Efficacy Analysis Of Excimer Laser And Drug-coated Balloon In The Treatment Of In-stent Restenosis In Lower Limb Atherosclerosis Obliterans

Objective:To investigate the short-term clinical effect of the treatment of patients with superficial femoral artery stenosis in the treatment of lower extremity arteriosclerosis occlusive disease with excimer laser ablation combined with drug-coated balloon.To provide a reference for the choice of intraluminal treatment options for restenosis of superficial femoral artery in stent occlusion of lower extremity arteriosclerosis.Method:A retrospective analysis of the data of 47 patients admitted to the Department of Lymphatic Surgery of China-Japan Union Hospital of Jilin University from September2015 to October 2018.These patients underwent stent implantation for SFA lesions in lower limb ASO.Subsequently,stenosis or occlusion occurred and intracavitary treatment was performed again.All patients had restenosis or occlusion in the SFA stent.Among them,34(72.3%)of the target vessel stenosis was> 70%,and 13(27.7%)of the target vessel were completely occlusive lesions.The patient's Fontaine stage was stage IIb(moderate or severe intermittent claudication),stage III(resting pain)or stage IV(tissue ulcer,gangrene).All patients were ineffective after conservative treatment,no obvious surgical contraindications,and successfully completed intracavitary treatment.Divided into three groups according to clinical treatment methods:excimer laser ablation plus common balloon plus drug-coated balloon group 11(23.4%)cases were set to group A;drug-coated balloon plus common balloon group 18(38.3%)cases were set to group B;common balloon group 18(38.3%)cases were set to group C.All patients were followed up for 12 to 24 months,during which clinical symptoms were relieved,fontaine classification changes,ankle brachial index,target vessel patency rate,target lesion blood flow reconstruction,target vessel minimum lumen diameter,and advanced lumen loss and limb salvage rate were recorded,and the clinical efficacy was compared between the groups in the near to mid term after statistical analysis.Results:In this study,the success rate of intracavitary treatment was 100%(47limbs).Ischemic symptoms,ABI and Fontaine classification of the affected limbs were significantly improved after surgery.Resting pain is obviously relieved or disappeared after operation.The postoperative ulcers and gangrene healed well after conventional treatments such as dressing changes,amputation,and closed-wound negative pressure drainage.11 patients in group A were followed up for 12 months,and 36 patients in group B and C were followed up for 24 months.During the follow-up period,none of the 47 patients had amputations above the ankle,and there were no deaths.At 6 months of follow-up in groups A,B,and C,the patency rates at the first stage were 100.0%(11/11),100.0%(18/18),and 72.2%(13/18)respectively,(Group A vs Group B,Group A vs Group C,P>0.05;Group B vs Group C,P<0.05).At the 12-month follow-up period,the patency rates of the A,B,and C groups were 90.9%(10/11),88.9%(16/18),and50.0%(9/18),(Group A vs Group C,Group B vs Group C,P<0.05;Group A vs Group B,P>0.05).At 18 months of follow-up,the patency rates of the first and second groups were 55.6%(10/18)vs38.9%(7/18).At a follow-up of 24 months,the patency rate at the first stage was 38.9%(7/18)vs22.2%(4/18),and the differences were not statistically significant(P>0.05).At 12 months of follow-up,no TLR patients appeared in group A,and TLRs in groups B and C were(5.6%vs22.2%,P>0.05).At 24 months of follow-up,TLRs in groups B and C were(44.4%vs50%,P>0.05).In terms of MLD and LLL,the three groups were better than group B and C at 6 and 12 months of follow-up(P<0.05);at 12 and 18 months of follow-up,group B was better than C(P<0.05);At 24 months follow-up,there was no significant difference in MLD and LLL between the two groups(P>0.05).Conclusion:(1)In lower extremity atherosclerotic occlusive disease,the treatment of restenosis of superficial femoral artery with excimer laser ablation and drug coated balloon is safe and effective.(2)Within 12 months after surgery,excimer laser ablation combined with drug-coated balloons for the treatment of superficial femoral artery stent restenosis has better efficacy in terms of patency,TLR,MLD,LLL than drug-coated balloons or ordinary Balloon.(3)At the 24-month follow-up,there was no statistical difference in the patency rate,TLR,MLD,and LLL in the first-stage stenosis of drug-coated balloon and ordinary balloon treated stent restenosis.