Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
J Vasc Surg. 2013 Dec;58(6):1547-55. doi: 10.1016/j.jvs.2013.05.107. Epub 2013 Aug 1.
Intraluminal femoropopliteal stenting enables favorable dilation and good immediate results; however, whether this contributes to long-term patency is unclear. We compared patency after femoropopliteal stenting for a long occlusion using either an intraluminal or subintimal approach.
Between January 2004 and December 2011, 902 endovascular procedures using either an intraluminal approach (651 procedures) or a subintimal approach (251 procedures) for long femoropopliteal occlusion were analyzed retrospectively. The outcomes of this study were periprocedural complication; primary, assisted-primary, and secondary patency; and overall survival.
The mean follow-up period of survivors was 29 ± 16 months. Between the intraluminal and subintimal approach, technical success (91% vs 90%; P = .71) and periprocedural complications (11% vs 13%; P = .34) were similar. However, procedure time was significantly longer for the intraluminal approach (126 ± 63 minutes vs 98 ± 49 minutes; P = .003). The improvement of ankle-brachial index was also similar. A quarter of cases started with the intraluminal approach were switched to a subintimal approach. There was no significant difference in primary, assisted-primary and secondary patency at 3 years between the two groups (55% vs 53%; P = .30; 65% vs 74%; P = .11; and 80% vs 85%; P = .37). The 3-year overall survival also did not differ significantly between groups (84% vs 86%; P = .55). After adjusting for baseline differences, the subintimal approach was found to be similar to the intraluminal approach for primary patency (hazard ratio, 1.21; 95% confidence interval, 0.94-1.56; adjusted P = .14).
Initial result and 3-year patency was similar in both approaches. Given the longer procedure time and high crossover rate, we suggest that a subintimal approach may be preferred in the treatment of long femoropopliteal occlusions with stenting.
腔内股腘动脉支架置入术可实现良好的扩张和即时效果，但长期通畅情况尚不清楚。我们比较了腔内和内膜下两种方法治疗股腘长段闭塞的通畅率。
2004 年 1 月至 2011 年 12 月，对 902 例腔内治疗（651 例）和内膜下治疗（251 例）的股腘长段闭塞患者进行回顾性分析。该研究的结局包括围手术期并发症、一期通畅率、辅助一期通畅率、二期通畅率和总生存率。
存活患者的平均随访时间为 29 ± 16 个月。腔内组和内膜下组在技术成功率（91%比 90%，P =.71）和围手术期并发症发生率（11%比 13%，P =.34）方面无显著差异。但腔内组的手术时间显著长于内膜下组（126 ± 63 分钟比 98 ± 49 分钟，P =.003）。踝肱指数的改善也相似。开始采用腔内治疗的患者中有四分之一转为内膜下治疗。两组患者 3 年时的一期通畅率、辅助一期通畅率和二期通畅率差异均无统计学意义（55%比 53%，P =.30；65%比 74%，P =.11；80%比 85%，P =.37）。两组患者 3 年总生存率也无显著差异（84%比 86%，P =.55）。在校正基线差异后，内膜下组与腔内组一期通畅率相似（风险比，1.21；95%置信区间，0.94-1.56；调整后 P =.14）。
两种方法的初始结果和 3 年通畅率相似。鉴于手术时间较长且转归率较高，我们建议在治疗股腘长段闭塞时，支架置入术可优先采用内膜下入路。
