QI Guangwei , YANG Yan , YANG Liuyu , YANG Zhenwei , WU Qingrui , PENG Jieguang , XU Pengfei , BAI Chao
  • Department of Vascular and Thyroid Surgery, Digestive and Vascular Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830056, P. R. China;
BAI Chao, Email: 736146410@qq.com
arteriosclerosis obliterans of the lower extremities; endovascular treatment; major adverse limb event; major adverse cardiovascular event; inverse probability of treatment weighting
10.7507/1007-9424.202411029
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Objective To compare the efficacy of three surgical approaches, including percutaneous transluminal angioplasty (PTA), PTA+bare metal stent (BMS), and Rotarex+PTA+drug-coated balloon (DCB), in treating femoropopliteal artery lesions in arteriosclerotic occlusive disease (ASO), and to explore the prognostic factors of femoropopliteal artery lesions in ASO. Methods A retrospective analysis was conducted on 314 patients with femoropopliteal artery lesions in ASO who were treated in the Department of Vascular and Thyroid Surgery in the First Affiliated Hospital of Xinjiang Medical University from March 2018 to March 2024. Propensity score inverse probability weighting was used to balance the baseline characteristics of the three groups of patients. The clinical examination, imaging examination, and ankle-brachial index (ABI) results of the three groups of patients at 3 months, 12 months, and 24 months after surgery were compared. Log-rank test was used to compare the incidence of all-cause mortality (ACM) and major adverse cardiovascular events (MALEs) among the three groups, and Cox proportional hazards regression model was used to analyze the prognostic factors of femoropopliteal artery lesions in ASO. Results A total of 314 patients with ASO femoropopliteal artery lesions were enrolled, comprising 153 cases in the PTA group, 89 cases in the PTA+BMS group, and 72 cases in the Rotarex+PTA+DCB group. After inverse probability weighting based on propensity scores, baseline characteristics were balanced across all groups (all P>0.05). Postoperative follow-up results demonstrated the following patency rates: at 3 months, 58.4% (87/149) for the PTA group, 79.5% (66/83) for the PTA+BMS group, and 87.5% (63/72) for the Rotarex+PTA+DCB group; at 12 months, 78.0% (60/79), 68.3% (43/63), and 80.0% (44/55), respectively; and at 24 months, 98.1% (52/53), 89.7% (35/39), and 100.0% (43/43), respectively. The Rotarex+PTA+DCB group exhibited significantly superior patency rates and claudication distances compared to both the PTA and PTA+BMS groups at 3 and 24 months (P<0.05). Furthermore, the Rotarex+PTA+DCB group showed improved ankle-brachial index (ABI) and Rutherford classification outcomes compared to the other two groups at all postoperative time points (3, 12, and 24 months; P<0.05). Survival analysis revealed that the Rotarex+PTA+DCB group had significantly better survival outcomes compared to the PTA+BMS group (χ2=14.266, P<0.001) and the PTA group (χ2=3.916, P=0.048). Cox proportional hazards regression analysis identified elevated red cell distribution width (RDW) as an independent risk factor for ACM/MALEs following endovascular therapy in ASO patients, with a relative risk of 1.069 [95%CI (1.008, 1.133), P=0.026]. Conclusions The Rotarex+PTA+DCB demonstrate superior outcomes compared to both the PTA and PTA+BMS in terms of patency rate, claudication distance, ABI, and Rutherford classification at 3 and 24 months postoperatively, along with the highest long-term survival rate (59.7%). Furthermore, elevated RDW may serve as a prognostic factor for adverse outcomes in patients with ASO femoropopliteal artery lesions.

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