Owens Christopher D, Ho Karen J, Conte Michael S
Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Semin Vasc Surg. 2008 Sep;21(3):143-53. doi: 10.1053/j.semvascsurg.2008.05.007.
Restenosis following lower-extremity revascularization remains a significant and costly public health burden. Technical advances in endovascular therapy afford us the choice of treating longer and more distal lesions, which were heretofore reserved for vein bypass surgery. While contemporary vascular surgeons are well-versed in both open and percutaneous techniques, predictive models of who is at risk for failure from a specific mode of therapy are lacking. Traditional Framingham cardiovascular risk factors have not been successful in discriminating risk for failure of peripheral bypass or angioplasty. At the heart of this is our inability to make sophisticated measurements necessary to resolve phenotypic profiles into those likely to experience restenosis versus those likely to enjoy long-term patency. In this article we outline the available literature in an epidemiological framework of the association of traditional cardiovascular risk factors, emerging risk factors, as well as novel biomarkers with failure of both endovascular and open lower-extremity reconstructive procedures.
下肢血管重建术后的再狭窄仍然是一个重大且代价高昂的公共卫生负担。血管内治疗的技术进步使我们能够选择治疗更长且更远端的病变，而这些病变此前只能通过静脉搭桥手术来处理。虽然当代血管外科医生对开放手术和经皮技术都很精通，但缺乏针对特定治疗方式失败风险的预测模型。传统的弗明汉姆心血管危险因素在区分外周搭桥或血管成形术失败风险方面并不成功。其核心问题在于，我们无法进行精细测量，以将表型特征解析为可能发生再狭窄的人群和可能长期保持通畅的人群。在本文中，我们在一个流行病学框架内概述了现有文献，内容涉及传统心血管危险因素、新兴危险因素以及新型生物标志物与血管内和开放下肢重建手术失败之间的关联。
