Vascular and Endovascular Surgery Department, Assiut University Hospital, Assiut, Egypt.
Vascular and Endovascular Surgery Department, Assiut University Hospital, Assiut, Egypt.
Eur J Vasc Endovasc Surg. 2020 Jun;59(6):947-955. doi: 10.1016/j.ejvs.2020.02.028. Epub 2020 Mar 27.
To assess mid term outcomes of common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with chronic limb threatening ischaemia (CLTI).
This was a prospective study. All patients who, for the first time, underwent planned one stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularisation procedure to achieve limb salvage in patients with CLTI due to multilevel disease were included between January 2015 and May 2017. Demographics, and clinical and lesion characteristics for each patient were reported. The primary outcome was primary patency. Secondary outcomes were technical success, peri-operative morbidity and mortality, assisted primary patency, secondary patency, clinically driven target lesion revascularisation and amputation free survival.
Three groups were created according to the endovascular treatment zone: group 1 (inflow, n = 60); group 2 (outflow, n = 46); and group 3 (combined inflow and outflow, n = 53). CFA endarterectomy was a fixed step in all cases. The overall technical success was 98%. The peri-operative complication rate was 14% and the mortality rate was 2%. Patients in group 3 demonstrated a significantly lower primary patency rate (53.9% ± 7.1%; p < .001) at 24 months but improved secondary patency rate of (94.0% ± 3.4%). Based on the outcomes of the Cox regression multivariable analysis, lesion length (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.06-1.14; p < .001), chronic total occlusion (CTO) (HR 0.50, 95% CI 0.25-0.98; p = .046), peripheral artery calcium scoring system (PACSS) grade 4 (HR 2.44, 95% CI 1.27-4.68; p = .008), incomplete revascularisation (HR 3.32, 95% CI 1.64-6.73; p = .001), and dyslipidaemia (HR 0.50, 95% CI 0.27-0.93; p = .031) were the only significant independent predictors of loss of primary patency.
Common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with CLTI is safe, with acceptable patency rates, despite the need for secondary interventions. Dyslipidaemia, lesion length, CTO, PACSS grade 4, and incomplete revascularisation are independent predictors of primary patency loss. The current study analysis supports the recommendation to stage the procedure based on patient risk and degree of limb threat.
评估慢性肢体威胁性缺血（CLTI）患者中，股总动脉内膜切除术联合入流出血管腔内再血管化治疗的中期结果。
这是一项前瞻性研究。2015 年 1 月至 2017 年 5 月期间，首次接受计划性一期杂交股总动脉（CFA）内膜切除术联合入流出血管腔内再血管化治疗，以实现多水平病变导致的 CLTI 肢体挽救的患者，均纳入本研究。报告了每位患者的人口统计学、临床和病变特征。主要结局为一期通畅率。次要结局为技术成功率、围手术期发病率和死亡率、辅助一期通畅率、二期通畅率、临床驱动的靶病变血运重建和无截肢生存率。
根据血管腔内治疗区域将患者分为三组：组 1（入流，n=60）；组 2（流出，n=46）；组 3（联合入流出，n=53）。所有病例均采用 CFA 内膜切除术作为固定步骤。整体技术成功率为 98%。围手术期并发症发生率为 14%，死亡率为 2%。组 3 的患者在 24 个月时表现出明显较低的一期通畅率（53.9%±7.1%；p<.001），但二期通畅率（94.0%±3.4%）得到改善。基于 Cox 回归多变量分析的结果，病变长度（风险比[HR]1.10，95%置信区间[CI]1.06-1.14；p<.001）、慢性完全闭塞（CTO）（HR 0.50，95%CI 0.25-0.98；p=0.046）、外周动脉钙评分系统（PACSS）分级 4（HR 2.44，95%CI 1.27-4.68；p=0.008）、不完全再血管化（HR 3.32，95%CI 1.64-6.73；p=0.001）和血脂异常（HR 0.50，95%CI 0.27-0.93；p=0.031）是一期通畅丧失的唯一显著独立预测因素。
尽管需要二次干预，但对于 CLTI 患者，股总动脉内膜切除术联合入流出血管腔内再血管化治疗是安全的，通畅率可接受。血脂异常、病变长度、CTO、PACSS 分级 4 和不完全再血管化是一期通畅丧失的独立预测因素。目前的研究分析支持根据患者风险和肢体威胁程度分期手术的建议。
