Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Vasc Surg. 2013 Jan;57(1):37-43. doi: 10.1016/j.jvs.2012.06.097. Epub 2012 Sep 10.
This study determined the incidence and characteristics of recurrent disease after femoropopliteal angioplasty, following either selective or routine stenting of diseased site(s).
Retrospective analysis of a prospectively maintained database for femoropopliteal interventions from June 2003 to July 2010 was performed. Interventions during this period were from a single institution, followed up at 1, 3, and 6 months after initial intervention and on a semiannual basis thereafter with clinical examinations and duplex ultrasound imaging. Two groups were identified: those with routine stenting (RS; routine stenting for all diseased areas) and those with selective stenting (SS; selective stenting for only segments which exhibited compromised flow from residual stenosis or significant dissection). Patients who developed recurrent symptoms (claudication, rest pain), a decrease in ankle-brachial index (ABI) (>0.2), or duplex documentation of a significant (>80%) recurrent stenosis underwent reintervention. Patient demographics, comorbidities, Trans-Atlantic Inter-Society Consensus (TASC) II classification, runoff, and degree of calcification (none, mild, moderate, severe) at initial intervention were recorded. The time to reintervention and recurrence pattern were recorded for both groups.
During the study period, 746 endovascular interventions in 477 patients were performed. Total reintervention rate, including bypass, amputation, and asymptomatic occlusion after initial intervention, was 36.48% (group SS, 42.9%; group RS, 33.1%; P=.04). Of all initial interventions, 182 endovascular reinterventions in 165 patients for recurrent femoropopliteal disease were identified (group SS, 70; group RS, 95). No differences were noted among the groups in gender, comorbidities, initial TASC II classification, run off, calcification scores, or statin or clopidogrel use, or both. Time to recurrence was similar in the RS and SS groups. TASC II classification, runoff score, and degree of calcification were similar between the two groups. Although not statistically significant, analysis of recurrence pattern demonstrated de novo stenosis was more common in the SS group (50.0% vs 34.7%; P=.06).
This single-center retrospective study found a significant difference in the incidence of recurrence requiring reintervention between patients treated with selective and routine stenting for femoropopliteal disease. Analysis of endovascular reinterventions, however, reveals no significant difference in recurrence time or recurrence pattern between the two groups. No significant differences were identified in time to recurrence, TASC II classification, runoff, and calcification of endovascular reinterventions between the two groups' end points. Additional prospective studies to evaluate the roles of routine and selective stenting in symptomatic femoropopliteal peripheral arterial disease and to investigate recurrence lesion characteristics and the patency of multiple endovascular interventions between these two groups are needed.
本研究旨在确定选择性或常规病变部位支架置入后股腘动脉成形术后复发疾病的发生率和特征。
对 2003 年 6 月至 2010 年 7 月期间股腘动脉介入治疗的前瞻性数据库进行回顾性分析。该期间的介入治疗均来自单一机构，在初次介入治疗后 1、3 和 6 个月以及此后每半年进行临床检查和双功能超声检查。将患者分为两组：常规支架置入组（RS；对所有病变部位进行常规支架置入）和选择性支架置入组（SS；仅对残余狭窄或严重夹层导致血流受损的节段进行选择性支架置入）。出现复发症状（跛行、静息痛）、踝肱指数（ABI）下降（>0.2）或双功能超声显示有明显（>80%）再狭窄的患者需要进行再次介入治疗。记录患者的人口统计学资料、合并症、跨大西洋腔内血管外科学会共识（TASC）II 分类、流出道和初始介入时的钙化程度（无、轻度、中度、重度）。记录两组患者的再次介入时间和复发模式。
在研究期间，对 477 例患者的 746 次血管内介入治疗进行了分析。初次介入治疗后包括旁路、截肢和无症状闭塞在内的总再次介入率为 36.48%（SS 组为 42.9%，RS 组为 33.1%；P=0.04）。所有初始介入治疗中，共发现 165 例患者的 182 次股腘动脉再介入治疗（SS 组 70 例，RS 组 95 例）。两组间性别、合并症、初始 TASC II 分类、流出道评分、他汀类药物或氯吡格雷的使用或两者均无差异。RS 组和 SS 组的复发时间无差异。两组间 TASC II 分类、流出道评分和钙化程度相似。虽然无统计学意义，但对复发模式的分析表明，新发狭窄在 SS 组更为常见（50.0% vs 34.7%；P=0.06）。
本单中心回顾性研究发现，选择性和常规支架置入治疗股腘动脉疾病患者的再介入治疗发生率存在显著差异。然而，对血管内再介入治疗的分析显示，两组之间的复发时间或复发模式无显著差异。两组的再介入终点的再发时间、TASC II 分类、流出道和钙化的血管内再介入无显著差异。需要开展更多的前瞻性研究，以评估常规和选择性支架置入在有症状的股腘周围动脉疾病中的作用，并探讨复发病变特征和这两组之间多次血管内介入治疗的通畅性。
