Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia.
Vascular Surgery Clinic, Demerdash and Ain Shams University Hospital, Cairo, Egypt; Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Eur J Vasc Endovasc Surg. 2021 Feb;61(2):258-269. doi: 10.1016/j.ejvs.2020.11.009. Epub 2020 Dec 15.
There are currently two treatments available for patients with chronic limb threatening ischaemia (CLTI): open surgical bypass (OSB) and percutaneous transluminal angioplasty with/without stenting (PTA/S). The aim of this study was to compare short and long term outcomes between PTA/S and OSB in CLTI patients with long (GLASS grade III and IV) femoropopliteal disease.
This was a two centre retrospective study including all consecutive patients with CLTI undergoing first time lower extremity intervention at two distinct vascular surgical centres. Between 1 January 2012 and 1 January 2018, 1 545 CLTI consecutive limbs were treated for femoropopliteal GLASS grade III and IV lesions at two vascular surgical centres. Using covariables from baseline and angiographic characteristics, a propensity score was calculated for each limb. Thus, comparable patient cohorts (235 in PTA/S and 235 in OSB group) were identified for further analysis. The primary outcomes were freedom from re-intervention in the treated extremity and major amputation. Secondary outcomes were all hospital complications among the two patient groups.
Total overall complication rates were significantly higher in the OSB group (20.42% vs. 5.96%, p < .001), especially wound infection/seroma rate that required prolonged hospitalisation and further treatment (7.65% vs. 0%, p < .001). After the median follow up of 61 months, re-intervention rates were significantly higher in the PTA/S group (log rank test, 44.68% vs. 29.79%, p = .002), but there was no significant difference in terms of major amputation rates between the two group of patients (log rank test, PTA/S 27.23% vs. OSB 22.13%, p = .17).
Bypass surgery seems to be superior to PTA/S for GLASS grade III and IV femoropopliteal lesions in patients with CLTI in terms of long term re-intervention rates, but with considerably higher rates of post-operative complications. A larger cohort of patients in currently ongoing randomised trials, as well as prospective cohort studies are necessary to confirm these findings.
对于患有慢性肢体威胁性缺血（CLTI）的患者，目前有两种治疗方法：开放式外科旁路（OSB）和经皮腔内血管成形术伴/不伴支架置入术（PTA/S）。本研究的目的是比较 PTA/S 和 OSB 治疗 CLTI 患者长段（GLASS 分级 III 和 IV）股腘病变的短期和长期疗效。
这是一项在两个不同血管外科中心进行的回顾性研究，共纳入所有首次接受下肢介入治疗的 CLTI 连续患者。2012 年 1 月 1 日至 2018 年 1 月 1 日，两个血管外科中心共治疗了 1545 例 CLTI 连续肢体的股腘 GLASS 分级 III 和 IV 病变。根据基线和血管造影特征的协变量，为每条肢体计算倾向评分。因此，为进一步分析确定了具有可比性的患者队列（PTA/S 组 235 例，OSB 组 235 例）。主要结局是治疗肢体的无再干预率和主要截肢率。次要结局是两组患者的所有医院并发症。
OSB 组的总并发症发生率明显高于 PTA/S 组（20.42%比 5.96%，p<0.001），尤其是需要延长住院时间和进一步治疗的伤口感染/血清肿发生率（7.65%比 0%，p<0.001）。中位随访 61 个月后，PTA/S 组的再干预率明显更高（对数秩检验，44.68%比 29.79%，p=0.002），但两组患者的主要截肢率无显著差异（对数秩检验，PTA/S 组 27.23%比 OSB 组 22.13%，p=0.17）。
在 CLTI 患者的 GLASS 分级 III 和 IV 股腘病变中，旁路手术在长期再干预率方面似乎优于 PTA/S，但术后并发症发生率较高。目前正在进行的随机临床试验和前瞻性队列研究需要纳入更大的患者队列，以证实这些发现。
