Baker Aaron C, Humphries Misty D, Noll Robert E, Salhan Navjeet, Armstrong Ehrin J, Williams Timothy K, Clouse W Darrin
Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, CA.
Division of Vascular Surgery, David Grant Medical Center, Travis Air Force Base, CA.
Ann Vasc Surg. 2015 Jan;29(1):55-62. doi: 10.1016/j.avsg.2014.10.011. Epub 2014 Oct 31.
Subintimal angioplasty is a common treatment for chronic total occlusions (CTOs) in the iliac and infrainguinal arteries. Although technical success has been described using intravascular ultrasound-guided reentry devices (IVUS-RED), outcomes are still not well defined. This report describes the technical aspects and longitudinal follow-up after intravascular ultrasound-guided reentry of iliac and infrainguinal CTOs.
A retrospective review was performed of 20 patients with lower extremity CTO treated with IVUS-RED from 2011 to 2013. A matched cohort of patients who underwent lower extremity interventions without the use of IVUS-RED was also identified. Procedural success, patency estimates, ankle-brachial indices (ABIs), complications, and limb salvage were analyzed.
Twenty patients (mean age, 69 ± 13 years), including 11 men and 9 women, underwent attempted IVUS-RED-guided recanalization. Median follow-up was 4.3 months (range, 0.4-24). Eleven patients presented with critical limb ischemia (CLI), and 9 presented with claudication. Technical success was achieved in 18 (90%) patients. Ten common iliac arteries, 3 external iliac arteries, and 5 superficial femoral arteries (SFA) were treated. No intraoperative complications resulted from device use. After procedure, ABIs significantly increased (0.5-0.9; P < 0.01) in the 13 patients with follow-up. Primary patency for the entire cohort was 62% at 12 months. No patient treated for claudication required reintervention, whereas 3 (27%) of those treated for CLI required repeat interventions. During follow-up, 2 patients died unrelated to the procedure, 1 patient required an amputation, and 1 patient eventually required open revascularization. When the IVUS-RED group was compared with a cohort matched on Trans-Atlantic Inter-Society Consensus and age, no difference was found in runoff scores and patency between the 2 groups during follow-up (P > 0.05).
Recanalization of CTO using IVUS-RED is safe and effective. Use of IVUS-RED does not adversely impact outcomes in conjunction with other endovascular techniques. Early follow-up demonstrates acceptable patency, especially in patients with claudication, and freedom from reintervention.
内膜下血管成形术是治疗髂动脉和腹股沟下动脉慢性完全闭塞（CTO）的常用方法。尽管使用血管内超声引导再通装置（IVUS-RED）已报道了技术成功率，但结局仍未明确界定。本报告描述了髂动脉和腹股沟下CTO血管内超声引导再通后的技术细节及长期随访情况。
对2011年至2013年期间接受IVUS-RED治疗的20例下肢CTO患者进行回顾性研究。同时确定一组未使用IVUS-RED进行下肢介入治疗的匹配患者队列。分析手术成功率、通畅率评估、踝肱指数（ABI）、并发症及肢体挽救情况。
20例患者（平均年龄69±13岁），包括11例男性和9例女性，尝试接受IVUS-RED引导下的再通治疗。中位随访时间为4.3个月（范围0.4 - 24个月）。11例患者表现为严重肢体缺血（CLI），9例表现为间歇性跛行。18例（90%）患者获得技术成功。共治疗了10条髂总动脉、3条髂外动脉和5条股浅动脉（SFA）。使用该装置未导致术中并发症。术后，13例接受随访患者的ABI显著升高（从0.5至0.9；P < 0.01）。整个队列12个月时的初级通畅率为62%。接受间歇性跛行治疗的患者无需再次干预，而接受CLI治疗的患者中有3例（27%）需要重复干预。随访期间，2例患者非手术相关死亡，1例患者需要截肢，1例患者最终需要进行开放血管重建术。将IVUS-RED组与根据跨大西洋跨学会共识和年龄匹配的队列进行比较时，随访期间两组的血流灌注评分和通畅率无差异（P > 0.05）。
使用IVUS-RED对CTO进行再通是安全有效的。IVUS-RED的使用与其他血管内技术联合应用时不会对结局产生不利影响。早期随访显示通畅率可接受，尤其是在间歇性跛行患者中，且无需再次干预。
