Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands.
Department of Vascular Surgery, OLVG, Amsterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2018 Nov;56(5):690-698. doi: 10.1016/j.ejvs.2018.06.063. Epub 2018 Aug 11.
The recent ESC guideline advises primary stent placement in superficial femoral arterial disease (SFAD). The aim of this study was to compare clinical outcomes of SFAD patients selected for stent placement with plain percutaneous transluminal angioplasty (PTA).
A single centre retrospective, observational analysis was performed of all consecutive patients undergoing endovascular treatment for SFAD from 2004 to 2015. Primary endpoints were primary and secondary clinical patency rates in patients with or without stent placement. Secondary endpoints were recurrence rates and number of amputations. Kaplan-Meier curves were used to compare patency rates. Multivariable Cox regression analysis was performed to adjust for confounding variables and to identify variables associated with loss of patency.
A total of 389 patients were analysed with a median follow up of 42 months. Two hundred and fifty one patients (64.5%) were stented. Primary clinical patency rates at 1, 3, and 5 years were 82.8%, 71.0%, and 65.6% after PTA and 76.3%, 65.7%, and 58.1% after stent placement (PTA-S), respectively (p = .30). Secondary patency rates were also comparable for the PTA and PTA-S group resulting in 1, 3 and 5 year clinical secondary patency of 89.1%, 81.0%, and 76.3% in the PTA group versus 87.8%, 78.5%, and 71.9% in the PTA-S group (p = .58). Multivariable analysis revealed equal primary and secondary clinical patency between the treatment groups. The absolute re-intervention rate was 29.3%. The number of re-interventions and amputation rate did not significantly differ between the two groups (p = .41 and p = .75).
Selective stenting in patients with SFAD shows comparable results in long-term clinical outcomes in patients who were treated with plain PTA as well as patients who are selected for stent placement. An approach of selective stenting is justified.
最近的 ESC 指南建议在股浅动脉疾病（SFAD）中进行初次支架置入。本研究旨在比较选择支架置入与单纯经皮腔内血管成形术（PTA）治疗的 SFAD 患者的临床结局。
对 2004 年至 2015 年期间行腔内治疗的所有连续 SFAD 患者进行单中心回顾性观察性分析。主要终点是支架置入组和非支架置入组患者的主要和次要临床通畅率。次要终点是复发率和截肢率。采用 Kaplan-Meier 曲线比较通畅率。采用多变量 Cox 回归分析调整混杂变量，并确定与通畅丧失相关的变量。
共分析了 389 例患者，中位随访时间为 42 个月。251 例（64.5%）患者行支架置入。PTA 组 1、3、5 年的主要临床通畅率分别为 82.8%、71.0%和 65.6%，支架置入组分别为 76.3%、65.7%和 58.1%（P=0.30）。两组次要通畅率也相似，PTA 组 1、3、5 年临床次要通畅率分别为 89.1%、81.0%和 76.3%，PTA-S 组分别为 78.5%、71.9%和 66.5%（P=0.58）。多变量分析显示，两组间主要和次要临床通畅率相等。绝对再干预率为 29.3%。两组间再干预和截肢率无显著差异（P=0.41 和 P=0.75）。
在 SFAD 患者中选择性支架置入与单纯 PTA 治疗患者以及选择支架置入的患者相比，其长期临床结局相似。选择性支架置入的方法是合理的。
