Bergan J J, Wilson S E, Wolf G, Deupree R H
Pittsburgh [Pa] Veterans Affairs [VA] Medical Center.
Arch Surg. 1992 Sep;127(9):1119-23; discussion 1123-4. doi: 10.1001/archsurg.1992.01420090127019.
In reviewing late morbidity of a multicenter clinical trial comparing balloon angioplasty (percutaneous transluminal angioplasty) with bypass surgery for lower-extremity ischemia, an unexpectedly high incidence of adverse systemic events in surgical patients was uncovered. The study was prospective and randomized, and included a total of 263 patients, with follow-up from 2 to 6 years. When end points of related deaths, amputations, and intervention failures were summed, surgery was favored over percutaneous transluminal angioplasty at 4 years. Progression of cardiac and renal dysfunction and mortality differed between groups. A total of 42 deaths were in the group who underwent surgery and 27 in those who underwent percutaneous transluminal angioplasty. The percentage difference in death rate between the two groups increased each year to reach 10% at 5 years. A significant difference in renal function was noted in nine patients who underwent surgery and zero who underwent percutaneous transluminal angioplasty. Myocardial infarctions were greater on follow-up of surgical patients. After 6 years, congestive heart failure had occurred in 19 patients who underwent surgery and eight who underwent percutaneous transluminal angioplasty. The trends in this study of patients with only moderately severe peripheral arterial disease suggest an increased rate of deterioration of cardiac and renal function in patients who have arterial operations. In surgical patients, mortality was 13.1% per year, whereas it was 8.4% for patients treated with percutaneous transluminal angioplasty. Future intervention studies should include long-term follow-up of such cardiovascular events.
在回顾一项多中心临床试验的晚期发病率时，该试验比较了球囊血管成形术（经皮腔内血管成形术）与旁路手术治疗下肢缺血的效果，结果发现手术患者出现不良全身事件的发生率意外地高。该研究为前瞻性随机试验，共纳入263例患者，随访时间为2至6年。当将相关死亡、截肢和干预失败的终点指标相加时，4年后手术治疗优于经皮腔内血管成形术。两组在心脏和肾功能恶化及死亡率方面存在差异。接受手术的患者中有42例死亡，接受经皮腔内血管成形术的患者中有27例死亡。两组死亡率的百分比差异逐年增加，在5年时达到10%。接受手术的9例患者出现肾功能显著差异，而接受经皮腔内血管成形术的患者为零。手术患者随访时心肌梗死发生率更高。6年后，接受手术的19例患者出现充血性心力衰竭，接受经皮腔内血管成形术的患者有8例。这项针对仅患有中度严重外周动脉疾病患者的研究趋势表明，接受动脉手术的患者心脏和肾功能恶化率增加。手术患者的年死亡率为13.1%，而经皮腔内血管成形术治疗的患者为8.4%。未来的干预研究应包括对此类心血管事件的长期随访。
