Division of Vascular Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA.
J Endovasc Ther. 2011 Oct;18(5):624-37. doi: 10.1583/11-3539.1.
To evaluate the role of endovascular therapy in the management of infrainguinal arterial chronic total occlusions (CTOs).
Data on all patients with CTOs treated at a single center from 2004 to 2010 were extracted from a prospectively maintained database for retrospective analysis. Patient demographics, angiographic studies, noninvasive vascular test results, and clinical outcomes were evaluated. In this time frame, 481 patients (283 men; mean age 71.7±11.5 years, range 52-85) with claudication (n = 177) or critical limb ischemia (CLI, n = 304) were treated for 688 CTOs. Lesions were segregated according to location [SFA (n = 193), popliteal (n = 67), tibial (n = 217), and multilevel (n = 211)] and analyzed based on treatment mode (angioplasty, angioplasty with stenting, or atherectomy) and clinical indication. Primary patency, assisted primary patency, and secondary patency, as well as limb salvage rates for CLI patients, were calculated.
At 2 years in claudicants with CTOs confined to the SFA, primary patency ranged from 44% to 58% and secondary patency to 92% depending on treatment type; there were no significant differences among the treatments. However, in CLI patients with SFA CTOs, atherectomy produced better outcomes at 2 years (p = 0.002 for primary and p = 0.012 for secondary patency) than angioplasty alone. The limb salvage rates ranged from 73% to 91% (no differences among treatment types). In diabetics, CTOs treated with angioplasty and stent had improved secondary patency rates over angioplasty alone.
The endovascular management of CTO results in reasonable primary patency; moreover, secondary patency at 2 years is excellent. Endovascular therapy should be the first-line option for many patients with peripheral artery disease, including those with CLI, claudicants with poor bypass conduit, or patients at high medical risk for surgery. The presence of CTOs does not appear to change these recommendations. Although multiple reinterventions may be required, endovascular therapies can be considered a primary therapy for many patients with CTO.
评估腔内治疗在治疗下肢动脉慢性完全闭塞（CTO）中的作用。
从 2004 年至 2010 年在单一中心接受治疗的所有 CTO 患者的数据均从前瞻性维护的数据库中提取出来进行回顾性分析。评估患者的人口统计学、血管造影研究、无创血管检查结果和临床结局。在此期间，688 例 CTO 患者（283 名男性；平均年龄 71.7±11.5 岁，范围 52-85 岁）中有 177 名跛行患者（跛行组）和 304 名严重肢体缺血（CLI）患者（CLI 组）接受了治疗。根据病变位置[股浅动脉（SFA，n=193）、腘动脉（n=67）、胫动脉（n=217）和多节段（n=211）]和治疗方式（单纯血管成形术、血管成形术联合支架置入术或动脉旋切术）进行病变分类，并根据临床指征进行分析。计算 CLI 患者的一期通畅率、辅助一期通畅率、二期通畅率和保肢率。
在单纯 SFA 慢性完全闭塞的跛行患者中，2 年时单纯血管成形术的一期通畅率为 44%-58%，二期通畅率为 92%，取决于治疗类型，各治疗方式之间无显著差异。然而，在 SFA CTO 的 CLI 患者中，动脉旋切术的 2 年时的效果优于单纯血管成形术（p=0.002 用于一期通畅率，p=0.012 用于二期通畅率）。保肢率为 73%-91%（治疗方式之间无差异）。在糖尿病患者中，血管成形术联合支架置入术治疗的 CTO 较单纯血管成形术具有更好的二期通畅率。
CTO 的腔内治疗可获得合理的一期通畅率；此外，2 年时的二期通畅率也非常好。血管腔内治疗应成为大多数外周动脉疾病患者的一线治疗选择，包括 CLI 患者、旁路血管较差的跛行患者或手术风险较高的患者。CTO 的存在似乎并没有改变这些建议。尽管可能需要多次再介入，但血管内治疗可以被认为是许多 CTO 患者的主要治疗方法。
