Influencing factors of restenosis at 1 year after drug-coated balloon angioplasty for in-stent restenosis in femoropopliteal artery
Wang Chengfang1, Yu Chaowen1, Ren Tiancai2, Shan Chuanze1, Luo Xiang1
1Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China; 2Department of Vascular Surgery, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang 236000, China
Abstract：Objective This study aims to investigate the 1-year restenosis rate and influencing factors of drug-coated balloon (DCB) angioplasty in the treatment of femoral-popliteal in-stent restenosis (ISR). Methods In this cross-sectional study, 58 patients (58 limbs) with ISR who were treated with DCB in the Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College from January 2016 to August 2021 were enrolled. The participants included 40 males and 18 females aged 52-85 (71.9±7.6) years. The preoperative ankle brachial index (ABI) was 0.34±0.10, and the Rutherford grades of lower extremity ischemia were as follows: 6 patients had grade 2, 23 patients had grade 3, 20 patients had grade 4, and 9 patients had grade 5. All 58 patients were treated with DCB angioplasty successfully. At 12 months after the surgery, the patency of the target lesion segment was evaluated according to the presence or absence of clinically driven-revascularization of target lesions (CD-TLR) combined with Doppler ultrasound parameter peak systolic velocity ratio (PSVR). The patients were divided into patency group (no CD-TLR, PSVR≤2.4, 43 patients) and non-patency group (with CD-TLR, PSVR>2.4, 15 patients). The clinicopathological factors of the two groups were compared and analyzed. Kaplan-Meier survival curve was used to analyze the patency rate of target lesion segment and the rate of free CD-TLR at 1 year after the operation. Logistic regression model analysis was used to evaluate factors influencing restenosis rate at 1 year after DCB angioplasty for ISR. Results In this group of 58 patients, the femoral popliteal artery ISR vessels were successfully reconstructed, and the clinical symptoms such as intermittent claudication and rest pain were significantly improved after the operation. On the 3rd day after operation, the Rutherford grade of lower extremities ischemia of the 58 patients were grade 0 in 17 patients, Grade 1 in 19 patients, grade 2 in 19 patients, Grade 3 in 3 patients, and the ABI of 1 year after operation was 0.72±0.16, which were significantly improved compared with those before the operation, and the differences were statistically significant (Z=-6.73, t=-24.32, all P values<0.001). The 1-year patency rate was 74.1%, and the 1-year CD-TLR rate was 78.4%. The results of univariate analysis showed that the odds ratio (OR) values (95% confidence interval [CI]) of vascular calcification, Tosaka classification, postoperative medication, and triglyceride levels were 4.714 (1.915-11.606), 14.458 (3.058-68.357), 0.048 (0.005-0.454), and 1.969 (1.119-3.465), respectively, and the differences were statistically significant (all P values<0.05). Multivariate analysis showed that severe calcification and Tosaka type Ⅲ were independent risk factors for postoperative restenosis (OR [95% CI] were 10.965 [1.786-67.326] and 57.385 [1.848-1 782.021], respectively, all P values<0.05). Regular postoperative medication was a protective factor for stenosis after DCB treatment (OR [95% CI] was 0.041 [0.002-0.799], P=0.035). Conclusion For patients with femoral popliteal artery ISR treated with DCB angioplasty, the occurrence of restenosis at 1 year after target lesion segment was related to the degree of vascular calcification, Tosaka classification, and postoperative regular medication. Severe calcification and Tosaka type Ⅲ were independent risk factors, and postoperative regular medication was a protective factor.
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Wang Chengfang, Yu Chaowen, Ren Tiancai, Shan Chuanze, Luo Xiang. Influencing factors of restenosis at 1 year after drug-coated balloon angioplasty for in-stent restenosis in femoropopliteal artery. Chinese Journal of Anatomy and Clinics, 2023, 28(6): 388-394.
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2023, Vol. 28 
