Ascher Enrico, Hingorani Anil P, Marks Natalie A
Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
J Vasc Surg. 2007 Jan;45(1):17-23; discussion 23-4. doi: 10.1016/j.jvs.2006.09.042. Epub 2006 Nov 21.
We have investigated whether popliteal artery volume flow (PAVF) measured immediately after balloon angioplasties of the superficial femoral artery-popliteal segments (SFA/POP) was predictive of early (30 days) and mid-term (6 months) arterial thrombosis.
During the last 24 months, 203 patients (56% men) with a mean age of 73 +/- 9 years had 268 duplex-guided balloon angioplasties of the SFA/POP. Critical ischemia was the indication in 36%. Group I included 176 (66%) with stenoses, and group II had 92 (34%) with occlusions. All patients had completion duplex examinations that included three measurements of PAVF of below-the-knee popliteal artery.
Early (30 days) thrombosis of the treated femoropopliteal arterial segment developed in 10 patients (3.7%), three in group I (1.7%) and seven in group II (7.6%; P < .04). All 10 cases of early thrombosis were in patients with TransAtlantic Inter-Society Consensus (TASC) class C (6/185, 3.2%) and D (4/26, 15%) lesions. Moreover, the 19% incidence (n = 4) of early thrombosis in patients with PAVF <100 mL/min (mean, 73 +/- 24 mL/min; range, 20 to 99 mL/min) was higher compared with the 2.4% rate for patients with higher flows (mean, 176 +/- 60 mL/min; range, 100 to 450 mL/min; P < .01). At 6 months of follow-up, femoropopliteal occlusions had developed in nine more patients, and it became apparent that low PAVF measurements were still predictive of thrombosis (29%) when compared with higher PAVF cases (6%; P < .002). Log-rank comparison of survival curves for cumulative primary stenosis-free patency in group I and group II demonstrated a statistically significant difference (P < .02). PAVF <100 mL/min and TASC classification were significant predictors of early (30 days) and mid-term (6 months) arterial thrombosis after femoropopliteal angioplasties. PAVF was the most powerful predictor of arterial thrombosis. The respective 6-month and 12-month limb salvage rates were 98% and 94% for patients with claudication and 88% and 85% for those with limb-threatening ischemia (P < .0001).
Our results demonstrate that low PAVF is the most powerful predictor of early (30 days) and mid-term (6 months) arterial thrombosis after femoropopliteal interventions. In the presence of a low postprocedure PAVF (<100 mL/min), one may consider not reversing the heparin or using intermittent calf compression, or both, to augment the arterial flow.
我们研究了在股浅动脉-腘动脉段（SFA/POP）球囊血管成形术后立即测量的腘动脉容积流量（PAVF）是否可预测早期（30天）和中期（6个月）动脉血栓形成。
在过去24个月中，203例平均年龄为73±9岁的患者（56%为男性）接受了268次SFA/POP双功超声引导下的球囊血管成形术。36%的患者因严重缺血而接受手术。I组包括176例（66%）有狭窄的患者，II组有92例（34%）有闭塞的患者。所有患者均接受了双功超声检查，包括对膝下腘动脉PAVF进行三次测量。
10例患者（3.7%）出现了治疗的股腘动脉段早期（30天）血栓形成，I组3例（1.7%），II组7例（7.6%；P<0.04）。所有10例早期血栓形成病例均为跨大西洋跨学会共识（TASC）C级（6/185，3.2%）和D级（4/26，15%）病变患者。此外，PAVF<100 mL/min的患者（平均73±24 mL/min；范围20至99 mL/min）早期血栓形成发生率为19%（n = 4），高于高流量患者（平均176±60 mL/min；范围100至450 mL/min）的2.4%（P<0.01）。在随访6个月时，又有9例患者出现股腘动脉闭塞，并且很明显，与高PAVF病例（6%）相比，低PAVF测量值仍可预测血栓形成（29%）（P<0.002）。I组和II组累积原发性无狭窄通畅的生存曲线的对数秩比较显示有统计学显著差异（P<0.02）。PAVF<100 mL/min和TASC分类是股腘动脉血管成形术后早期（30天）和中期（6个月）动脉血栓形成的显著预测因素。PAVF是动脉血栓形成的最有力预测因素。间歇性跛行患者的6个月和12个月肢体挽救率分别为98%和94%，有肢体威胁性缺血的患者分别为88%和85%（P<0.0001）。
我们的结果表明，低PAVF是股腘动脉干预后早期（30天）和中期（6个月）动脉血栓形成的最有力预测因素。在术后PAVF较低（<100 mL/min）的情况下，可考虑不停用肝素或使用间歇性小腿压迫，或两者兼用，以增加动脉血流。
