腔内治疗股总动脉病变：360 例连续手术的中期结果。

Endovascular treatment of common femoral artery disease: medium-term outcomes of 360 consecutive procedures.

机构信息

Angiology Division, Heart Center, Bad Krozingen, Germany.

出版信息

J Am Coll Cardiol. 2011 Aug 16;58(8):792-8. doi: 10.1016/j.jacc.2011.01.070.

DOI:10.1016/j.jacc.2011.01.070

PMID:21835313

Abstract

OBJECTIVES

The purpose of this study was to evaluate the technical feasability, safety, and 1-year efficacy of the endovascular treatment of atherosclerotic common femoral artery (CFA) obstructions.

BACKGROUND

Atherosclerotic CFA obstruction is a known cause of symptomatic peripheral arterial disease. Although surgical endarterectomy is considered the therapy of choice for this condition, little is known about the percutaneous options.

METHODS

Using a prospectively maintained single-center database, we retrospectively analyzed the outcomes of 360 consecutive percutaneous interventions of the CFA for atherosclerotic disease and assessed procedural success, in-hospital complications, and 1-year patency and target lesion revascularization rates.

RESULTS

Ninety-seven procedures (26.9%) were isolated CFA interventions, whereas 157 (43.6%) and 152 (42.2%) also involved inflow and outflow vessels, respectively. Bifurcation lesions were present in 140 cases (38.9%), and concomitant treatment of the profunda femoral artery was performed on 93 occasions (25.8%). Chronic total CFA occlusions were recanalized in 60 cases (16.7%). Balloon angioplasty was performed as the primary intervention in virtually all cases (98.6%), whereas stenting was needed for suboptimal angioplasty results in 133 procedures (36.9%). Failures-defined as a final angiographic result with a >30% residual stenosis-were observed on 26 occasions (7.2%). In-hospital major (i.e., requiring surgery) and minor (i.e., treated percutaneously or conservatively) complications occurred in 5 (1.4%) and 18 (5.0%) procedures, respectively. One-year follow-up data were available for 281 patients (87.5%). Restenosis >50% by duplex scanning and target lesion revascularization were observed in 74 of 268 (27.6%) and 64 of 322 (19.9%) procedures, respectively.

CONCLUSIONS

This large series suggests that the percutaneous approach may be a valid alternative to surgery for CFA atherosclerotic obstructions.

摘要

目的

本研究旨在评估腔内治疗粥样硬化性股总动脉（CFA）阻塞的技术可行性、安全性和 1 年疗效。

背景

粥样硬化性 CFA 阻塞是症状性外周动脉疾病的已知原因。虽然外科内膜切除术被认为是该病症的首选治疗方法，但对于经皮治疗方法知之甚少。

方法

我们使用前瞻性维护的单中心数据库，回顾性分析了 360 例连续的 CFA 粥样硬化性疾病经皮介入治疗的结果，并评估了手术成功率、住院并发症以及 1 年通畅率和靶病变血运重建率。

结果

97 例（26.9%）为单纯 CFA 介入治疗，157 例（43.6%）和 152 例（42.2%）分别还涉及流入和流出血管，140 例（38.9%）为分叉病变，93 例（25.8%）同时进行了股深动脉治疗。60 例（16.7%）慢性完全性 CFA 闭塞得到再通。几乎所有病例（98.6%）均采用单纯球囊血管成形术作为主要治疗手段，而 133 例（36.9%）因血管成形术效果不理想而需要支架置入。26 例（7.2%）出现失败定义为最终血管造影结果显示残余狭窄>30%。住院期间发生主要（即需要手术）和次要（即经皮或保守治疗）并发症分别为 5 例（1.4%）和 18 例（5.0%）。281 例患者（87.5%）获得 1 年随访数据。268 例中有 74 例（27.6%）和 322 例中有 64 例（19.9%）经双功能超声检查发现再狭窄>50%，靶病变血运重建。