Lee Michael S, Heikali Daniel, Mustapha Jihad, Adams George, Mahmud Ehtisham
1 UCLA Medical Center, Los Angeles, CA, USA.
2 Metro Health Hospital, Wyoming, MI, USA.
Vasc Med. 2017 Aug;22(4):301-306. doi: 10.1177/1358863X17708254. Epub 2017 May 26.
This analysis compared the angiographic outcomes of patients treated with orbital atherectomy for calcified common femoral artery (CFA) and superficial femoral artery (SFA) disease. The ideal revascularization strategy for CFA disease is unknown. Endarterectomy has been considered the standard of care for CFA disease for over 50 years. Endovascular intervention is becoming more commonly used to revascularize the CFA given the advances in technology and the less invasive nature of the procedure. Patient demographics, lesion characteristics, and procedure data for all CONFIRM patients with at least one CFA lesion location ( n=147 patients; n=200 lesions) were compared to patients with at least one SFA lesion location ( n=1508 patients; n=2367 lesions). The primary endpoint was angiographic complication, defined as the composite of dissection, perforation, slow flow, closure, spasm, embolism, or thrombosis. The CFA group had more patients with Rutherford class 4 and shorter lesion length. The CFA group had a higher final residual stenosis, shorter total run time, and shorter total inflation time. The primary endpoint was lower in the CFA group compared with the SFA group (17% vs 24%, p=0.02), driven by a lower dissection rate (10% vs 15%, p=0.04). Plaque modification of the CFA with orbital atherectomy was safe and compared favorably with SFA disease. The need for bail-out stenting was low. A randomized trial is needed to determine the ideal treatment strategy for calcified CFA disease.
本分析比较了接受眼眶旋切术治疗钙化股总动脉（CFA）和股浅动脉（SFA）疾病患者的血管造影结果。CFA疾病的理想血运重建策略尚不清楚。在过去50多年里，内膜切除术一直被视为CFA疾病的治疗标准。鉴于技术进步和手术侵入性较小，血管内介入治疗越来越普遍地用于CFA的血运重建。将所有至少有一个CFA病变部位的CONFIRM患者（n = 147例患者；n = 200个病变）的患者人口统计学、病变特征和手术数据与至少有一个SFA病变部位的患者（n = 1508例患者；n = 2367个病变）进行比较。主要终点是血管造影并发症，定义为夹层、穿孔、血流缓慢、闭塞、痉挛、栓塞或血栓形成的综合情况。CFA组中Rutherford 4级患者更多，病变长度更短。CFA组的最终残余狭窄更高，总运行时间更短，总充盈时间更短。与SFA组相比，CFA组的主要终点更低（17%对24%，p = 0.02），这是由更低的夹层发生率（10%对15%，p = 0.04）驱动的。眼眶旋切术对CFA的斑块修饰是安全的，与SFA疾病相比具有优势。补救性支架置入的需求较低。需要进行一项随机试验来确定钙化CFA疾病的理想治疗策略。
