Eleissawy Mohamed I, Elbarbary Ahmed H, Elwagih Mohammed M, Elheniedy Mohamed A, Santoso Charista, Fourneau Inge
Department of Vascular Surgery, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt.
Department of Vascular Surgery, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt.
Ann Vasc Surg. 2019 Nov;61:55-64. doi: 10.1016/j.avsg.2019.05.062. Epub 2019 Aug 5.
Management of superficial femoral artery flush occlusion using the ipsilateral antegrade approach is challenging. The study aimed to assess technical feasibility, patency, and limb salvage of ipsilateral antegrade angioplasty versus surgery for this lesion in patients with lifestyle-limiting claudications and critical limb ischemia.
Between June 2015 and March 2018, 53 patients were randomized to either ipsilateral antegrade angioplasty (n = 28) or surgical bypass (n = 25). We included patients with Trans-Atlantic Inter-Society Consensus IIB, C, or D lesions, having a patent popliteal artery. Technical success, patency, limb salvage, and major adverse events were assessed during the 12-month follow-up.
The technical success was 100% and 89.3% in the surgical and endovascular groups, respectively (P = 0.238). At 12 months, the primary, assisted, and secondary patency rates were 72% vs. 64.5%, 78.2% vs. 74.7%, and 81.6% vs. 74.2% in the surgical versus the endovascular groups, respectively, without significant differences between both groups. Limb salvage was 88% vs. 92% in the surgical versus the endovascular group, respectively (P = 0.564). The length of hospital stay was longer in the surgical versus the endovascular group (6.24 ± 0.37 vs. 1.84 ± 0.19 days, respectively, P = 0.001). Local complications were higher in the surgical group (P = 0.046).
Technical success, patency, and limb salvage of endovascular approach were comparable to surgical bypass. The endovascular approach had the advantages of reduced local complications and hospitalization.
采用同侧顺行入路治疗股浅动脉完全闭塞具有挑战性。本研究旨在评估对于有生活方式受限型间歇性跛行和严重肢体缺血的患者，同侧顺行血管成形术与手术治疗该病变的技术可行性、通畅率和肢体挽救情况。
在2015年6月至2018年3月期间，53例患者被随机分为同侧顺行血管成形术组（n = 28）或手术旁路移植术组（n = 25）。我们纳入了患有跨大西洋两岸血管外科学会（Trans-Atlantic Inter-Society Consensus）IIB、C或D级病变且腘动脉通畅的患者。在12个月的随访期间评估技术成功率、通畅率、肢体挽救情况和主要不良事件。
手术组和血管内治疗组的技术成功率分别为100%和89.3%（P = 0.238）。在12个月时，手术组与血管内治疗组的初级通畅率、辅助通畅率和次级通畅率分别为72%对64.5%、78.2%对74.7%和81.6%对74.2%，两组之间无显著差异。手术组与血管内治疗组的肢体挽救率分别为88%对92%（P = 0.564）。手术组的住院时间长于血管内治疗组（分别为6.24 ± 0.37天和1.84 ± 0.19天，P = 0.001）。手术组的局部并发症更高（P = 0.046）。
血管内治疗方法的技术成功率、通畅率和肢体挽救情况与手术旁路移植术相当。血管内治疗方法具有局部并发症减少和住院时间缩短的优点。
