Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan.
J Endovasc Ther. 2014 Apr;21(2):289-95. doi: 10.1583/13-4489MR.1.
To compare the safety and success of a retrograde approach using a microcatheter vs. a sheath in the treatment of superficial femoral artery (SFA) chronic total occlusions (CTOs).
From April 2007 to December 2012, 188 consecutive patients underwent EVT for 229 de novo SFA CTOs using the retrograde approach in 68 patients (35 men; mean age 72 years). This cohort was divided into cases performed with a 4-F or 6-F sheath (n=28, 36 limbs) and those with a 2.1-F microcatheter (n=35, 49 limbs). The primary outcomes were mean time to hemostasis and number of intra- and postoperative puncture site complications, as well as the success of popliteal artery puncture, lesion crossing, and reperfusion.
There were no significant differences between two groups in baseline characteristics. PA puncture was successful in all limbs, and the success in crossing the lesion with the wire was not significantly different (91.9% in the sheath group vs. 89.8% in the microcatheter group). Mean time to hemostasis was 8.9±8.8 minutes in the microcatheter group vs. 47.7±13 minutes in the sheath group (p<0.0001). There was a significant difference in intraoperative and postoperative complications (22.2% in the sheath group vs. 2.0% in the microcatheter group, p=0.002).
Based on this retrospective analysis, the use of a microcatheter for SFA CTO retrograde access appears to be superior to 4-F or 6-F sheaths in terms of shorter time to hemostasis and fewer complications.
比较使用微导管和鞘管逆行入路治疗股浅动脉（SFA）慢性完全闭塞（CTO）的安全性和成功率。
2007 年 4 月至 2012 年 12 月，188 例连续患者因 229 例新发 SFA CTO 接受 EVT，其中 68 例患者（35 例男性；平均年龄 72 岁）采用逆行入路。该队列分为使用 4-F 或 6-F 鞘管（n=28，36 条肢体）和 2.1-F 微导管（n=35，49 条肢体）的病例。主要结果是止血的平均时间和术中及术后穿刺部位并发症的数量，以及腘动脉穿刺、病变穿越和再灌注的成功率。
两组在基线特征上无显著差异。所有肢体均成功进行 PA 穿刺，钢丝穿越病变的成功率无显著差异（鞘管组 91.9%，微导管组 89.8%）。微导管组止血的平均时间为 8.9±8.8 分钟，鞘管组为 47.7±13 分钟（p<0.0001）。术中及术后并发症有显著差异（鞘管组 22.2%，微导管组 2.0%，p=0.002）。
基于这项回顾性分析，使用微导管进行 SFA CTO 逆行入路在止血时间更短和并发症更少方面似乎优于 4-F 或 6-F 鞘管。
