Nelson P R, Powell R J, Proia R R, Schermerhorn M L, Fillinger M F, Zwolak R M, Walsh D B, Cronenwett J L
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
J Vasc Surg. 2001 Sep;34(3):526-31. doi: 10.1067/mva.2001.116805.
Endovascular superficial femoral artery (SFA) endarterectomy with a ring stripper/cutter and distal stenting has been suggested to have a patency comparable with above-knee bypass surgery. We report our initial experience with this technique.
Seventeen patients (13 men and 4 women; mean age, 64 years) with SFA occlusion and above-knee popliteal reconstitution underwent attempted remote endarterectomy with a ring cutter system combined with primary stenting of the distal end point. Analysis was performed in a prospective manner with patency rates determined by Kaplan-Meier life-table analysis.
The indication for operation was claudication in 8 patients, rest pain in 6, and tissue loss in 3. Initial technical success was achieved in 11 patients (65%). Reasons for technical failure included SFA perforation (4), inability to traverse a calcified/diseased segment (1), and inability to retract/remove the ring cutter (1). Life-table analysis of all patients revealed a primary patency at 1 year of 26% +/- 11%. Primary-assisted patency was 38% +/- 12% at 1 year, with 59% of patients ultimately requiring surgical bypass grafting. In patients in whom initial technical success was achieved, the 1-year primary and primary-assisted patency rates were 40% and 59%, respectively. There were four reocclusions requiring surgical revascularization with below-knee popliteal (2) or tibial (2) bypass grafting, 1 symptomatic restenosis requiring repeat angioplasty, and 1 symptomatic restenosis treated conservatively.
The results of endovascular SFA endarterectomy were disappointing, with technical success in less than two thirds of patients and a 1-year primary patency of only 26%. Remote SFA endarterectomy appears less effective than above-knee femoropopliteal bypass grafting, and after early failure, patients may require more distal revascularization for limb salvage.
有观点认为，使用环形剥离器/切割器行股浅动脉（SFA）腔内内膜切除术并在远端置入支架，其通畅率与膝上旁路手术相当。我们报告了我们在这项技术方面的初步经验。
17例（13例男性，4例女性；平均年龄64岁）患有SFA闭塞且膝上腘动脉需重建的患者，尝试使用环形切割器系统进行远端内膜切除术，并对远端终点进行初次支架置入。采用前瞻性分析，通过Kaplan-Meier生存表分析确定通畅率。
手术指征为8例间歇性跛行、6例静息痛和3例组织缺损。11例患者（65%）获得了初始技术成功。技术失败的原因包括SFA穿孔（4例）、无法通过钙化/病变节段（1例）以及无法收回/取出环形切割器（1例）。对所有患者的生存表分析显示，1年时的初始通畅率为26%±11%。1年时的初次辅助通畅率为38%±12%，最终59%的患者需要进行手术旁路移植。在获得初始技术成功的患者中，1年时的初次通畅率和初次辅助通畅率分别为40%和59%。有4例再闭塞需要通过膝下腘动脉（2例）或胫动脉（2例）旁路移植进行手术血运重建，1例症状性再狭窄需要重复血管成形术，1例症状性再狭窄采用保守治疗。
SFA腔内内膜切除术的结果令人失望，不到三分之二的患者获得技术成功，1年时的初始通畅率仅为26%。远端SFA内膜切除术似乎不如膝上股腘旁路移植有效，早期失败后，患者可能需要更远端的血运重建以挽救肢体。
