Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland.
Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland; Department of Vascular Surgery, Cairo University Hospital, Cairo, Egypt.
Ann Vasc Surg. 2021 May;73:234-243. doi: 10.1016/j.avsg.2020.11.024. Epub 2020 Dec 25.
Endovascular therapy (EVT) is being adopted by many surgeons as a suitable first choice in the treatment of most femoropopliteal disease when clinically indicated. However, there are multiple factors affecting the outcome of EVT including the anatomy of lesions and distal runoff status. The evidence of runoff effect on the outcome of superficial femoral artery (SFA) interventions is still scarce and not well studied in the current literature. The aim of this study was to investigate the effect of runoff score on the outcomes of SFA endovascular interventions.
Retrospective analysis was carried out on prospectively collected data on patients who underwent SFA endovascular intervention for critical limb ischemia (CLI) in a single tertiary center. Patients with Rutherford categories 4, 5, and 6 who did not have any previous vascular interventions were included in the study. The modified SVS runoff score was used after calculating scores from popliteal and all tibial vessels. Runoff was stratified into good (score <5), compromised (score 5-10), and poor (score >10). Amputation-free survival, patency rates, and overall survival were compared between all groups at 5 years.
Between 2011 and 2018, 254 procedures were performed in 220 patients. Technical success was >92%; 66 patients required SFA stents, and 55 had concomitant tibial angioplasty. There was no significant difference between good, compromised, or poor runoff groups regarding complication rates, with 3.5% overall perioperative mortality (5 cases in the compromised group and 4 in the poor runoff group). A runoff score of <5 was associated with significantly marked clinical improvement (P < 0.001). Patency rates were significantly worse in the compromised and poor runoff groups, with 5-year cumulative primary patency rates of 80%, 50%, and 22% in the good, compromised, and poor runoff groups, respectively (P < 0.001). Amputation-free survival worsened as the runoff got poorer with 98%, 91%, and 78% in the good, compromised, and poor runoff groups, respectively, at 5 years (P < 0.001). SFA stenting and concomitant tibial angioplasty led to slight improvement in patency rates in the poor runoff group.
Poor runoff with a score of >10 was associated with significantly reduced amputation-free survival and patency rates at 5 years in patients undergoing SFA endovascular intervention for CLI. Patients with a runoff score of <5 showed marked clinical improvement postoperatively when compared with patients with a runoff score of ≥5.
腔内治疗 (EVT) 正在被许多外科医生作为治疗大多数股腘疾病的首选方法，只要临床需要。然而，有许多因素会影响 EVT 的结果，包括病变的解剖结构和远端流出道状态。目前的文献中关于流出道效应对股浅动脉 (SFA) 介入治疗结果的影响证据仍然很少且研究不足。本研究旨在探讨流出道评分对 SFA 腔内干预结果的影响。
对在一家三级中心接受 SFA 腔内介入治疗严重肢体缺血 (CLI) 的患者前瞻性收集的数据进行回顾性分析。本研究纳入了 Rutherford 分类 4、5 和 6 且无任何先前血管介入治疗的患者。计算腘动脉和所有胫后血管的分数后，采用改良 SVS 流出道评分。流出道分为良好（评分<5）、受损（评分 5-10）和差（评分>10）。比较所有组在 5 年时的免于截肢生存率、通畅率和总体生存率。
2011 年至 2018 年，220 例患者共进行了 254 次手术。技术成功率>92%；66 例患者需要 SFA 支架，55 例患者需要同时进行胫前动脉成形术。在并发症发生率方面，良好、受损或差流出道组之间无显著差异，围手术期总死亡率为 3.5%（受损组 5 例，差流出道组 4 例）。流出道评分<5 与明显的临床改善显著相关（P<0.001）。受损和差流出道组的通畅率明显较差，5 年累积原发性通畅率分别为 80%、50%和 22%，在良好、受损和差流出道组（P<0.001）。随着流出道变差，免于截肢生存率恶化，5 年时良好、受损和差流出道组分别为 98%、91%和 78%（P<0.001）。SFA 支架置入和同时进行的胫前动脉成形术可略微改善差流出道组的通畅率。
在 CLI 患者中接受 SFA 腔内介入治疗时，评分>10 的差流出道与 5 年时明显降低的免于截肢生存率和通畅率显著相关。与流出道评分≥5 的患者相比，流出道评分<5 的患者术后临床改善明显。
