对于晚期下肢动脉闭塞性疾病，股浅动脉介入治疗失败对肢体保全有显著的负面影响。
Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvage.
机构信息
Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
出版信息
J Vasc Surg. 2012 Jul;56(1):106-10; discussion 110-1. doi: 10.1016/j.jvs.2011.10.108. Epub 2012 Jan 5.
OBJECTIVE
Endovascular treatment of superficial femoral artery (SFA) lesions is a well-established practice. The repercussions of failed SFA interventions are unclear. Our goal was to review the efficacy of SFA stenting and define negative effects of its failure.
METHODS
A retrospective chart review was conducted from January 2007 to January 2010 that identified 42 limbs in 39 patients that underwent SFA stenting. Follow-up ankle-brachial index and a duplex ultrasound scan was performed at routine intervals.
RESULTS
Mean patient age was 68 years (range, 43-88 years); there were 22 men (56%) and 17 women (44%). Intervention indication was claudication in 15 patients (36%), rest pain in seven patients (17%), and tissue loss in 19 patients (45%). There were 15 patients (36%) with TransAtlantic Inter-Society Consensus (TASC) A, nine patients (21%) with TASC B, five patients (12%) with TASC C, and 13 patients (31%) with TASC D lesions. The majority of lesions intervened on were the first attempt at revascularization. Three stents (7.7%) occluded within 30 days. One-year primary, primary-assisted, and secondary patency rates were 24%, 44%, and 51%, respectively. Limb salvage was 93% during follow-up. Seventeen interventions failed (40%) at 1 year. Of these, seven patients (41%) developed claudication, seven patients (41%) developed ischemic rest pain, and three patients (18%) were asymptomatic. During follow-up, three patients (7.7%) required bypass and three patients (7.7%) major amputation, one after failed bypass. All limbs requiring bypass or amputation had TASC C/D lesions. Thirty-day and 1-year mortality was 2.6% and 10.3%, respectively.
CONCLUSIONS
Interventions performed for TASC C/D lesions are more likely to fail and more likely to lead to bypass or amputation. Interventions performed for TASC C/D lesions that fail have a negative impact on limb salvage. This should be considered when performing stenting of advanced SFA lesions.
目的
股浅动脉（SFA）病变的血管内治疗是一种成熟的治疗方法。股浅动脉介入治疗失败的后果尚不清楚。我们的目的是回顾股浅动脉支架置入术的疗效，并确定其失败的负面影响。
方法
回顾性分析 2007 年 1 月至 2010 年 1 月期间的病历，共纳入 39 例患者的 42 条肢体，均接受了股浅动脉支架置入术。常规间隔进行踝肱指数和双功超声检查。
结果
患者平均年龄为 68 岁（43-88 岁）；男性 22 例（56%），女性 17 例（44%）。介入指征为 15 例（36%）间歇性跛行，7 例（17%）静息痛，19 例（45%）组织缺失。15 例（36%）患者为 TransAtlantic Inter-Society Consensus（TASC）A 型，9 例（21%）为 TASC B 型，5 例（12%）为 TASC C 型，13 例（31%）为 TASC D 型病变。大多数病变是首次血管再通治疗。3 个支架（7.7%）在 30 天内闭塞。1 年时的原发性、原发性辅助和继发性通畅率分别为 24%、44%和 51%。随访期间肢体存活率为 93%。1 年后 17 例（40%）治疗失败。其中，7 例（41%）出现间歇性跛行，7 例（41%）出现缺血性静息痛，3 例（18%）无症状。随访期间，3 例（7.7%）需要旁路手术，3 例（7.7%）需要大截肢，其中 1 例在旁路手术后截肢。所有需要旁路或截肢的肢体均为 TASC C/D 型病变。30 天和 1 年死亡率分别为 2.6%和 10.3%。
结论
TASC C/D 型病变的介入治疗更容易失败，更有可能导致旁路或截肢。TASC C/D 型病变失败后对肢体存活率有负面影响。在进行股浅动脉晚期病变支架置入术时应考虑这一点。
Zotero 插件