跨大西洋跨学会共识II C/D型股腘动脉病变患者血管内治疗的中期结果及复发危险因素
Mid-term outcomes of endovascular treatment and risk factors for recurrence in patients with Trans-Atlantic-Inter-Society II C/D femoropopliteal lesions.
作者信息
Lin Yisheng, Li Weihao, Liu Wendao, Liu Min, Li Yin, Chen Yong
机构信息
Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.
出版信息
Quant Imaging Med Surg. 2021 May;11(5):2028-2039. doi: 10.21037/qims-20-221.
BACKGROUND
The purpose of this study was to determine the efficacy of interventional endovascular treatment (EVT) and the risk factors for postoperative restenosis in patients with Trans-Atlantic Inter-Society Consensus (TASC) II C/D femoropopliteal lesions.
METHODS
A total of 55 patients who received EVT for TASC II C/D femoropopliteal lesions (64 affected limbs) from October 2014 to September 2017 were examined. The mean lesion length was 19.6±5.3 (range, 15.5-26.4 cm). The femoropopliteal lesions were classified as TASC II C and TASC II D in 39 and 16 cases, respectively. The ankle-brachial index (ABI), primary patency rate, secondary patency rate, and limb salvage rate were monitored in follow-up evaluations for up to 24 months. A Cox regression model was used to evaluate the correlation between each of these factors and the restenosis rate after EVT.
RESULTS
Patent TASC II C/D femoropopliteal lesions were present in 59 of the 64 limbs. The mean ABI values for the dorsal pedal artery and posterior tibial artery increased 1 month after treatment from a baseline level of 0.35±0.12 to 0.89±0.10 and from 0.43±0.15 to 0.90±0.13, respectively (P<0.01). The mean follow-up time was 19.3 (range, 6-24) months. The cumulative primary patency rates at 1, 3, 6, 12, 18, and 24 months were 98.3%, 91.5%, 84.3%, 61.1%, 53.1%, and 31.1%, respectively. The secondary patency rates at 12 and 24 months were 70.4% and 60.0%, respectively. Factors with a high hazard ratio included male sex, TASC II D, smoking, and diabetes mellitus (DM).
CONCLUSIONS
EVT had a safe and satisfactory mid-term therapeutic effect on TASC II C/D femoropopliteal lesions. Male sex, TASC II D (compared to TASC II C), smoking, and DM were risk factors for restenosis. EVT has a secondary patency rate comparable to that of open surgery and can be considered a first-line treatment for TASC II C/D femoropopliteal lesions.
背景
本研究旨在确定经皮腔内血管成形术（EVT）治疗跨大西洋跨学会共识（TASC）II C/D 型股腘动脉病变患者的疗效以及术后再狭窄的危险因素。
方法
对 2014 年 10 月至 2017 年 9 月期间因 TASC II C/D 型股腘动脉病变接受 EVT 治疗的 55 例患者（64 条患肢）进行检查。平均病变长度为 19.6±5.3（范围 15.5 - 26.4 cm）。股腘动脉病变分别为 TASC II C 型 39 例和 TASC II D 型 16 例。在长达 24 个月的随访评估中监测踝肱指数（ABI）、一期通畅率、二期通畅率和肢体挽救率。采用 Cox 回归模型评估这些因素与 EVT 术后再狭窄率之间的相关性。
结果
64 条肢体中有 59 条 TASC II C/D 型股腘动脉病变血管通畅。治疗 1 个月后，足背动脉和胫后动脉的平均 ABI 值从基线水平 0.35±0.12 分别增至 0.89±0.10，从 0.43±0.15 增至 0.90±0.13（P<0.01）。平均随访时间为 19.3（范围 6 - 24）个月。1、3、6、12、18 和 24 个月时的累积一期通畅率分别为 98.3%、91.5%、84.3%、61.1%、53.1%和 31.1%。12 个月和 24 个月时的二期通畅率分别为 70.4%和 60.0%。高风险比因素包括男性、TASC II D 型、吸烟和糖尿病（DM）。
结论
EVT 对 TASC II C/D 型股腘动脉病变具有安全且令人满意的中期治疗效果。男性、TASC II D 型（与 TASC II C 型相比）、吸烟和 DM 是再狭窄的危险因素。EVT 的二期通畅率与开放手术相当，可被视为 TASC II C/D 型股腘动脉病变的一线治疗方法。
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