Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Policlinico di Tor Vergata, 00133, Rome, Italy.
Cardiovasc Intervent Radiol. 2013 Feb;36(1):75-83. doi: 10.1007/s00270-012-0344-x. Epub 2012 Jan 26.
The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access.
Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 ± 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56 patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted.
Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 ± 1.1 vs. 15.7 ± 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively).
The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.
本研究旨在描述腔内（EV）替代技术，并评估其在减少经股动脉顺行腔内血管重建术治疗复杂膝下（BTK）闭塞失败率方面的可行性和疗效，这些闭塞病变无法用传统的顺行入路进行治疗。
2007 年 12 月至 2010 年 11 月，我院对 1035 例（557 例男性）肢体严重缺血患者进行 EV 治疗。124 例（12%[83 例男性]，平均年龄 68.2±0.5 岁）患者经股动脉顺行血运重建术尝试失败，采用了替代方法。术后 1 个月和 6 个月进行随访。结果与 56 例 2002 年 11 月至 2007 年 11 月间采用传统技术治疗失败而未采用非常规技术的患者进行了比较。
119 例（96%）患者技术上获得成功。1 个月和 6 个月的保肢率分别为 96.8%和 83%。1 个月和 6 个月时，分别有 16 例（12.9%）和 33 例（26.6%）患者接受再介入治疗。1 个月时，经皮氧分压升高（44.7±1.1 对 15.7±0.8 毫米汞柱；p<0.001），随访时保持稳定。20 例（16.1%）患者需要进行大截肢。随访期间，13 例（10.4%）患者死亡。在我们之前的经验中，经皮腔内血管成形术失败、截肢和死亡率分别为 10.9%、39.2%和 23.2%。替代技术可显著降低大截肢和死亡率（p=0.0001 和 p=0.02）。
在经股动脉顺行 BTK 血运重建术尝试失败的情况下，采用替代技术是可行的，在治疗复杂闭塞病变时可以降低失败率，同时在 6 个月时提供满意的临床成功率。
