Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA.
Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
J Endovasc Ther. 2021 Aug;28(4):567-574. doi: 10.1177/15266028211012402. Epub 2021 May 10.
Percutaneous lower extremity revascularization is being performed via upper extremity, pedal, or popliteal access with increasing frequency. This study aimed to compare periprocedural outcomes of popliteal (POA) and upper extremity (UEA) access for the treatment of isolated superficial femoral artery (SFA) occlusive disease.
A retrospective cohort study compared the outcomes of patients undergoing primary percutaneous intervention of SFA occlusive disease with POA or UEA using the Vascular Quality Initiative database from December 2010 to June 2019. Our primary endpoint was technical success. Secondary endpoints included factors associated with perioperative complications.
A total of 349 patients underwent isolated SFA intervention through the popliteal, radial, or brachial artery. UEA was performed in 188 (53.9%) patients and POA in 161 (46.1%). Technical success with TASC A lesions was 95.8% and with TASC D lesions, 65.0%. POA had a higher proportion of TASC D lesions (24.8% vs 10.6%, p<0.001), and larger (≥7 Fr) sheath size (14.3% vs 2.7%, p<0.001). UEA had a higher proportion of no calcification (27.1% vs 11.2%, p<0.001), and smaller (4-5 Fr) sheath size (46.8% vs 34.8%, p=0.023). There was no difference in technical success between UEA and POA (88.8% vs 84.5%, p=0.230), which was also seen on multivariable analysis (p=0.985). Univariate analysis revealed technical failure was associated with TASC D lesions (45.7% vs 12.9%, p<0.001) and the presence of severe calcifications (39.1% vs 17.5%, p=0.002). Multivariable analysis confirmed technical failure was associated with degree of calcification (OR, 2.4; 95% CI, 1.18 to 4.89; p=0.016) and TASC D lesions (OR, 5.01; 95% CI, 2.45 to 10.24; p<0.001). Postoperative complications were associated with UEA on univariate (p=0.041) and multivariate analysis (OR, 2.08; 95% CI, 0.80 to 5.37; p=0.016). Access site complications were also associated with UEA compared to POA (4.3% vs 0.0%, p=0.027).
There is no difference in technical success between UEA and POA when treating isolated SFA occlusive disease, and UEA is associated with a higher complication rate. Technical success is dependent on calcification and TASC II classification. Based on similar technical success rates and low complication rates, POA should be considered as a viable alternative to UEA when planning endovascular interventions.
经皮下肢血管重建术通过上肢、足部或腘动脉进行的频率越来越高。本研究旨在比较腘动脉（POA）和上肢（UEA）入路治疗孤立性股浅动脉（SFA）闭塞性疾病的围手术期结果。
回顾性队列研究比较了 2010 年 12 月至 2019 年 6 月期间使用血管质量倡议数据库接受 SFA 闭塞性疾病经皮腔内血管成形术治疗的 POA 或 UEA 患者的结局。我们的主要终点是技术成功。次要终点包括与围手术期并发症相关的因素。
共有 349 例患者经腘动脉、桡动脉或肱动脉行孤立性 SFA 介入治疗。UEA 治疗 188 例（53.9%），POA 治疗 161 例（46.1%）。TASC A 病变的技术成功率为 95.8%，TASC D 病变的技术成功率为 65.0%。POA 有更高比例的 TASC D 病变（24.8%比 10.6%，p<0.001）和更大的（≥7 Fr）鞘管尺寸（14.3%比 2.7%，p<0.001）。UEA 有更高比例的无钙化（27.1%比 11.2%，p<0.001）和更小的（4-5 Fr）鞘管尺寸（46.8%比 34.8%，p=0.023）。UEA 和 POA 的技术成功率无差异（88.8%比 84.5%，p=0.230），多变量分析也显示如此（p=0.985）。单变量分析显示，技术失败与 TASC D 病变（45.7%比 12.9%，p<0.001）和严重钙化的存在（39.1%比 17.5%，p=0.002）有关。多变量分析证实，技术失败与钙化程度（OR，2.4；95%CI，1.18 至 4.89；p=0.016）和 TASC D 病变（OR，5.01；95%CI，2.45 至 10.24；p<0.001）有关。术后并发症与 UEA 有关（p=0.041）和多变量分析（OR，2.08；95%CI，0.80 至 5.37；p=0.016）。与 POA 相比，UEA 还与入路部位并发症相关（4.3%比 0.0%，p=0.027）。
治疗孤立性 SFA 闭塞性疾病时，UEA 和 POA 的技术成功率无差异，UEA 与更高的并发症发生率相关。技术成功率取决于钙化和 TASC II 分类。基于相似的技术成功率和较低的并发症发生率，在计划血管内介入治疗时，POA 可作为 UEA 的可行替代方案。
