DeRubertis Brian G, Vouyouka Angela, Rhee Soo J, Califano Joseph, Karwowski John, Angle Niren, Faries Peter L, Kent K Craig
Division of Vascular Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY 10021, USA.
J Vasc Surg. 2008 Jul;48(1):150-7; discussion 157-8. doi: 10.1016/j.jvs.2008.03.007.
Experience with open surgical bypass suggests similar overall outcomes in women compared with men, but significantly increased risk of wound complications. Percutaneous treatment of lower extremity occlusive disease is therefore an attractive alternative in women, although it is not clear whether there is a difference in outcomes between women and men treated with this technique. We sought to determine the results and predictors of failure in women treated by percutaneous intervention.
Percutaneous infrainguinal revascularization was performed on 309 women between 2001 and 2006. Procedures, complications, demographics, comorbidities, and follow-up data were entered into a prospective database for review. Patency was assessed primarily by duplex ultrasonography. Outcomes were expressed by Kaplan-Meier curves and compared by log-rank analysis.
A total of 447 percutaneous interventions performed in 309 women were analyzed and compared with 553 interventions in men. Mean age in women was 73.2 years; comorbidities included hypertension (HTN) (86%), diabetes melitus (DM) (58%), chronic renal insufficiency (CRI) (15%), hemodialysis (7%), hypercholesterolemia (52%), coronary artery disease (CAD) (42%), and tobacco use (47%). Indications in women included claudication (38.0%), rest pain (18.8%), and tissue loss (43.2%). Overall primary & secondary patency and limb-salvage rates for women were 38% +/- 4%, 66% +/- 3%, and 80% +/- 4% at 24 months. In this patient sample, women were significantly more likely than men to present with limb-threatening ischemia (61.6% vs 47.3%, P < 0.001) and have lesions of TASC C and D severity (71.4% vs 61.7%, P < .005). However, there were no significant differences in primary and secondary patency rates or limb-salvage rates between genders. Furthermore, while women with limb-threat, diabetes, and advanced TASC severity lesions were at increased risk of failure overall, there were no differences between women and men with these characteristics.
Percutaneous infrainguinal revascularization is a very effective modality in women with lower extremity occlusive disease. Although women in this sample were more likely to present with limb-threat than men, patency and limb-salvage rates were equivalent between genders, even in high-risk subsets such as diabetics or those with lesions of increased TASC severity.
开放手术搭桥的经验表明，与男性相比，女性的总体预后相似，但伤口并发症风险显著增加。因此，下肢闭塞性疾病的经皮治疗对女性来说是一种有吸引力的替代方法，尽管尚不清楚采用这种技术治疗的女性和男性在预后方面是否存在差异。我们试图确定经皮介入治疗的女性患者的治疗结果及失败的预测因素。
2001年至2006年期间，对309名女性进行了经皮股动脉以下血管重建术。将手术、并发症、人口统计学、合并症及随访数据录入前瞻性数据库进行分析。主要通过双功超声评估血管通畅情况。采用Kaplan-Meier曲线表示预后，并通过对数秩检验进行比较。
共分析了对309名女性实施的447次经皮介入治疗，并与对男性实施的553次介入治疗进行比较。女性的平均年龄为73.2岁；合并症包括高血压（HTN）（86%）、糖尿病（DM）（58%）慢性肾功能不全（CRI）（15%）、血液透析（7%）、高胆固醇血症（52%）、冠状动脉疾病（CAD）（42%）及吸烟（47%）。女性的治疗指征包括间歇性跛行（38.0%）、静息痛（18.8%）及组织缺损（43.2%）。女性患者24个月时的总体一期和二期通畅率及肢体挽救率分别为38%±4%、66%±3%和80%±4%。在该患者样本中，女性比男性更易出现肢体威胁性缺血（61.6%对47.3%，P<0.001），且TASC C和D级严重病变的发生率更高（71.4%对61.7%，P<0.005）。然而，男女之间的一期和二期通畅率及肢体挽救率并无显著差异。此外，虽然有肢体威胁、糖尿病及TASC严重程度较高病变的女性总体失败风险增加，但具有这些特征的女性和男性之间并无差异。
经皮股动脉以下血管重建术对下肢闭塞性疾病的女性患者是一种非常有效的治疗方式。尽管该样本中的女性比男性更易出现肢体威胁，但男女之间的通畅率及肢体挽救率相当。即使在糖尿病患者或TASC严重程度较高病变患者等高风险亚组中也是如此。
