD patients.Methods: A retrospective analysis of 62 patients with AIOD who were treated in our hospital from October 2015 to October 2018 was performed.The patients were 42-83 years old,with an average(64.51±8.05)years old,38 males and 24 females,TASC In the classification criteria of type ?,there were 16 cases of type B,30 cases of type C,16 cases of type D,28 cases of stage ?,23 cases of stage ?,and 11 cases of stage ? of Fontaine clinical symptoms.The underlying disease: history of cerebral infarction 7 Cases,33 cases of essential hypertension,5 cases of renal insufficiency,26 cases of hyperlipidemia,20 cases of coronary heart disease,25 cases of diabetes,and 38 cases of long-term smoking and drinking history.After admission,the patient's lower extremity blood flow map was detected,and the ankle brachial index(ABI)value was recorded.The lower extremity computer tomography angiography and color ultrasound Doppler detection were used to determine the type and location of the lesion,and clarify the target vessel occlusion or stenosis.length.According toFontaine's clinical symptom staging,the Pan Atlantic International Consensus TASC ?standard classification of disease symptoms of aortic occlusion.According to the different stents used in the treatment of patients,the patients were divided into a control group and an observation group,of which 34 cases in the control group used bare metal stents,and 28 cases in the observation group used Viabahn peritoneal stents from GORE.Observe the ankle-brachial index,Fontaine staging,target lesion revascularization(TLR)rate,first-stage patency rate,stent breakage rate,and salvage rate before and after operation at 3 days,3months,3 months,6 months,12 months and 24 months.Results: All patients were successfully operated,and no adverse events such as death,dissection,and arterial rupture occurred during the operation,and the affected limb was opened.There were 8 postoperative complications in the observation group,with a total incidence of 14.29%.Among them,2 patients had cardiac insufficiency.The patient had a good prognosis after treatment with drugs such as improved circulation and diuresis.Symptoms improved after treatment;2 cases of intermittent hemorrhage from the puncture mouth,and the elastic bandage stopped after the pressure bandage.In the control group,2patients suffered secondary cerebral infarction and recovered well after neurological treatment;4 patients developed postoperative pneumonia and received anti-infective treatment.The patient's condition improved;2 patients developed deep vein thrombosis of the lower extremity during bed rest,and a temporary filter and thrombolysis were placed The condition improved after catheter treatment;4 patients had acute thrombosis in the stent,and the situation improved after inserting the thrombolytic catheter.The intermittent claudication distances in the observation group and control group were(501.42±50.74)m and(488.96±53.26)m,and the ankle-brachial indexes were(0.95±0.14)and(0.92±0.16),respectively,which was higher than that before surgery(P<0.05);There was no significant difference in the intermittent claudication distance,ankle brachial index and postoperative complications between the two groups of patients(P>0.05).The ankle brachial index of the observation group and control group were(0.86±0.18)and(0.80±0.21)respectively in the last 3 months,and the ankle brachial index of the observation group and control group were(0.80±0.15)and(0.78±0.13),the difference was not statistically significant(P>0.05),the ankle brachial index of the observation group was(0.77±0.12)and(0.70±0.10)in the observation group at12 months after operation,and the control group was(0.69 ± 0.12)and(0.59 ±0.12),the difference was statistically significant(P<0.05);the clinical symptoms of the two groups of patients were relieved after operation,and there was no statistically significant difference between the two groups of patients in the Fontaina stage at 3 months,6 months,12 months,and 24 months(P>0.05).The TLR value of the observation group was 7.14%,lower than that of the control group of 26.47%,the difference was statistically significant(P<0.05).Thepositive rate of events in the observation group was 14.29%,4 patients still had no remission after symptomatic treatment,and then re-intracavity treatment,and the other 4 patients had mild clinical symptoms,improved after vasodilator,thrombolysis and anticoagulation treatment;control group events The positive rate was 26.47%.All 18 patients had recurrent rest pain,intermittent claudication,and intracavitary intervention again.In addition,the limb salvage rate,TASC type ? patency rate and one-stage patency rate in the observation group were all higher than those in the control group,But the difference was not statistically significant(P>0.05).Conclusion: Patients with aortic sclerosing occlusive disease treated with covered stents had a lower rate of secondary surgical intervention than bare metal stents.The clinical effects of the two stents on patients were similar,and there was no significant difference between patients in the short and medium term.