University of Vermont Medical Center, Burlington, VT, USA.
University of Vermont College of Medicine, Burlington, VT, USA.
J Endovasc Ther. 2020 Apr;27(2):205-210. doi: 10.1177/1526602820908056. Epub 2020 Feb 19.
To describe the use and 1-year outcomes of retrograde pedal access during peripheral vascular interventions (PVI) for chronic limb-threatening ischemia (CLTI). From October 2016 to September 2017, 159 patients (mean age 71±10 years; 112 men) undergoing PVI via retrograde pedal access were enrolled in the multicenter Vascular Quality Initiative (VQI) registry. The pedal access approach included retrograde femoral (40%), antegrade femoral (26%), retrograde to antegrade femoral (22%), and pedal only (11%). A comparator group of 1972 patients (mean age 69±12 years; 1129 men) having a contralateral retrograde femoral access was established for propensity matching, which resulted in 156 patients per group. Procedure characteristics, technical success, and access site complications were compared. Major adverse limb events (MALE) and amputation-free survival (AFS) at 1 year were analyzed using the Kaplan-Meier method and Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI). Technical failure was similar for retrograde femoral and pedal access (7% vs 13%, p=0.07). Complications were rare and included access site hematoma (2 vs 5, p=0.32) and target artery thrombosis (0 vs 2) for the femoral vs pedal access groups, respectively. The rates of MALE at 1 year were significantly lower after retrograde femoral access (24%) compared with pedal access (38%; log-rank p=0.01; HR 1.95, 95% CI 1.15 to 3.30). AFS estimates at 1 year were similar: 86% for retrograde femoral and 83% for pedal access (log-rank p=0.37; HR 1.32, 95% CI 0.73 to 2.39), as were major amputation estimates: 10% for retrograde femoral access and 13% for pedal access group (log-rank p=0.21; HR 1.58, 95% CI 0.77 to 3.26). In this analysis of multicenter registry data, retrograde pedal access in patients with CLTI had similar technical success and early complications in comparison with traditional contralateral retrograde femoral access. The rates of MALE were higher after pedal access but AFS was similar, indicating a tradeoff between limb salvage and repeat interventions.
描述慢性肢体威胁性缺血 (CLTI) 患者外周血管介入治疗 (PVI) 中逆行足动脉入路的使用情况和 1 年结果。2016 年 10 月至 2017 年 9 月，159 例（平均年龄 71±10 岁；112 例男性）接受逆行足动脉入路 PVI 的患者纳入多中心血管质量倡议（VQI）登记处。足动脉入路包括逆行股动脉（40%）、顺行股动脉（26%）、逆行至顺行股动脉（22%）和仅足动脉（11%）。为了倾向匹配，建立了 1972 例（平均年龄 69±12 岁；1129 例男性）对侧逆行股动脉入路的对照组，每组匹配 156 例患者。比较手术特点、技术成功率和入路部位并发症。采用 Kaplan-Meier 法和 Cox 比例风险模型分析 1 年时的主要肢体不良事件（MALE）和免于截肢的生存率（AFS），以计算风险比（HR）和 95%置信区间（CI）。逆行股动脉和足动脉的技术失败率相似（7%比 13%，p=0.07）。并发症罕见，包括股动脉组和足动脉组的入路部位血肿（2%比 5%，p=0.32）和靶动脉血栓形成（0 比 2）。1 年后逆行股动脉入路的 MALE 发生率明显低于足动脉入路（24%比 38%；log-rank p=0.01；HR 1.95，95%CI 1.15 至 3.30）。1 年时的 AFS 估计值相似：逆行股动脉组为 86%，足动脉组为 83%（log-rank p=0.37；HR 1.32，95%CI 0.73 至 2.39），主要截肢估计值也相似：逆行股动脉组为 10%，足动脉组为 13%（log-rank p=0.21；HR 1.58，95%CI 0.77 至 3.26）。在这项多中心登记处数据的分析中，CLTI 患者的逆行足动脉入路与传统的对侧逆行股动脉入路相比，具有相似的技术成功率和早期并发症。足动脉入路后 MALE 发生率较高，但 AFS 相似，表明保肢与重复干预之间存在权衡。
