Wieker Carola Marie, Schönefeld Eva, Osada Nani, Lührs Christina, Beneking Roland, Torsello Giovanni, Böckler Dittmar
Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany.
J Vasc Surg. 2016 Oct;64(4):995-1001. doi: 10.1016/j.jvs.2016.04.036.
The aim of this study was to investigate the long-term outcome of common femoral artery thromboendarterectomy in patients with peripheral arterial occlusive disease.
The study retrospectively evaluated 713 vessels in 655 patients (75% male; mean age, 69.4 ± 9.5 years) who underwent common femoral thromboendarterectomy from January 2006 until May 2012 in two high-volume vascular centers. Critical limb ischemia was present in 221 patients, and intermittent claudication was present in 434. Three patent tibial arteries, described as runoff vessels, were available in 33% of the cohort, two were present in 28.3%, one runoff vessel was present in 23.4%, and 15.2% (n = 102) showed no runoff option. Hybrid procedures were used to treat 255 limbs (35.8%). The primary end point was primary patency (PP). Secondary patency (SP), limb salvage, and survival were the secondary end points.
Survival rates were 93.9%, 83.0%, 74.1%, and 60.1% at 1, 3, 5, and 7 years, respectively. PP was 78.5% and SP was 89.1% at 7 years. Patency rates were 97.3% (PP) and 97.8% (SP) at 6 months and 90.2% (PP) and 98.3% (SP) at 3 years, respectively, with 76 target lesion revascularizations. No significant difference was demonstrated for PP rates stratified for nonhybrid procedures and hybrid procedures (78.1% vs 78.6%; P = .22) and for critical limb ischemia vs intermittent claudication (76.3% vs 79.4%; P = .20) at 7 years. The mean ± standard deviation ankle-brachial index increased from 0.46 ± 0.3 preoperatively to 0.81 ± 0.2 postoperatively and to 0.77 ± 0.3 at 7 years (P < .001). A total of 20 major amputations were performed, achieving a limb salvage rate of 92.6%. Procedure-related complications occurred in 11.5% during 7 years of follow-up.
Open surgery for common femoral artery stenosis is safe and effective in the long-term. Endovascular therapy will need to compete with these excellent results.
本研究旨在调查外周动脉闭塞性疾病患者股总动脉血栓内膜切除术的长期疗效。
本研究回顾性评估了2006年1月至2012年5月期间在两个大型血管中心接受股总动脉血栓内膜切除术的655例患者（75%为男性；平均年龄69.4±9.5岁）的713条血管。221例患者存在严重肢体缺血，434例患者存在间歇性跛行。33%的队列中有三条通畅的胫动脉，被描述为流出道血管；28.3%的队列中有两条；23.4%的队列中有一条流出道血管；15.2%（n = 102）没有流出道选择。采用杂交手术治疗255条肢体（35.8%）。主要终点是原发性通畅率（PP）。继发性通畅率（SP）、肢体挽救率和生存率为次要终点。
1年、3年、5年和7年的生存率分别为93.9%、83.0%、74.1%和60.1%。7年时PP为78.5%，SP为89.1%。6个月时通畅率分别为97.3%（PP）和97.8%（SP），3年时分别为90.2%（PP）和98.3%（SP），有76次靶病变血管重建。7年时，非杂交手术和杂交手术分层的PP率（78.1%对78.%, P = 0.22）以及严重肢体缺血与间歇性跛行的PP率（76.3%对79.4%, P = 0.20）均无显著差异。平均±标准差踝肱指数从术前的0.46±0.3增加到术后的0.81±0.2，7年时为0.77±0.3（P < 0.001）。共进行了20次大截肢手术,肢体挽救率达到了92.6%。在7年的随访期间，与手术相关的并发症发生率为11.5%。
股总动脉狭窄的开放手术长期来看是安全有效的。血管内治疗将需要与这些优异的结果相竞争。
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