Thiney Pierre-Olivier, Millon Antoine, Boudjelit Tarek, Della Schiava Nellie, Feugier Patrick, Lermusiaux Patrick
Service de Chirurgie Vasculaire, Groupement Hospitalier Edouard Herriot, CHU, Lyon, France.
Service de Chirurgie Vasculaire, Groupement Hospitalier Edouard Herriot, CHU, Lyon, France; Faculté de Médecine Lyon 1, Université Claude Bernard Lyon 1, Lyon, France.
Ann Vasc Surg. 2015 Jul;29(5):960-7. doi: 10.1016/j.avsg.2015.02.001. Epub 2015 Mar 9.
To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) of atherosclerotic lesions of the common femoral artery (CFA) and its bifurcation.
From 2009 to 2013, 53 patients (43 men, average age, 68 years) were included in a single-center, nonrandomized, prospective study. Indication was disabling intermittent claudication (n = 36) or chronic critical limb ischemia (n = 17). Thirty-four procedures (64%) were isolated CFA PTA, whereas 7 of 53 (13%) involved inflow (including 4 iliac occlusions) and 12 of 53 (23%) involved outflow vessels. Primary stenting was performed in 50 cases (95%). CFA occlusions were recanalized in 4 of 53. Lesions involved the bifurcation in 22 cases (40%). Follow-up consisted of clinical examination and duplex scanning with ankle-brachial index measurement at 1, 6, and 12 months. A biplane X-ray was performed at 1 year. The primary end point was the absence of binary restenosis (>50% reobstruction of the CFA). Secondary end points were freedom from target lesion revascularization (TLR) and stent fracture rate.
Procedural success was achieved in 96% of cases. At a mean follow-up of 24 months (with 1 patient lost of follow-up), the absence of binary restenosis was 92.5%. At the end of follow-up, 82% of patients continued to show clinical improvement. Freedom from TLR was 97%. Stent fracture rate at 1 year was 9%.
PTA of the CFA and its bifurcation is a reliable technique with good midterm functional results. These results justify performing a randomized study comparing surgery and endovascular treatment.
评估经皮腔内血管成形术（PTA）治疗股总动脉（CFA）及其分叉处动脉粥样硬化病变的疗效。
2009年至2013年，53例患者（43例男性，平均年龄68岁）纳入一项单中心、非随机、前瞻性研究。入选标准为致残性间歇性跛行（n = 36）或慢性严重肢体缺血（n = 17）。53例中有34例（64%）为单纯CFA PTA，53例中有7例（13%）涉及流入道（包括4例髂动脉闭塞），53例中有12例（23%）涉及流出道血管。50例（95%）患者进行了初次支架置入。53例中有4例CFA闭塞病变成功再通。22例（40%）病变累及分叉处。随访包括临床检查以及在1、6和12个月时进行双功超声扫描并测量踝肱指数。1年时进行双平面X线检查。主要终点为无二元再狭窄（CFA再阻塞>50%）。次要终点为免于靶病变血管重建（TLR）和支架骨折率。
96%的病例手术成功。平均随访24个月（1例失访）时，无二元再狭窄率为92.5%。随访结束时，82%的患者临床症状持续改善。免于TLR率为97%。1年时支架骨折率为9%。
CFA及其分叉处的PTA是一种可靠的技术，中期功能结果良好。这些结果证明有必要开展一项比较手术治疗和血管内治疗的随机研究。
