Timaran Carlos H, Stevens Scott L, Freeman Michael B, Goldman Mitchell 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. 2002 Sep;36(3):507-13. doi: 10.1067/mva.2002.126541.
The role of iliac artery angioplasty and stenting (IAS) for the treatment of limb-threatening ischemia is not defined. IAS has been used primarily for patients with disabling claudication. Because poorer results have been shown in patients with critical ischemia after iliac artery angioplasty, the purpose of this study was to estimate the influence of risk factors on the outcome of iliac angioplasty and stent placement in patients with limb-threatening ischemia.
During a 5-year period (from 1996 to 2001), 85 iliac angioplasty and stent placement procedures (107 stents) were performed in 31 women and 43 men with limb-threatening ischemia. Patients with claudication were specifically excluded. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic InterSociety 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 between variables, cumulative patency, limb salvage, and survival.
Indications for iliac angioplasty with stenting were ischemic rest pain (56%) and tissue loss (44%). Primary stenting was performed in 36 patients (42%). Stents were placed selectively after iliac angioplasty mainly for residual stenosis or pressure gradient (43%). Overall, primary stent patency rate was 90% at 1 year, 74% at 3 years, and 69% at 5 years. Primary stent patency rate was significantly reduced in women compared with men (KM, log-rank test, P <.001). Primary patency rates at 1, 3, and 5 years were 79%, 57%, and 38% for women and 92%, 88%, and 88% for men. Primary stent patency rate also was significantly reduced in patients with renal insufficiency (creatinine level, >1.6 mg/dL; KM, log-rank test, P <.001). Cox regression analysis identified female gender (relative risk, 5.1; 95% CI, 1.8 to 7.9; P =.002) and renal insufficiency (relative risk, 6.6; 95% CI, 1.6 to 14.2; P =.01) as independent predictors of decreased primary stent patency. No independent predictors for limb salvage and survival were identified.
Women undergoing iliac angioplasty and stenting for limb-threatening ischemia have significantly reduced primary stent patency rates and may need additional procedures to obtain satisfactory clinical improvement and limb salvage. Patients with renal insufficiency and critical ischemia also have reduced primary stent patency rates after IAS. Limb salvage, as shown in this study, is not affected by previous iliac stent failure.
髂动脉血管成形术和支架置入术（IAS）在治疗肢体威胁性缺血中的作用尚未明确。IAS主要用于治疗致残性跛行患者。由于髂动脉血管成形术后严重缺血患者的治疗效果较差，本研究旨在评估危险因素对肢体威胁性缺血患者髂动脉血管成形术和支架置入术预后的影响。
在5年期间（1996年至2001年），对31名女性和43名男性肢体威胁性缺血患者进行了85例髂动脉血管成形术和支架置入术（107枚支架）。明确排除跛行患者。遵循血管外科协会/国际心血管外科学会报告标准特设委员会制定的标准来定义变量。采用跨大西洋两岸协会共识分类法对髂动脉病变类型进行分类。单因素分析（Kaplan-Meier [KM]法）和多因素分析（Cox比例风险模型）均用于确定变量、累积通畅率、肢体挽救率和生存率之间的关联。
髂动脉血管成形术联合支架置入术的适应证为静息性缺血性疼痛（56%）和组织缺损（44%）。36例患者（42%）进行了初次支架置入。主要在髂动脉血管成形术后选择性置入支架，主要用于残余狭窄或压力阶差（43%）。总体而言，初次支架1年通畅率为90%，3年为74%，5年为69%。与男性相比，女性的初次支架通畅率显著降低（KM法，对数秩检验，P<.001）。女性1年、3年和5年的初次通畅率分别为79%、57%和38%，男性分别为92%、88%和88%。肾功能不全患者（肌酐水平>1.6 mg/dL；KM法，对数秩检验，P<.001）的初次支架通畅率也显著降低。Cox回归分析确定女性性别（相对风险，5.1；95%可信区间，1.8至7.9；P=.002）和肾功能不全（相对风险，6.6；95%可信区间，1.6至14.2；P=.01）是初次支架通畅率降低的独立预测因素。未发现肢体挽救和生存的独立预测因素。
因肢体威胁性缺血接受髂动脉血管成形术和支架置入术的女性患者，其初次支架通畅率显著降低，可能需要额外的手术来获得满意的临床改善和肢体挽救。肾功能不全和严重缺血患者在IAS术后的初次支架通畅率也降低。如本研究所示，肢体挽救不受既往髂动脉支架失败的影响。
Zotero 插件