Methodist DeBakey Heart and Vascular Center, Department of Cardiovascular Surgery, The Methodist Hospital, 6550 Fannin, Houston, TX 77030, USA.
J Endovasc Ther. 2011 Apr;18(2):169-80. doi: 10.1583/10-3257.1.
To evaluate the outcomes of percutaneous therapy for symptomatic >50% angiographic restenosis after iliac intervention versus outcomes of the primary procedure.
A retrospective analysis was performed of 937 patients (733 men; mean age 65 years) who underwent 1532 endovascular interventions for symptomatic atherosclerotic iliac artery obstruction and were followed by duplex ultrasound between 1990 and 2009. In this population, 374 vessels restenosed (>50% on duplex); about half (176, 47%) were associated with recurrent symptoms. In 102 symptomatic patients (58 men; mean age 61 years), 147 limbs (84%) had repeat angioplasty/stenting and were compared to the primary treatment group.
Thirty-day mortality was <1% in both primary and recurrent treatment groups, but morbidity was doubled in the reintervention group (4% versus 8%; p<0.05). While the incidence of systemic complications was low in both groups, the drivers for increased morbidity in the recurrent group were lesion-specific and access-site complications. In the 937-patient cohort, the rate of >50% restenosis on duplex was 15%±1% at 5 years. Gender (p = 0.03), diabetes (p = 0.04), metabolic syndrome (p = 0.001), symptoms (p<0.001), angioplasty alone (p = 0.04), concurrent superficial femoral artery occlusion (p = 0.02), and increasing complexity of the iliac intervention (p = 0.02) were associated with primary failure. Patency rates at 10 years for primary versus recurrent treatment were 73%±2% versus 66±8% for primary patency (p = 0.004); 88%±2% versus 74%±7% for assisted primary patency (p = 0.005); and 90%±2% versus 78%±10% for secondary patency (p = 0.002). Female gender (p = 0.01), continued smoking (p = 0.02), eGFR <60 mL/min/1.73m(2) (p = 0.03), lesion length (p = 0.02), lesion calcification (p = 0.005), and TASC II category (p = 0.04) negatively influenced patency of recurrent lesions. Sustained clinical success (absence of recurrent symptoms) was 74%±2% in the primary group and 66%±8% in the restenotic group (p = 0.014) at 10 years. Symptoms (p = 0.04), female gender (p = 0.002), hypertension (p = 0.004), eGFR <60 mL/min/1.73 m(2) (p = 0.02), external iliac artery disease (p = 0.02), lesion length (p = 0.02), and poor immediate clinical outcome (p<0.001) negatively influenced clinical success of recurrent lesions.
Percutaneous reintervention for recurrent iliac artery disease has a higher procedure-related morbidity compared to primary intervention. Longer-term outcomes are also poorer than for primary lesions. The patients who present with restenosis are more likely to be younger and of female gender than patients presenting for primary intervention. Both patency and functional outcomes after reintervention are worse than those for primary interventions.
评估髂动脉介入治疗后症状性＞50%血管造影再狭窄的经皮治疗结果与初次治疗结果的对比。
回顾性分析了 937 名（733 名男性；平均年龄 65 岁）因症状性动脉粥样硬化性髂动脉阻塞而行 1532 次血管内介入治疗的患者，1990 年至 2009 年间进行了双功超声随访。在该人群中，374 支血管发生再狭窄（双功超声显示＞50%）；约一半（176 支，47%）与复发性症状相关。在 102 名有症状的患者（58 名男性；平均年龄 61 岁）中，147 条肢体（84%）进行了重复血管成形术/支架置入，并与初次治疗组进行了比较。
初次和再治疗组的 30 天死亡率均＜1%，但再介入组的发病率增加了一倍（4%对 8%；p＜0.05）。虽然两组的全身并发症发生率较低，但再治疗组发病率增加的原因是病变特异性和入路并发症。在 937 例患者队列中，双功超声显示 5 年内再狭窄率为 15%±1%。性别（p=0.03）、糖尿病（p=0.04）、代谢综合征（p=0.001）、症状（p＜0.001）、单纯血管成形术（p=0.04）、同时伴有股浅动脉闭塞（p=0.02）和髂动脉介入治疗复杂性增加（p=0.02）与初次治疗失败相关。初次治疗与再治疗的 10 年通畅率分别为原发性通畅率 73%±2%与 66±8%（p=0.004）；辅助原发性通畅率 88%±2%与 74%±7%（p=0.005）；继发性通畅率 90%±2%与 78%±10%（p=0.002）。女性（p=0.01）、持续吸烟（p=0.02）、eGFR＜60 mL/min/1.73 m2（p=0.03）、病变长度（p=0.02）、病变钙化（p=0.005）和 TASC II 分类（p=0.04）对再发病变的通畅率有负面影响。初次治疗组的持续临床成功率（无复发性症状）为 74%±2%，再狭窄组为 66%±8%（p=0.014），随访 10 年。症状（p=0.04）、女性（p=0.002）、高血压（p=0.004）、eGFR＜60 mL/min/1.73 m2（p=0.02）、髂外动脉疾病（p=0.02）、病变长度（p=0.02）和即刻临床结局不良（p＜0.001）对再发病变的临床成功率有负面影响。
与初次介入治疗相比，髂动脉疾病复发患者的经皮再介入治疗相关发病率更高。长期结果也比初次病变差。与初次治疗的患者相比，出现再狭窄的患者更年轻，且女性比例更高。再介入治疗后的通畅率和功能结局均比初次治疗差。
