Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
J Cardiol. 2021 Apr;77(4):417-423. doi: 10.1016/j.jjcc.2020.11.008. Epub 2020 Nov 20.
Endovascular treatment (EVT) for femoropopliteal artery disease is common in clinical practice. However, little is known about its prognostic factors, causes of death, and long-term clinical outcomes.
Two hundred eighty-five consecutive patients (mean age, 72±8 years, 73% men) undergoing their first EVT for de-novo femoropopliteal artery disease from 2009 to 2018 were studied. Patients were divided in two groups according to the presence of critical limb ischemia (CLI). We evaluated the incidence of major adverse limb events (MALE) including clinically driven target vessel revascularization and target limb major amputation, and all-cause death.
The procedure was successful in 97.9% of cases. The non-CLI group comprised 205 patients (72%), and the CLI group comprised 80 patients (28%). The CLI group exhibited higher high-sensitivity C-reactive protein (hs-CRP) levels and a higher rate of hemodialysis than the non-CLI group. During the median follow-up period of 3.5 years, there were 62 deaths (21.8%) including cardiovascular (32.3%), infection (32,3%), and malignancy-related (22.6%) deaths. Kaplan-Meier analysis revealed that the CLI group had a significantly higher incidence of MALE and all-cause death (log-rank, both p<0.001, respectively). The leading causes of death in the CLI group were cardiovascular- and infection-related death; the leading cause of death in the non-CLI group was malignancy-related. On multivariate Cox hazard analysis, hemodialysis, TASC II classification C/D lesions, and CLI were significant predictors of MALE (p<0.001, p=0.005, and p=0.012, respectively). Hemodialysis, age, higher hs-CRP levels, and CLI were significant predictors of all-cause death (p<0.001, p=0.003, p=0.009, and p=0.021, respectively).
Although EVT for femoropopliteal artery disease appears feasible with a high rate of procedural success, a high incidence of MALE and all-cause death was observed. Further studies are needed to improve the outcomes in patients with CLI.
股腘动脉疾病的血管内治疗（EVT）在临床实践中很常见。然而，对于其预后因素、死亡原因和长期临床结果知之甚少。
对 2009 年至 2018 年间首次接受股腘动脉疾病 EVT 的 285 例连续患者（平均年龄 72±8 岁，73%为男性）进行了研究。根据是否存在临界肢体缺血（CLI）将患者分为两组。我们评估了主要不良肢体事件（MALE）的发生率，包括临床驱动的靶血管血运重建和靶肢体主要截肢，以及全因死亡。
手术成功率为 97.9%。非 CLI 组 205 例（72%），CLI 组 80 例（28%）。CLI 组的高敏 C 反应蛋白（hs-CRP）水平较高，血液透析率也较高。在中位 3.5 年的随访期间，共有 62 例死亡（21.8%），包括心血管（32.3%）、感染（32.3%）和恶性肿瘤相关（22.6%）死亡。Kaplan-Meier 分析显示，CLI 组的 MALE 和全因死亡率均显著较高（对数秩检验，均 p<0.001）。CLI 组死亡的主要原因是心血管相关和感染相关死亡；非 CLI 组死亡的主要原因是恶性肿瘤相关。多变量 Cox 风险分析显示，血液透析、TASC II 分类 C/D 病变和 CLI 是 MALE 的显著预测因素（p<0.001、p=0.005 和 p=0.012）。血液透析、年龄、较高的 hs-CRP 水平和 CLI 是全因死亡的显著预测因素（p<0.001、p=0.003、p=0.009 和 p=0.021）。
尽管 EVT 治疗股腘动脉疾病的成功率较高，但观察到 MALE 和全因死亡率均较高。需要进一步研究以改善 CLI 患者的预后。
