Department of Surgery, Slingeland Hospital, Doetinchem, The Netherlands.
J Endovasc Ther. 2012 Dec;19(6):797-804. doi: 10.1583/JEVT-12-3941MR.1.
To evaluate the 4-year results of polytetrafluoroethylene (PTFE)-covered stents in the treatment of iliac artery occlusive disease.
Between January 2003 and September 2010, PTFE-covered stents were implanted in 115 iliac arteries of 87 patients (73 men; mean age 60 ± 11 years) in a single center. The lesions were classified as TASC II A (n=40), B (n=41), C (n=7), and D (n=27). There were 69 primary endograft placements, while 46 procedures were performed after previous bare metal stent placement (reintervention group). Follow-up consisted of clinical investigation, ankle-brachial index (ABI) measurement, and duplex ultrasound scanning. In this retrospective analysis, outcomes were reported on a per-limb basis.
The median Rutherford classification decreased from category 3 at baseline to 0 after the procedure (p<0.001) and the ABI increased from 0.66 ± 0.24 to 0.89 ± 0.21 (p<0.001). The primary limb patency was significantly higher in the primary treatment group (p=0.03): 88.7% at 1 year, 86.4% at 2 years, and 71.5% at 4 years compared to the reintervention group (77.9%, 72.1%, and 53.0%, respectively). Univariate analysis revealed prior stent placement as the only factor associated with loss of primary patency. The freedom from target lesion revascularization (TLR) in the primary treatment group was 95.2% at 1 year, 89.6% at 2 years, and 74.4% at 4 years, which did not differ significantly from rates in the reintervention group (88.0%, 82.3%, and 63.8%, respectively).
The use of PTFE-covered stents for occlusive disease in the iliac arteries is related to satisfactory limb patency rates and high freedom from TLR. Previous stent placement was related to a lower primary patency rate. Additional studies are indicated to establish subgroups that may specifically benefit from covered stents.
评估聚四氟乙烯（PTFE）覆膜支架治疗髂动脉闭塞性疾病的 4 年结果。
2003 年 1 月至 2010 年 9 月，在一家中心对 87 例患者（73 例男性；平均年龄 60±11 岁）的 115 条髂动脉植入了 PTFE 覆膜支架。病变分为 TASC II A（n=40）、B（n=41）、C（n=7）和 D（n=27）。46 例为初次裸金属支架置入后的再次介入治疗（再治疗组），69 例为初次覆膜支架置入。随访包括临床检查、踝肱指数（ABI）测量和双功超声检查。在这项回顾性分析中，结果按肢体进行报告。
与基线时的 3 级相比，术后的 Rutherford 分级中位数从 3 级降至 0 级（p<0.001），ABI 从 0.66±0.24 升至 0.89±0.21（p<0.001）。初次治疗组的初始肢体通畅率明显更高（p=0.03）：1 年时为 88.7%，2 年时为 86.4%，4 年时为 71.5%，而再治疗组分别为 77.9%、72.1%和 53.0%。单因素分析显示，初次治疗前支架置入是影响初始通畅率的唯一因素。初次治疗组的靶病变血运重建（TLR）无失败率为 1 年时 95.2%，2 年时 89.6%，4 年时 74.4%，与再治疗组的 88.0%、82.3%和 63.8%相比无显著差异。
在髂动脉闭塞性疾病中使用 PTFE 覆膜支架与令人满意的肢体通畅率和较高的 TLR 无失败率相关。初次治疗前支架置入与初始通畅率较低相关。需要进一步的研究来确定可能从覆膜支架中获益的特定亚组。
