关键词: 药物涂层球囊； 下肢动脉硬化闭塞症； 经皮腔内血管成形术； 支架内再狭窄； 靶病变血管； 凝血功能； 血管内皮功能

Abstract: Objective To explore the effects of drug-coated balloons (DCB) on the patency rate of target lesion vessels, coagulation function and vascular endothelial function in patients with in-stent restenosis (ISR) after percutaneous endovascular angioplasty (PTA) for lower extremity arteriosclerosis obliterans (ASO).Methods A total of 62 patients with ISR and ASO admitted to the hospital were retrospectively enrolled between March 2020 and March 2022.According to different treatment methods,they were divided into DCB group (n=38) and common balloon (SAB) group (n=24).All were followed up for 12 months after surgery.The changes in primary patency rate of target lesion vessel,clinically driven-target lesion revascularization (CD-TLR) rate,late loss of values in the lumen (LLL),ankle-brachial index (ABI),coagulation function indexes [prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),D-dimer (D-D)] and vascular endothelial function indexes [serum endothelin-1 (ET-1),nitric oxide (NO),flow-mediated dilatation (FMD)] were observed,and the occurrence of postoperative complications in the two groups was recorded.Results At 12 months after surgery,primary patency rate of target lesion vessels in DCB group was higher than that in SAB group (86.84% vs 50.00%),CD-TLR rate,LLL and ABI were lower than those in SAB group[13.16%,(1.39±0.52)mm,(0.76±0.12) vs 50.00%,(1.79±0.64) mm,(0.62±0.11);P<0.05].At 24h and 2 weeks after surgery,there was no significant difference in PT,APTT,FIB or D-D between the two groups (P>0.05).At 24h and 2 weeks after surgery,levels of serum ET-1 in DCB group were lower than those in SAB group [(66.65±7.12)pg/ml,(65.58±6.98)pg/ml vs (71.74±6.92)pg/ml,(68.84±6.51)pg/ml)],while NO levels were higher than those in SAB group [(32.21±4.17)pg/ml,(34.62±3.32)pg/ml vs (28.53±5.23)pg/ml,(31.21±4.19)pg/ml;P<0.05].At 2 weeks after surgery,FMD in DCB group was higher than that in SAB group [(12.49±5.33)% vs (9.14±4.42)%,P<0.05].There was no significant difference in the total incidence of complications between the two groups (21.50% vs 12.50%,P>0.05).Conclusion Compared with SAB,DCB can effectively protect vascular endothelial function and improve the primary patency rate of ISR after PTA in patients with lower extremity ASO.

Key words: drug-coated balloon;lower extremity arteriosclerosis obliterans;percutaneous transluminal angioplasty;in-stent restenosis;target lesion vessel;coagulation function;vascular endothelial function