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Clinical Research| Volume 91, P223-232, April 2023

Results of Excimer Laser Ablation Combined with Drug-Coated Balloon for Atherosclerotic Obliterans of Lower Extremity and Risk Factors for Loss of Primary Patency

  • Xiaolang Jiang
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Xiaoyan Li
    Affiliations
    Center for Vascular Surgery and Wound Care, Jinshan Hospital, Fudan University, Shanghai, China
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  • Bin Chen
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Junhao Jiang
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Yun Shi
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Tao Ma
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Changpo Lin
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Daqiao Guo
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Xin Xu
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
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  • Shuai Ju
    Affiliations
    Center for Vascular Surgery and Wound Care, Jinshan Hospital, Fudan University, Shanghai, China
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  • Weiguo Fu
    Correspondence
    Correspondence to: Zhihui Dong and Weiguo Fu, Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China
    Search for articles by this author
  • Zhihui Dong
    Correspondence
    Correspondence to: Zhihui Dong and Weiguo Fu, Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
    Affiliations
    Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    National Clinical Research Center for Interventional Medicine, Shanghai, China

    Center for Vascular Surgery and Wound Care, Jinshan Hospital, Fudan University, Shanghai, China
    Search for articles by this author
Published:December 27, 2022DOI:https://doi.org/10.1016/j.avsg.2022.11.026

      Background

      The results of excimer laser ablation (ELA) combining with drug-coated balloon (DCB) in the treatment for atherosclerotic obliterans (ASO) remains unclear.

      Methods

      Retrospectively enrolled patients who underwent ELA combined with DCB in 2 centers. The primary endpoint was primary patency, and secondary endpoints included technical success, procedure-related complications, major amputation, clinically driven target lesions reintervention (CD-TLR), measurements of ankle-brachial index (ABI), and quality of life (QoL).

      Results

      102 patients were enrolled. The primary patency was 86.7% (95% confidence interval [CI]: 72.9%–89.0%) at 12 months and 82.6% (95% CI: 78.2%–92.1%) at 24 months. The freedom from reintervention was 87.8% (95% CI: 79.5%–92.9%) at 12 months and 86.6% (95% CI: 78.1%–92.0%) at 24 months. The ABI measurement and QoL were significantly improved at each follow-up point. Sixteen (15.7%) patients lost the primary patency. Patients losing the primary patency demonstrated higher Rutherford class (P = 0.004), worse runoff (P < 0.001), higher Peripheral Arterial Calcium Scoring System (PACSS) (P < 0.001), and smaller ratio of tube diameter to reference vessel diameter (TD/RVD) (P < 0.001) compared with patients without losing it. The run-off ≥7 (adjusted odds ratio [aOR]: 34.3; 95% CI: 2.9–398.3; P = 0.005) and TD/RVD <4.9 (aOR: 24.7; 95% CI: 1.7–359.5; P = 0.019) were independent risk factors for loss of primary patency.

      Conclusions

      ELA combined with DCB seemed an effective and safe treatment for ASO of lower extremity, and it could not only reduce the implantation of stent but significantly improve QoL. The run-off ≥7 and TD/RVD <4.9 were independent risk factors for loss of primary patency.
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