Siracuse Jeffrey J, Van Orden Kathryn, Kalish Jeffrey A, Eslami Mohammad H, Schermerhorn Marc L, Patel Virendra I, Rybin Denis, Farber Alik
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, Boston, Mass.
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, Boston, Mass.
J Vasc Surg. 2017 Apr;65(4):1039-1046. doi: 10.1016/j.jvs.2016.10.078. Epub 2016 Dec 29.
Endovascular interventions of the common (CFA) and deep (DFA) femoral arteries are becoming more common. However, there is very little published data for guidance. Our objective was to analyze practice patterns and outcomes from these interventions.
The Vascular Quality Initiative (2010-2015) was queried for all endovascular interventions of the CFA and DFA. Cases that were emergent or for acute limb ischemia were excluded. Those with isolated CFA with or without DFA treatment were analyzed.
There were 1014 patients that had either an isolated CFA intervention (946) with or without a DFA intervention (68). Average age of this isolated cohort was 67.4 ± 10.8 years, and 59% were male. Indications were claudication (67%), rest pain (16.3%), and tissue loss (16.7%). Periprocedural complications were access site hematoma (5.2%), arterial dissection (2.9%), distal embolization (0.7%), access site stenosis/occlusion (0.5%), and arterial perforation (0.6%). Thirty-day mortality was 1.6%. Survival was 92.9% at 1 year and 87.2% at 3 years. Amputation-free survival, freedom from loss of patency or death, and reintervention-free survival were 93.5%, 83%, and 87.5% at 1 year, respectively, by Kaplan-Meier analysis. Multivariable predictors of mortality were tissue loss, chronic obstructive pulmonary disease (COPD), end-stage renal disease, urgent case, and age, whereas aspirin use and non-Caucasian race were protective. Tissue loss, rest pain, COPD, end-stage renal disease, stent use, nonambulatory status, and female sex were predictive of major amputation whereas aspirin use, P2Y12 antagonist use, statin use, and initial technical success were protective. Tissue loss, case urgency and nonambulatory status predicted patency loss or death. Tissue loss, COPD, stent use, and history of prior bypass predicted reintervention.
Endovascular interventions of the CFA/DFA have a low rate of periprocedural morbidity and mortality. One-year patency is lower than historically observed for CFA endarterectomy. Stent use is associated with reinterventions and amputation. Longer-term analysis is needed to better assess durability.
股总动脉（CFA）和股深动脉（DFA）的血管内介入治疗正变得越来越普遍。然而，公开的指导数据非常少。我们的目的是分析这些介入治疗的实践模式和结果。
查询血管质量倡议（2010 - 2015年）中所有CFA和DFA的血管内介入治疗病例。排除急诊或急性肢体缺血的病例。分析单纯CFA治疗（无论是否联合DFA治疗）的病例。
有1014例患者接受了单纯CFA介入治疗（946例），其中68例同时接受了DFA介入治疗。该单纯队列的平均年龄为67.4±10.8岁，59%为男性。治疗指征为间歇性跛行（67%）、静息痛（16.3%）和组织缺损（16.7%）。围手术期并发症包括穿刺部位血肿（5.2%）、动脉夹层（2.9%）、远端栓塞（0.7%）、穿刺部位狭窄/闭塞（0.5%）和动脉穿孔（0.6%）。30天死亡率为1.6%。1年生存率为92.9%，3年生存率为87.2%。通过Kaplan-Meier分析，1年时无截肢生存率、通畅性无丧失或死亡生存率以及无再次干预生存率分别为93.5%、83%和87.5%。死亡率的多变量预测因素为组织缺损、慢性阻塞性肺疾病（COPD）、终末期肾病、急诊病例和年龄，而使用阿司匹林和非白种人种族具有保护作用。组织缺损、静息痛、COPD、终末期肾病、使用支架、非行走状态和女性性别是大截肢的预测因素，而使用阿司匹林、P2Y12拮抗剂、他汀类药物和初始技术成功具有保护作用。组织缺损、病例紧急程度和非行走状态预测通畅性丧失或死亡。组织缺损、COPD、使用支架和既往旁路手术史预测再次干预。
CFA/DFA的血管内介入治疗围手术期发病率和死亡率较低。1年通畅率低于历史上股总动脉内膜切除术的观察结果。使用支架与再次干预和截肢相关。需要进行长期分析以更好地评估耐久性。
