南加州血管结局改善协作组中的斑块旋切术相关并发症
Atherectomy-Associated Complications in the Southern California Vascular Outcomes Improvement Collaborative.
作者信息
Azar Yara, DeRubertis Brian, Baril Donald, Woo Karen
机构信息
Division of Vascular Surgery, Department of Surgery, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
Division of Vascular Surgery, Department of Surgery, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
出版信息
Ann Vasc Surg. 2018 May;49:241-246. doi: 10.1016/j.avsg.2017.11.029. Epub 2017 Nov 29.
BACKGROUND
Atherectomy has become an increasingly utilized modality for the endovascular treatment of peripheral arterial occlusive disease. The objective of this study was to determine the incidence and risk factors for atherectomy-associated complications.
METHODS
A retrospective review was performed for all atherectomy procedures performed between January 2011 and December 2015 in the Southern California Vascular Outcomes Improvement Collaborative. Atherectomy was defined as laser, orbital, or excisional atherectomy. Complications were dissection, perforation, and distal embolization.
RESULTS
Seven hundred twenty-nine atherectomy procedures were performed at 7 institutions by 27 practitioners. The mean age was 73 years with 415 (57%) males. Four hundred nineteen (57%) were diabetic, 673 (92%) hypertensive, 457 (63%) smokers, and 244 (34%) had coronary artery disease. Dissection occurred in 51 (7%) procedures, embolization in 23 (3.1%), and perforation in 12 (1.6%). The mean number of lesions treated per artery was the same at 1.6 in patients with any complication and no complication (P = 0.77). The total occluded length was 7.4 cm for complications versus 7.2 cm for no complication (P = 0.73). The total treated length was 12.9 cm for complications versus 11.3 cm for no complication (P = 0.03). The incidence of complications for Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions were 13% compared to 10% for TASC A/B lesions (P = 0.05). The incidence of complications in superficial femoral/popliteal lesions was 12.9% vs. 10.4% in tibial lesions (P = 0.13). In multivariable analysis, treatment length was associated with a small increased risk of complication (odds ratio = 1.02, 95% confidence interval = 1.0-1.04).
CONCLUSIONS
Increased treatment length is associated with an increased risk of atherectomy-associated complications. Demographic factors and comorbidities were not predictors of complications.
背景
斑块旋切术已成为外周动脉闭塞性疾病血管内治疗中越来越常用的一种方式。本研究的目的是确定斑块旋切术相关并发症的发生率及危险因素。
方法
对2011年1月至2015年12月在南加州血管结局改善协作组进行的所有斑块旋切术进行回顾性分析。斑块旋切术定义为激光、轨道或切除性斑块旋切术。并发症包括夹层、穿孔和远端栓塞。
结果
27名术者在7家机构共进行了729例斑块旋切术。平均年龄为73岁，男性415例（57%）。419例（57%）患有糖尿病，673例（92%）患有高血压，457例（63%）吸烟，244例（34%）患有冠状动脉疾病。51例（7%）手术发生夹层，23例（3.1%）发生栓塞，12例（1.6%）发生穿孔。发生任何并发症和未发生并发症患者每条动脉治疗病变的平均数量相同，均为1.6个（P = 0.77）。并发症患者的总闭塞长度为7.4 cm，无并发症患者为7.2 cm（P = 0.73）。并发症患者的总治疗长度为12.9 cm，无并发症患者为11.3 cm（P = 0.03）。跨大西洋跨学会共识（TASC）C/D级病变的并发症发生率为13%，而TASC A/B级病变为10%（P = 0.05）。股浅/腘动脉病变的并发症发生率为12.9%，胫动脉病变为10.4%（P = 0.13）。多变量分析显示，治疗长度与并发症风险略有增加相关（比值比 = 1.02，95%置信区间 = 1.0 - 1.04）。
结论
治疗长度增加与斑块旋切术相关并发症风险增加有关。人口统计学因素和合并症不是并发症的预测因素。
Zotero 插件