de Athayde Soares Rafael, Matielo Marcelo Fernando, Brochado Neto Francisco Cardoso, Martins Cury Marcus Vinícius, Matoso Chacon André Câmara, Nakamura Edson Takamitsu, Sacilotto Roberto
Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
J Vasc Surg. 2018 Nov;68(5):1422-1429. doi: 10.1016/j.jvs.2018.02.052. Epub 2018 May 24.
This study aimed to report the long-term limb salvage, survival and patency rates of endovascular treatment for aortoiliac occlusive disease (AIOD) when outflow was achieved through the profunda femoris artery (PFA) only vs both the PFA and superficial femoral artery (SFA).
From January 2008 to July 2016, patients with AIOD who underwent aortoiliac angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, were classified into two groups according to whether they had femoral outflow via the PFA only (group 1) or both the PFA and SFA (group 2) in the affected leg. The primary outcome was amputation-free survival. The secondary outcomes were the patency and overall survival rates.
In total, 69 aortoiliac angioplasties were performed in 69 patients: 22 patients (31.8%) in group 1 and 47 (67.2%) in group 2. A total of 12 reinterventions (17.4%) were performed, seven (31.8%) in group 1 and five (10.2%) in group 2, without statistical significance between the groups (P = .063). The mean clinical follow-up period was 2500 ± 880.5 days. Both the primary and secondary patency rates analyzed at 1800 days were similar between groups 1 and 2 (80.2% vs 82.3%; P = .80 and 84.7% vs 97.6%; P = .10, respectively). Furthermore, the limb salvage rates at 1800 days were similar between groups 1 and 2 (91.3% vs 86.1%; P = .60), as were the survival rates (74.7% vs 78%; P = .80). The Bollinger score was worse in group 1 (P = .001), as expected, because of occlusion of the SFA. However, the PFA and popliteal artery scores were similar between the two groups. Occlusion of the SFA did not influence the limb salvage rate according to univariate analysis (P = .509) and multivariate Cox regression analysis (P = .671).
The patency of the SFA does not interfere with the outcomes of endovascular treatment for chronic AIOD. The PFA in conjunction with the popliteal artery as the sole outflow route for iliac endovascular treatment is associated with similar patency, survival, and limb salvage rates as those for outflow through both the PFA and SFA.
本研究旨在报告当仅通过股深动脉（PFA）实现流出道与通过PFA和股浅动脉（SFA）两者实现流出道时，腹主动脉-髂动脉闭塞性疾病（AIOD）血管内治疗的长期肢体挽救率、生存率和通畅率。
2008年1月至2016年7月，在巴西圣保罗州立公务员医院血管与血管内外科接受腹主动脉-髂动脉血管成形术的AIOD患者，根据患侧下肢的流出道是仅通过PFA（第1组）还是同时通过PFA和SFA（第2组）分为两组。主要结局是无截肢生存率。次要结局是通畅率和总生存率。
总共对69例患者进行了69次腹主动脉-髂动脉血管成形术：第1组22例患者（31.8%），第2组47例患者（67.2%）。共进行了12次再次干预（17.4%），第1组7次（31.8%），第2组5次（10.2%），两组之间无统计学意义（P = 0.063）。平均临床随访期为2500 ± 880.5天。在1800天时分析的第1组和第2组的初级和次级通畅率相似（分别为80.2%对82.3%；P = 0.80和84.7%对97.6%；P = 0.10）。此外，第1组和第2组在1800天时的肢体挽救率相似（91.3%对86.1%；P = 0.60），生存率也相似（74.7%对78%；P = 0.80）。正如预期的那样，由于SFA闭塞，第1组的林格评分更差（P = 0.001）。然而，两组之间的PFA和腘动脉评分相似。根据单因素分析（P = 0.509）和多因素Cox回归分析（P = 0.671），SFA闭塞不影响肢体挽救率。
SFA的通畅性不影响慢性AIOD血管内治疗的结果。PFA与腘动脉联合作为髂血管内治疗的唯一流出道，其通畅率、生存率和肢体挽救率与通过PFA和SFA两者作为流出道时相似。
