Keeling Aoife N, Naughton Peter A, Khalidi Karim, Ayyoub Alaa S, Kelly Cathal K, Leahy Austin L, Bouchier-Hayes David J, Athanasiou Thanos, Lee Michael J
Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
J Vasc Interv Radiol. 2009 Sep;20(9):1133-40. doi: 10.1016/j.jvir.2009.05.035. Epub 2009 Jul 29.
The clinical importance of angiographically detected asymptomatic lower-limb stenoses and occlusions is unknown. This study aims to (i) assess the clinical outcome of asymptomatic lesions in the lower limb, (ii) identify predictors of clinical deterioration, and (iii) determine which asymptomatic lower-limb lesions should be treated at presentation.
All 918 patients undergoing peripheral angiography with or without angioplasty over a period of 7.5 years (January 1999 through June 2006) at a single institution were retrospectively evaluated. One hundred twenty-two patients (54% men; mean age, 70.3 years; age range, 41-91 y) with angiographic stenoses (> or =50%) or occlusions on the asymptomatic leg were included. The composite endpoint of interest was major adverse clinical outcome (MACO) of the asymptomatic limb at clinical follow-up, which was defined as the development of intermittent claudication (IC), critical limb ischemia (CLI), or need for subsequent endovascular or surgical revascularization. Actuarial freedom from MACO was assessed with Kaplan-Meier curves and multivariable Cox proportional-hazards regression.
During a 4.2-year mean follow-up in 122 patients with significant concomitant asymptomatic disease, 32.8% of patients developed symptoms (13.9% with IC, 18.9% with CLI); 42.5% of these cases required revascularization. Cox regression revealed two independent predictors of MACO on the asymptomatic side: contralateral below-knee amputation (BKA; hazard ratio, 2.93; 95% CI, 1.21-7.10; P = .01) and statin treatment (hazard ratio, 3.56; 95% CI, 1.56-8.13; P = .003).
Asymptomatic peripheral angiographic stenoses and occlusions become symptomatic in one third of patients, necessitating treatment in 13.9% overall. Previous contralateral BKA and statin use were independent predictors of adverse outcome in this population. Close clinical follow-up and appropriate risk factor modification are recommended.
血管造影检测到的无症状下肢狭窄和闭塞的临床重要性尚不清楚。本研究旨在：（i）评估下肢无症状病变的临床结局；（ii）确定临床恶化的预测因素；（iii）确定哪些无症状下肢病变在就诊时应接受治疗。
对一家机构在7.5年期间（1999年1月至2006年6月）接受外周血管造影（无论是否进行血管成形术）的所有918例患者进行回顾性评估。纳入122例无症状侧血管造影显示狭窄（≥50%）或闭塞的患者（男性占54%；平均年龄70.3岁；年龄范围41 - 91岁）。感兴趣的复合终点是临床随访时无症状肢体的主要不良临床结局（MACO），定义为间歇性跛行（IC）、严重肢体缺血（CLI）的发生，或需要后续进行血管内或外科血管重建术。采用Kaplan - Meier曲线和多变量Cox比例风险回归评估无MACO的精算自由度。
在122例伴有明显无症状疾病的患者中，平均随访4.2年，32.8%的患者出现症状（13.9%为IC，18.9%为CLI）；其中42.5%的病例需要进行血管重建术。Cox回归显示无症状侧MACO的两个独立预测因素：对侧膝下截肢（BKA；风险比，2.93；95%置信区间，1.21 - 7.10；P = 0.01）和他汀类药物治疗（风险比，3.56；95%置信区间，1.56 - 8.13；P = 0.003）。
三分之一的无症状外周血管造影狭窄和闭塞患者会出现症状，总体上13.9%的患者需要治疗。既往对侧BKA和他汀类药物的使用是该人群不良结局的独立预测因素。建议进行密切的临床随访并适当调整危险因素。
