Timaran C H, Stevens S L, Freeman M B, Goldman M H
Division of Vascular Surgery, Department of Surgery and Graduate School of Medicine, University of Tennessee Medical Center, Knoxville 37920-6999, USA.
J Vasc Surg. 2001 Sep;34(3):440-6. doi: 10.1067/mva.2001.117148.
The effect of anatomic location of stent placement on the outcome of iliac artery angioplasty and stenting is not defined. Analyses of patency rates of external iliac artery (EIA) and common iliac artery (CIA) stents have provided conflicting results and have not considered men and women independently. The purpose of this study was to estimate the influence of the anatomic location of stenting on the outcome of iliac angioplasty and stent placement in both men and women.
From 1995 to 1999, 247 iliac angioplasty and stent placement procedures (303 stents) were performed in 67 women and 122 men, and all were included in a retrospective cohort study. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed. The TransAtlantic Inter-Society Consensus classification was used to characterize the type of iliac lesions. Both univariate (Kaplan-Meier [KM]) and multivariate analyses (Cox proportional hazards model) were used to determine the association among the variables, cumulative patency, limb salvage, and survival.
Indications for iliac angioplasty with stenting were disabling claudication (65%), limb salvage (33%), and blue toe syndrome (2%). Primary stenting was performed in 103 procedures (42%). Stents were placed selectively after iliac angioplasty mainly for residual stenosis or pressure gradient (43%). Patients with EIA stents, as compared with those who had CIA stents, had more extensive lesions (TransAtlantic Inter-Society Consensus type C lesions), poorer runoff, smaller vessel size, and less frequency of hyperlipidemia (P <.05). Primary patency rates at 1, 3, and 5 years were 76%, 56%, and 56%, respectively, for patients with EIA stents and 92%, 85%, and 76%, respectively, for those with CIA stents. Although overall primary patency rates were significantly decreased in patients with EIA lesions (KM, log-rank test, P =.001), stratified analyses revealed that women with EIA stents had the poorest outcome, with 61%, 47%, and 23% primary patency rates at 1, 3, and 5 years, respectively, (KM, log-rank test, P <.001). Cox regression analysis identified EIA stenting (relative risk, 4.3; 95% CI, 2.3-7.9; P <.001) as an independent predictor of decreased primary patency in women but not in men.
Women undergoing EIA angioplasty with stent placement have significantly reduced primary patency rates. Despite initial technical success, these patients are at increased risk of long-term failure and might require subsequent procedures to obtain clinical success. Conversely, men undergoing EIA stenting have a more favorable outcome than women.
支架置入的解剖位置对髂动脉血管成形术和支架置入术结果的影响尚不明确。对髂外动脉（EIA）和髂总动脉（CIA）支架通畅率的分析结果相互矛盾，且未分别对男性和女性进行考量。本研究的目的是评估支架置入的解剖位置对男性和女性髂动脉血管成形术及支架置入术结果的影响。
1995年至1999年，对67名女性和122名男性进行了247例髂动脉血管成形术及支架置入手术（共置入303枚支架），所有病例均纳入一项回顾性队列研究。遵循了血管外科学会/国际心血管外科学会报告标准特设委员会制定的标准。采用跨大西洋跨学会共识分类法对髂动脉病变类型进行描述。单变量分析（Kaplan-Meier [KM]法）和多变量分析（Cox比例风险模型）均用于确定各变量、累积通畅率、肢体挽救率和生存率之间的关联。
髂动脉血管成形术加支架置入术的适应证为致残性跛行（65%）、肢体挽救（33%）和蓝趾综合征（2%）。103例手术（42%）进行了初次支架置入。髂动脉血管成形术后主要因残余狭窄或压力梯度而选择性置入支架（43%）。与置入CIA支架的患者相比，置入EIA支架的患者病变范围更广（跨大西洋跨学会共识C型病变）、血流灌注更差、血管直径更小且高脂血症发生率更低（P<.05）。置入EIA支架患者1年、3年和5年的初次通畅率分别为76%、56%和56%，而置入CIA支架患者相应的通畅率分别为92%、85%和76%。尽管EIA病变患者的总体初次通畅率显著降低（KM法，对数秩检验，P=.001），但分层分析显示，置入EIA支架的女性预后最差，1年、3年和5年的初次通畅率分别为61%、47%和23%（KM法，对数秩检验，P<.001）。Cox回归分析确定EIA支架置入（相对风险，4.3；95%可信区间，2.3 - 7.9；P<.001）是女性初次通畅率降低的独立预测因素，而在男性中并非如此。
接受EIA血管成形术加支架置入术的女性初次通畅率显著降低。尽管初始技术成功，但这些患者长期失败的风险增加，可能需要后续手术以获得临床成功。相反，接受EIA支架置入术的男性预后比女性更有利。
