Bosiers Marc, Hart Joseph P, Deloose Koen, Verbist Jurgen, Peeters Patrick
Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium.
Vascular. 2006 Mar-Apr;14(2):63-9. doi: 10.2310/6670.2006.00014.
Endovascular strategies for the treatment of critical infrageniculate peripheral arterial occlusive disease exist and are becoming the primary methodology for such lesions at many centers. Although technically feasible for experienced operators, the evidence to support this strategy for below the knee (BTK) interventions is still evolving. We studied the 6-month and 1-year outcomes of percutaneous transluminal angioplasty (PTA) alone, PTA with stenting, and excimer laser recanalization for BTK lesions in patients with critical limb ischemia. Between September 2002 and June 2005, 443 patients (355 Rutherford category 4, 82 category 5, 6 category 6) underwent intervention for 681 BTK lesions. Follow-up was performed at 6-month intervals after index intervention: limb salvage data were recorded and duplex ultrasonography was performed to measure the patency of treated areas. The primary patency and limb salvage rates of the entire population were 85.2% and 97.0% and 74.2% and 96.6% at 6 months and 1 year, respectively. Stratified for the treatment strategy (PTA alone in 79, PTA with stenting in 300 patients, and excimer laser in 64), 1-year primary patency rates were 68.6%, 75.5%, and 75.4%, whereas the limb salvage rates were 96.7%, 98.6%, and 87.9% for each modality, respectively. Endovascular intervention will become the primary treatment for BTK lesions in patients with critical limb ischemia, with 1-year primary patency and limb salvage rates that compare favorably with published surgical data. Prospective, randomized, multicenter trials will be needed to further establish the role of endovascular intervention in this challenging patient group.
治疗严重膝下外周动脉闭塞性疾病的血管内治疗策略已经存在，并且在许多中心正成为治疗此类病变的主要方法。尽管对于经验丰富的操作者来说在技术上可行，但支持这种策略用于膝下（BTK）干预的证据仍在不断发展。我们研究了单纯经皮腔内血管成形术（PTA）、带支架的PTA以及准分子激光再通术治疗严重肢体缺血患者BTK病变的6个月和1年结局。在2002年9月至2005年6月期间，443例患者（355例Rutherford分级4级，82例5级，6例6级）因681处BTK病变接受了干预。在首次干预后每隔6个月进行随访：记录肢体挽救数据，并进行双功超声检查以测量治疗区域的通畅情况。整个人群的主要通畅率和肢体挽救率在6个月时分别为85.2%和97.0%，在1年时分别为74.2%和96.6%。按治疗策略分层（79例单纯PTA，300例带支架的PTA，64例准分子激光），每种方式的1年主要通畅率分别为68.6%、75.5%和75.4%，而肢体挽救率分别为96.7%、98.6%和87.9%。血管内干预将成为严重肢体缺血患者BTK病变的主要治疗方法，其1年主要通畅率和肢体挽救率与已发表的手术数据相比具有优势。需要进行前瞻性、随机、多中心试验来进一步确立血管内干预在这个具有挑战性的患者群体中的作用。
