Bartuś Stanisław, Siudak Zbigniew, Brzeziński Michał, Rakowski Tomasz, Dziewierz Artur, Chyrchel Michał, Jakała Jacek, Dubiel Jacek, Dudek Dariusz
Institute of Cradiology, Collegium Medicum, Jagiellonian University, Krakow, Poland.
Kardiol Pol. 2008 Feb;66(2):135-41; discussion 142-3.
The coexistence of peripheral artery disease (PAD) and multilevel atherosclerosis increases death and stroke rates in patients with coronary artery disease (CAD). Due to many comorbidities these patients are often treated conservatively without revascularisation.
To investigate whether complex percutaneous cardiovascular interventions for CAD and PAD may improve prognosis and long-term outcome in this group of patients.
We studied consecutive patients treated for symptomatic CAD who also had chronic PAD. The primary cause of hospital admission for all our patients was non-ST elevation acute coronary syndrome (NSTE ACS). All percutaneous peripheral interventions were performed during one hospital stay (index hospitalisation). Major adverse cardio- and cerebrovascular events (MACCE) during follow-up were defined as follows: death (cardiac and non-cardiac), myocardial infarction (MI), urgent revascularisation (surgical or repeat PCI, peripheral percutaneous intervention), stroke/TIA or amputation.
We performed 109 interventions in 78 consecutive patients with chronic peripheral artery stenoses and occlusions. The average age was 61.5+/-8.6 years and the majority were males (80%). Preinterventional angiography showed occlusions that involved the common iliac artery in 28 (36%) patients, the external iliac artery in 16 (21%) patients, internal iliac artery in 2 (3%) patients, and superficial femoral artery in 63 (81%) patients. Stenting was performed in half of the patients with a mean stent length of 69.6+/-50.3 mm. An average number of 1.24+/-0.55 stents was used for each lesion. During a mean follow-up of 18 months (range 4 to 42), there were 4 deaths, 3 MIs, 13 repeated percutaneous peripheral interventions due to restenosis in previously treated peripheral lesions, two urgent coronary interventions, two ischaemic strokes, two TIAs and one amputation. The combined follow--up MACCE end-point occurred in 32% of patients.
Patients with concomitant CAD and PAD could safely undergo percutaneous cardiovascular and peripheral interventions. Multilevel intervention is associated with a promising long-term follow-up.
外周动脉疾病（PAD）与多节段动脉粥样硬化并存会增加冠状动脉疾病（CAD）患者的死亡率和中风发生率。由于存在多种合并症，这些患者通常采用保守治疗，不进行血运重建。
研究针对CAD和PAD的复杂经皮心血管介入治疗是否可改善该组患者的预后和长期结局。
我们研究了因症状性CAD接受治疗且同时患有慢性PAD的连续患者。所有患者入院的主要原因是非ST段抬高型急性冠状动脉综合征（NSTE ACS）。所有经皮外周介入治疗均在一次住院期间（索引住院）进行。随访期间的主要不良心脑血管事件（MACCE）定义如下：死亡（心脏性和非心脏性）、心肌梗死（MI）、紧急血运重建（外科手术或重复PCI、外周经皮介入）、中风/短暂性脑缺血发作（TIA）或截肢。
我们对78例患有慢性外周动脉狭窄和闭塞的连续患者进行了109次介入治疗。平均年龄为61.5±8.6岁，大多数为男性（80%）。介入治疗前的血管造影显示，28例（36%）患者的闭塞累及髂总动脉，16例（21%）患者累及髂外动脉，2例（3%）患者累及髂内动脉，63例（81%）患者累及股浅动脉。一半的患者进行了支架置入，平均支架长度为69.6±50.3 mm。每个病变平均使用1.24±0.55个支架。在平均18个月（4至42个月）的随访期间，有4例死亡、3例MI、13例因先前治疗的外周病变再狭窄而进行的重复经皮外周介入治疗、2例紧急冠状动脉介入治疗、2例缺血性中风、2例TIA和截肢1例。32%的患者出现了联合随访MACCE终点。
合并CAD和PAD的患者可安全地接受经皮心血管和外周介入治疗。多节段介入治疗与有前景的长期随访相关。
