Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
J Vasc Surg. 2012 Jul;56(1):118-25. doi: 10.1016/j.jvs.2011.12.066. Epub 2012 Feb 17.
The purpose of this study was to assess the 1-year patency rates of heparin-bonded covered stents in the treatment of chronic occlusive disease of the superficial femoral artery (SFA).
All patients treated with a heparin-bonded endograft between April 2009 and October 2010 for chronic occlusive disease of the SFA were prospectively gathered in a database and retrospectively analyzed. Primary, primary-assisted, and secondary patency rates, assessed by ultrasound scanning, were analyzed at 1-year, as were the complication rates and mortality.
A total of 56 limbs were treated with a heparin-bonded covered stent in 53 patients for chronic ischemia Rutherford category 3 (n = 36), 4 (n = 5), 5 (n = 11), and 6 (n = 1). Lesions were classified as TransAtlantic Inter-Society Consensus (TASC)-2-B (n = 9), C (n = 14), and D (n = 33), and the mean treated lesion length was 18.5 ± 7.7 cm. Postoperative complications occurred in 7.5%, including hematoma (n = 1), edema (n = 1), pneumonia (n = 1), and urinary retention (n = 1), and the 30-day mortality rate was 0%. The mean follow-up was 413 ± 208 days. At 1 year, the primary patency was 76%, the primary-assisted patency 82%, and the secondary patency 89%. The limb salvage rate was 100%.
Heparin-bonded covered stents seem to provide a valid alternative to surgical treatment of long occlusive lesions in the SFA. Randomized trials and long-term data are required before considering the technique as a new standard of care.
本研究旨在评估肝素结合涂层支架治疗股浅动脉(SFA)慢性闭塞性疾病的 1 年通畅率。
2009 年 4 月至 2010 年 10 月,前瞻性地收集数据库中所有因 SFA 慢性闭塞性疾病接受肝素结合腔内移植物治疗的患者,并进行回顾性分析。通过超声扫描评估 1 年时的主要通畅率、主要辅助通畅率和次要通畅率,分析并发症发生率和死亡率。
53 例患者的 56 条肢体因慢性缺血 Rutherford 分类 3 级(n = 36)、4 级(n = 5)、5 级(n = 11)和 6 级(n = 1)接受肝素结合涂层支架治疗。病变分为 TransAtlantic Inter-Society Consensus(TASC)-2-B(n = 9)、C(n = 14)和 D(n = 33),平均治疗病变长度为 18.5 ± 7.7cm。术后并发症发生率为 7.5%,包括血肿(n = 1)、水肿(n = 1)、肺炎(n = 1)和尿潴留(n = 1),30 天死亡率为 0%。平均随访时间为 413 ± 208 天。1 年时,主要通畅率为 76%,主要辅助通畅率为 82%,次要通畅率为 89%。保肢率为 100%。
肝素结合涂层支架似乎为治疗 SFA 长段闭塞性病变提供了一种有效的手术替代方法。在将该技术视为新的治疗标准之前,需要进行随机试验和长期数据研究。