Department of Vascular and Endovascular Surgery, Santa Marcelina Hospital, São Paulo, Brazil.
Department of Vascular and Endovascular Surgery, Santa Marcelina Hospital, São Paulo, Brazil.
J Vasc Surg. 2019 May;69(5):1510-1518. doi: 10.1016/j.jvs.2018.08.176. Epub 2019 Jan 2.
The outcomes of endovascular treatment of femoropopliteal atherosclerotic lesions have been improving recently. Although open repair is indicated for class D femoropopliteal lesions based on the TransAtlantic Inter-Society Consensus II (TASC II) document, in some cases, it is reasonable to use the endovascular approach for these lesions. The aim of this study was to retrospectively analyze the technical aspects and outcomes of treating TASC II D femoropopliteal disease with endovascular approaches.
In total, 91 procedures between January 2011 and December 2016 were retrospectively analyzed. We collected data corresponding to the technical aspects and outcomes of treatment from an electronic database. Images and videos of all procedures were reviewed. Among the 91 procedures, 70 were for popliteal artery occlusions involving the trifurcation vessels, and 12 were for superficial femoral artery (SFA) occlusions of >20 cm in length; 9 procedures for occlusions meeting both criteria were also performed. The χ test was employed for statistical analyses, and logistic regression analyses were conducted to identify risk factors. Patency, wound healing, and survival were analyzed using the Kaplan-Meier method. Statistical significance was considered at P < .05.
Approximately 44.4% of all patients were male. The mean age was 67.3 ± 20.7 years. Hypertension, diabetes, current smoker, kidney impairment, coronary disease, and cardiac insufficiency were identified in 92.3%, 66.6%, 21.7%, 7.6%, 25.6%, and 62.8% of the patients, respectively. All included patients had critical limb ischemia (11.5%, 84.6%, and 3.8% of cases corresponding to Rutherford categories 4, 5, and 6, respectively). Technical failure was observed in three patients (3.3%). The mean number of stents used was 0.7 ± 0.65 per patient. Primary patency at 30 days, 1 year, 2 years, and 3 years was 91%, 60.1%, 55.7%, and 50.6%, respectively. Limb salvage at 30 days, 1 year, 2 years, 3 years, and 4 years was 95.2%, 82.2%, 76.9%, 71.8%, and 63.7%, respectively. Reinterventions were necessary in 11.1% of the patients. Comparison of curves revealed significant differences in the 60-day primary patency for the SFA and popliteal groups (standard error, <10%; log-rank, P = .039). Analysis of the risk and technical factors affecting primary patency, limb salvage, and overall survival indicated that female sex was associated with poor survival (odds ratio, 8.942; 95% confidence interval, 1.105-72.36) and that the use of stents was associated with high rates of limb loss in the popliteal group (log-rank, P = .033).
For endovascular treatment of TASC II D femoropopliteal lesions, primary patency was better in patients with popliteal artery occlusions involving the trifurcation vessels than in those with SFA occlusions >20 cm in length. Female sex was associated with the risk of major amputations, and the use of stents in patients with popliteal occlusions was associated with major limb loss.
最近，股腘动脉粥样硬化病变的血管内治疗结果一直在改善。尽管根据跨大西洋血管内共识 II（TASC II）文件，对于 TASC II D 型股腘病变，开放修复是指征，但在某些情况下，对于这些病变使用血管内方法是合理的。本研究的目的是回顾性分析采用血管内方法治疗 TASC II D 型股腘病变的技术方面和结果。
共回顾分析了 2011 年 1 月至 2016 年 12 月期间进行的 91 例手术。我们从电子数据库中收集了与治疗技术方面和结果相关的数据。回顾了所有手术的图像和视频。91 例手术中，70 例为涉及三分叉血管的腘动脉闭塞，12 例为股浅动脉（SFA）闭塞>20cm；9 例同时符合上述两种标准的闭塞也进行了治疗。采用卡方检验进行统计学分析，采用逻辑回归分析识别风险因素。采用 Kaplan-Meier 方法分析通畅率、伤口愈合和生存率。P<0.05 为差异有统计学意义。
所有患者中约 44.4%为男性，平均年龄为 67.3±20.7 岁。92.3%、66.6%、21.7%、7.6%、25.6%和 62.8%的患者分别患有高血压、糖尿病、当前吸烟者、肾功能不全、冠心病和心功能不全。所有纳入的患者均有严重肢体缺血（Rutherford 分类的 4、5 和 6 级病例分别对应 11.5%、84.6%和 3.8%）。3 例患者（3.3%）出现技术失败。每位患者平均使用 0.7±0.65 个支架。30 天、1 年、2 年和 3 年的初始通畅率分别为 91%、60.1%、55.7%和 50.6%。30 天、1 年、2 年、3 年和 4 年的肢体存活率分别为 95.2%、82.2%、76.9%、71.8%和 63.7%。11.1%的患者需要再次介入治疗。SFA 组和腘动脉组的 60 天初始通畅率曲线比较差异有统计学意义（标准误差，<10%；对数秩检验，P=0.039）。分析影响初始通畅率、肢体存活率和总生存率的风险和技术因素表明，女性与生存风险增加相关（优势比，8.942；95%置信区间，1.105-72.36），而腘动脉组中支架的使用与较高的肢体丧失风险相关（对数秩检验，P=0.033）。
对于 TASC II D 型股腘动脉病变的血管内治疗，涉及三分叉血管的腘动脉闭塞患者的初始通畅率优于股浅动脉闭塞>20cm 的患者。女性与主要截肢风险相关，而在腘动脉闭塞患者中使用支架与主要肢体丧失风险相关。
