Giusca Sorin, Lichtenberg Micheal, Hagstotz Saskia, Eisenbach Christoph, Katus Hugo A, Erbel Christian, Korosoglou Grigorios
Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
Department of Angiology, Klinikum Arnsberg, Arnsberg, Germany.
Heart Vessels. 2020 Mar;35(3):346-359. doi: 10.1007/s00380-019-01498-8. Epub 2019 Sep 17.
To compare antegrade versus retrograde recanalization, in terms of procedural time, radiation and contrast agent exposure, number and total length of implanted stents and procedural complications, in long and calcified, de novo femoropopliteal occlusions. We performed retrospective matching of prospectively acquired data by lesion length, occlusion length and lesion calcification by the peripheral arterial calcium scoring system (PACSS) score in patients who were referred for endovascular treatment due to symptomatic peripheral artery disease (PAD). Forty-two consecutive patients with antegrade and 23 patients with retrograde after failed antegrade recanalization were identified (mean lesion length = 32.1 ± 6.9 cm; mean occlusion length = 24.6 ± 7.7 cm; PACSS score = 3.25 ± 0.91). 23% of the patients had intermittent claudication, whereas 77% exhibited critical limb ischemia (CLI). Patients who underwent retrograde versus antegrade recanalization required a significantly lower number of stents (0.9 ± 1.0 versus 1.8 ± 1.4, p = 0.01) and a lower total stent length (6.8 ± 8.5 cm versus 11.7 ± 9.9 cm, p < 0.05) in the interest of more extensive coverage of the lesions using drug coated balloons (DCB) (28.5 ± 12.0 cm versus 18.2 ± 16.0 cm, p = 0.01). No re-entry device was required with the retrograde versus 9 of 42 (21%) with the antegrade recanalization group (p = 0.02). The rate of complications due to retrograde puncture was low (one patient with hematoma and one with distal pseudoaneurysm, both managed conservatively). In long and calcified femoropopliteal occlusions, the retrograde approach is associated with a lower number of re-entry devices and stents and with more extensive lesion coverage with DCB, in the interest of costs and possibly long-term patency.German Clinical Trials Register: DRKS00015277.
为比较顺行与逆行再通术在手术时间、辐射和造影剂暴露、植入支架的数量和总长度以及手术并发症方面的差异，研究对象为长段钙化的初发股腘动脉闭塞病变。我们对因症状性外周动脉疾病（PAD）接受血管内治疗的患者，根据病变长度、闭塞长度和病变钙化情况，采用外周动脉钙化评分系统（PACSS）评分对前瞻性获取的数据进行回顾性匹配。确定了42例接受顺行再通术的连续患者和23例顺行再通失败后接受逆行再通术的患者（平均病变长度 = 32.1 ± 6.9 cm；平均闭塞长度 = 24.6 ± 7.7 cm；PACSS评分 = 3.25 ± 0.91）。23%的患者有间歇性跛行，而77%表现为严重肢体缺血（CLI）。与顺行再通术相比，接受逆行再通术的患者所需支架数量显著减少（0.9 ± 1.0 对比 1.8 ± 1.4，p = 0.01），总支架长度也较短（6.8 ± 8.5 cm对比11.7 ± 9.9 cm，p < 0.05），这有利于使用药物涂层球囊（DCB）更广泛地覆盖病变（28.5 ± 12.0 cm对比18.2 ± 16.0 cm，p = 0.01）。逆行再通术无需使用再入路装置，而顺行再通术组42例中有9例（21%）需要（p = 0.02）。逆行穿刺引起的并发症发生率较低（1例血肿患者和1例远端假性动脉瘤患者，均保守治疗）。在长段钙化的股腘动脉闭塞病变中，逆行入路与再入路装置和支架数量减少以及DCB对病变的更广泛覆盖相关，这有利于控制成本并可能提高长期通畅率。德国临床试验注册编号：DRKS00015277。
