Abstract：Objective This study aimed to explore the efficacy of endovascular treatment for lower-limb arteriosclerosis obliterans (ASO) and related the influencing factors of postoperative restenosis. Methods A case-control study was conducted from January 2019 to June 2021. A total of 182 patients with lower-limb ASO in the Vascular Surgery Department of the First Affiliated Hospital of Bengbu Medical University, including 126 males and 56 females, aged 46-93 (70.5±10.2) years old, were enrolled in the study. All patients underwent computed tomographic arteriography or arterial angiography and had ankle brachial index (ABI) ranging from 0.15 to 0.58 (0.38±0.18). The 182 patients received intracavitary treatment. Observation indicators included the following: (1) efficacy of intracavitary treatment (primary vascular patency rate, ABI of 1 month after treament and other indicators) and incidence of adverse events, such as cardiovascular and cerebrovascular accidents, renal insufficiency, and major amputations during the perioperative period; (2) incidence of arterial restenosis in the 182 patients 12 months after analysis of the operation. All patients were divided into the restenosis and nonrestenosis groups based on whether the patients had arterial restenosis 12 months after surgery. Single-factor analysis involved clinical baseline data, such as gender, age, Fontaine stage, internal medicine comorbidities, smoking history, and lower limb ASO lesion site, stenosis degree, lesion length, treatment method, and postoperative antiplatelet treatment time for two groups of patients. A stepwise multivariate logistic regression analysis was performed on variables with P<0.01. Results (1) Surgery was successful in all 182 patients. The clinical symptoms of the patients improved to varying degrees after surgery, and no major amputations, gastrointestinal bleeding, severe cardiovascular and cerebrovascular complications, or deaths were recorded. The postoperative primary vascular patency rate was 100%, ABI of 1 month after treament was 0.68±0.25, which was higher than that before operation. The difference was statistically significant (t=15.15, P<0.001). Among the 182 patients, 100 experienced arterial restenosis 12 months after surgery (restenosis rate: 54.9%). (2) Univariate analysis revealed statistically significant differences among indicators, such as lesion length of the lower-limb ASO, antiplatelet treatment time, and smoking history between the two groups of patients (χ2=8.69, 8.43, 9.25, all P values <0.01). However, no statistically significant differences were detected in indicators, such as gender, age, internal medicine complications, lesions location of lower limb ASO, and degree of stenosis (all P values >0.05). Further multivariate logistic regression analysis unveiled lesion length ≥3 cm (OR=2.835, 95%CI: 1.478-5.438), and smoking (OR=2.776, 95%CI: 1.460-5.277) as independent risk factors for arterial restenosis in ASO patients after intracavitary treatment (all P values <0.001). Meanwhile, antiplatelet therapy >6 months (OR=0.220, 95%CI: 0.084-0.574) was a protective factor for preventing luminal restenosis after intracavitary treatment. Conclusion The intraluminal treatment is safe and effective for lower-limb ASO. Patients with lesions whose length ≥3 cm and a history of smoking are independent risk factors for postoperative arterial restenosis, and postoperative antiplatelet therapy >6 months is a protective factor for the prevention of luminal restenosis.
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