TASC Ⅱ C/D型下肢动脉硬化闭塞症术后再狭窄列线图预测模型的构建OA

Objective To develop and validate a nomogram-based predictive tool for postoperative restenosis in patients with Trans-Atlantic Inter-Society Consensus(TASC)Ⅱ C/D lower extremity arteriosclerosis obliterans(ASO).Methods Clinical data of 307 patients with TASC Ⅱ C/D ASO admitted to the Second Hospital of Lanzhou University from January 2018 to December 2023 were collected and analyzed,including basic information,medical history,imaging findings,treatment regimens,and follow-up outcomes.According to whether stenosis occurred within 2 years postoperatively,patients were divided into restenosis group(n=101)and patency group(n=206).A prediction model was established by univariate analysis,multivariate binary logistic regression analysis,and variables selected by least absolute shrinkage and selection operator(LASSO)regression.The area under the receiver operating characteristic(ROC)curve(AUC),calibration curve,and decision curve analysis were employed to evaluate the prediction performance of the model,and the Bootstrap method was performed for internal verification.Results LASSO regression,univariate analysis and multivariate binary logistic regression analyses showed that long smoking history,low transcutaneous oxygen pressure(TcPO2),decreased peripheral perfusion index(PI),TASC Ⅱ type D classification,long vascular lesion length,high degree of arterial calcification,and non-use of drug-coated balloon(DCB)during operation were independent risk factors for postoperative restenosis in ASO patients.On this basis,considering clinical importance and model performance optimization,age,lower limb capillary filling time(CRT),and whether regular dual antiplatelet therapy was administered postoperatively were further incorporated into the model.Finally,a nomogram prediction model for postoperative restenosis in patients with TASC Ⅱ C/D type ASO was established by integrating the above 10 factors.The model exhibited good discrimination ability in training set,with an AUC of 0.844(95%CI 0.797-0.891);the AUC still reached 0.820(95%CI 0.775-0.870)in internal validation.Hosmer-Lemeshow test of the calibration curve showed a P-value of 0.856,indicating that the prediction model had good calibration.Conclusions Patients'age,smoking history,lower limb CRT,TcPO2,PI,TASC Ⅱ classification,vascular lesion length,degree of arterial calcification,whether DCB was used intraoperatively,and whether regular dual antiplatelet therapy was administered postoperatively are independent influencing factors for postoperative restenosis in patients with TASC Ⅱ C/D type ASO.The prediction model based on these factors has favorable predictive performance and can provide a reference basis for formulating individualized clinical treatment strategies.