Costanza Michael J, Queral Luis A, Lilly Michael P, Finn William R
University of Maryland School of Medicine, Baltimore, MD 21201, USA.
J Vasc Surg. 2004 Feb;39(2):343-50. doi: 10.1016/j.jvs.2003.07.007.
Endovascular therapy for moderate femoropopliteal arterial occlusive disease remains controversial. This study reviewed our experience with endovascular therapy for TransAtlantic InterSociety Consensus (TASC) type B disease, which is defined as multiple stenoses less than 3 cm in diameter or a single stenosis or occlusion 3 to 5 cm in diameter. Stenosis-free patency was used as an objective end point to evaluate the hemodynamic outcome.
A retrospective review was performed of all patients who had undergone endovascular treatment of TASC type B lesions between 1997 and 2002 at two referral centers. Balloon angioplasty was performed in all patients. Stenting was used selectively as an adjunct in patients with suboptimal angioplasty results. The treated sites were examined with duplex ultrasound scanning at 6-month to 12-month intervals. Stenosis-free patency was defined as the absence of stenosis greater than 50% diameter in the treated arterial segment with standard duplex criteria.
One hundred fifteen limbs in 98 patients were studied. The indication for treatment was claudication in 92 patients (80%) and ischemic rest pain or gangrene in the remaining patients (20%). Multiple lesions greater than 3 cm were treated in 89 limbs (77%), and a single lesion 3 to 5 cm long was treated in 26 limbs (23%). Balloon angioplasty alone was performed in 74 limbs (65%), and angioplasty and adjunctive stenting was performed in 41 limbs (35%). Endovascular therapy was technically successful in all but one patient (99%), and there was no perioperative mortality or limb loss. During follow-up recurrent stenosis was detected in 46 limbs (40%), and reocclusion occurred in 11 limbs (10%). Seven patients (6%) underwent surgical bypass after endovascular treatment failure. The aggregate 1-year stenosis-free patency rate at life table analysis was 55.1%. The 1-year stenosis-free patency for angioplasty alone was 58%, compared with 51% (NS) for angioplasty and adjunctive stenting. Univariate regression analysis failed to demonstrate a difference in stenosis-free patency for demographic variables, medical comorbidities, and anatomic characteristics (multiple vs single lesions; number of angioplasty procedures).
Endovascular therapy for TASC type B femoropopliteal lesions is safe and technically feasible. However, the length of time that a treated arterial segment remains free of stenosis is limited, and is not improved with adjunctive stenting. Recurrent stenosis, not occlusion, was the most common study end point, and few patients subsequently required surgical bypass. Predictors of outcome after endovascular therapy for TASC type B lesions were not identified in this study.
中度股腘动脉闭塞性疾病的血管内治疗仍存在争议。本研究回顾了我们对跨大西洋两岸血管外科学会（TASC）B型疾病进行血管内治疗的经验，该型疾病定义为多个直径小于3 cm的狭窄或单个直径3至5 cm的狭窄或闭塞。无狭窄通畅率被用作评估血流动力学结果的客观终点。
对1997年至2002年间在两个转诊中心接受TASC B型病变血管内治疗的所有患者进行回顾性研究。所有患者均接受了球囊血管成形术。对于血管成形术效果欠佳的患者，选择性地使用支架作为辅助治疗。每隔6至12个月用双功超声扫描检查治疗部位。无狭窄通畅率定义为根据标准双功超声标准，治疗的动脉节段内直径狭窄大于50%的情况不存在。
对98例患者的115条肢体进行了研究。治疗的指征为92例患者（80%）有间歇性跛行，其余患者（20%）有静息性缺血性疼痛或坏疽。89条肢体（77%）治疗了多个大于3 cm的病变，26条肢体（23%）治疗了一个3至5 cm长的单个病变。74条肢体（65%）仅进行了球囊血管成形术，41条肢体（35%）进行了血管成形术及辅助支架置入术。除1例患者外，血管内治疗在技术上均成功（99%），且无围手术期死亡或肢体丧失。在随访期间，46条肢体（40%）检测到复发性狭窄，11条肢体（10%）发生再闭塞。7例患者（6%）在血管内治疗失败后接受了外科搭桥手术。生命表分析得出的1年无狭窄通畅率总计为55.1%。单纯血管成形术的1年无狭窄通畅率为58%，血管成形术及辅助支架置入术为51%（无显著性差异）。单变量回归分析未能显示人口统计学变量、内科合并症和解剖学特征（多个病变与单个病变；血管成形术操作次数）在无狭窄通畅率方面存在差异。
对TASC B型股腘病变进行血管内治疗是安全且在技术上可行的。然而，治疗的动脉节段保持无狭窄的时间长度有限，且辅助支架置入术并不能改善这一情况。复发性狭窄而非闭塞是最常见的研究终点，且随后很少有患者需要进行外科搭桥手术。本研究未确定TASC B型病变血管内治疗后预后的预测因素。
