性别对髂动脉支架置入术后通畅率的影响。
The influence of gender on patency rates after iliac artery stenting.
机构信息
Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria; Department of Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria.
出版信息
J Vasc Surg. 2014 Jun;59(6):1588-96. doi: 10.1016/j.jvs.2014.01.010. Epub 2014 Feb 16.
OBJECTIVE
The purpose of this study was to investigate the influence of gender on the long-term outcome after iliac artery stenting and to assess gender-specific differences of the influence of risk factors on treatment success and patency rates.
METHODS
Between January 2000 and December 2006, 404 percutaneous transluminal angioplasties with primary stent deployment for symptomatic iliac artery occlusive disease were performed at our center. These included 128 interventions in women and 276 interventions in men.
RESULTS
Whereas average age was significantly higher (65.9 ± 12.9 years; P = .007) and arterial hypertension more frequent (60.9% vs 49.3%; P = .032) in women, hyperuricemia (7.0% vs 14.1%; P = .047) and a positive smoking status (61.7% vs 74.3%; P = .014) were more frequently observed in men. Fontaine stage was more advanced (stages III and IV) in women than in men (P = .028; P < .001). Technical success was 97.7% in women and 99.3% in men. Overall complication rate was higher in women compared with men (P = .002), mostly caused by access site hematomas (4.7% vs 0.4%) and pseudoaneurysms (8.6% vs 2.5%). Patients were followed up for 45.0 ± 33.3 months. Restenosis developed in 16.8% of cases in women and in 14.6% of cases in men and was treated in 73.7% by an endovascular approach. Primary patency rates at 1, 3, 5, and 7 years were 90.3%, 77.2%, 60.2%, and 46.4% in women and 89.9%, 71.5%, 63.6%, and 59.7% in men, respectively (P = .524; log-rank, .406). Secondary patency rates were 97.2%, 91%, 81.5%, and 70.3% in women and 97.1%, 89.1%, 82.6%, and 78% in men, respectively (P = .959; log-rank, .003). Multivariate analysis identified lower age as the only independent risk factor for recurrent disease in both groups. Age-defined subgroup analysis showed a restenosis/reocclusion rate of 23.9% in men and 22.1% in women older than 63.5 years (P = .861) but 32.1% in men and 49.1% in women younger than that (P = .034).
CONCLUSIONS
Our data suggest that although women are older and present with a more advanced stage of peripheral arterial occlusive disease, endovascular therapy is equally effective irrespective of gender. Surprisingly, the subgroup of young female patients had a specifically poor outcome.
目的
本研究旨在探讨性别对髂动脉支架置入术后长期疗效的影响，并评估危险因素对治疗成功率和通畅率的影响是否存在性别差异。
方法
2000 年 1 月至 2006 年 12 月，我们中心对 404 例有症状的髂动脉闭塞性疾病患者进行了经皮腔内血管成形术（PTCA），其中包括 128 例女性患者和 276 例男性患者。
结果
与男性相比，女性的平均年龄显著更高（65.9±12.9 岁；P=0.007），且动脉高血压更常见（60.9%比 49.3%；P=0.032），而高尿酸血症（7.0%比 14.1%；P=0.047）和阳性吸烟状态（61.7%比 74.3%；P=0.014）在男性中更常见。女性的 Fontaine 分期较男性更晚期（Ⅲ期和Ⅳ期）（P=0.028；P＜0.001）。女性的技术成功率为 97.7%，男性为 99.3%。女性的总体并发症发生率高于男性（P=0.002），主要是由于穿刺部位血肿（4.7%比 0.4%）和假性动脉瘤（8.6%比 2.5%）。患者平均随访 45.0±33.3 个月。16.8%的女性和 14.6%的男性出现再狭窄，并分别有 73.7%和 71.5%的患者通过血管内治疗得到了处理。女性的 1 年、3 年、5 年和 7 年的原发性通畅率分别为 90.3%、77.2%、60.2%和 46.4%，男性分别为 89.9%、71.5%、63.6%和 59.7%（P=0.524；对数秩检验，P=0.406）。女性的 2 年、7 年和 10 年的继发性通畅率分别为 97.2%、91%、81.5%和 70.3%，男性分别为 97.1%、89.1%、82.6%和 78%（P=0.959；对数秩检验，P=0.003）。多变量分析确定年龄是两组患者疾病复发的唯一独立危险因素。根据年龄定义的亚组分析显示，年龄大于 63.5 岁的男性和女性的再狭窄/再闭塞率分别为 23.9%和 22.1%（P=0.861），而年龄小于该值的男性和女性的再狭窄/再闭塞率分别为 32.1%和 49.1%（P=0.034）。
结论
我们的数据表明，尽管女性年龄较大，且外周动脉闭塞性疾病分期更晚期，但血管内治疗的效果在性别间是相当的。令人惊讶的是，年轻女性亚组的预后特别差。
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