Jobst Vascular Institute, Toledo, OH; The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Jobst Vascular Institute, Toledo, OH.
Ann Vasc Surg. 2022 Aug;84:270-278. doi: 10.1016/j.avsg.2022.01.015. Epub 2022 Jan 31.
To assess whether stent-grafts crossing the hinge point (HP) in the popliteal artery are associated with increased complications and decreased patency rates, after endovascular treatment of the popliteal artery aneurysm.
This was a single-center, case-control study. Patients were allocated to either the HP group (subjects with stent-grafts crossing the HP) or the control group (subjects with stent-grafts above and/or below the HP) based on stent-graft location in the femoropopliteal artery. HP was defined as the main curve in the popliteal artery in the most acute angle toward the femur that appeared during knee flexion, which was identified by reviewing postoperative angiograms. Independent, blinded reviews were performed for all imaging data. Graft evaluation by CTA or duplex ultrasound was performed at 1, 3, 6, and 12 months and annually thereafter. Outcomes measured included: stent-graft patency, stent-graft fracture, other stent-related complications, and major adverse events, including reintervention, death, amputation, stroke, and myocardial infarction.
A total of 44 limbs treated with placement of heparin-bonded Viabahn endoprostheses were included in this study. Twenty and twenty-four patients were allocated to the HP group and the control group, respectively. Primary patency rates of the HP group at 1, 2, 3, and 5 years were 84.1 ± 8.4%, 84.1 ± 8.4%, 84.1 ± 8.4%, and 72.1 ± 13.3%, respectively. The primary patency rates of the control group were 87.0 ± 7.0%, 82.4 ± 8.0%, 82.4 ± 8.0%, and 82.4 ± 8.0%, respectively. There was no significant difference between the 2 groups (P = 0.81). No reintervention was performed in the control group. In the HP group, 5 limbs (25.0%) developed endoleak, 3 (15.0%) developed thrombosis, and 1 (5.0%) developed a stent fracture followed by thrombosis. Thrombosis occurred in 2 limbs (8.3%) of the control group, and stent-graft migration was observed in another 2 cases (8.3%). Neither group demonstrated stent-graft infection or acute popliteal artery embolism. Overall, incidence of stent-related complications were significantly higher in the HP group (P= 0.04). Event-free survival rates of the HP group at 1, 2, 3, and 5 years were 75.0 ± 9.7%, 69.6 ± 10.4%, 61.9 ± 11.8%, and 29.0 ± 12.8%, respectively. Corresponding rates in the control group were 79.2 ± 8.3%, 79.2 ± 8.3%, 79.2 ± 8.3%, and 79.2 ± 8.3%, respectively. The difference was not statistically significant between the 2 groups (P = 0.20) CONCLUSIONS: crossing the HP with femoropopliteal artery stent-grafts increased the risk of stent-related complications and reinterventions but did not decrease stent patency or event-free survival.
为了评估在治疗腘动脉瘤时，支架-移植物穿过腘动脉铰链点（HP）是否会增加并发症的发生和降低通畅率，我们进行了这项研究。
这是一项单中心、病例对照研究。根据支架-移植物在股腘动脉中的位置，将患者分为 HP 组（支架-移植物穿过 HP 的患者）或对照组（支架-移植物位于 HP 上方和/或下方的患者）。HP 定义为膝关节弯曲时出现的向股骨方向最锐角的腘动脉主曲，通过回顾术后血管造影来确定。所有的影像学数据都进行了独立、盲法的评估。术后 1、3、6 和 12 个月以及此后每年进行 CTA 或双功能超声检查评估移植物通畅情况。测量的结果包括：支架-移植物通畅率、支架-移植物断裂、其他与支架相关的并发症和主要不良事件，包括再次介入、死亡、截肢、卒中和心肌梗死。
本研究共纳入了 44 条接受肝素结合 Viabahn 支架置入术治疗的肢体。20 例和 24 例患者分别被分配到 HP 组和对照组。HP 组在术后 1、2、3 和 5 年的主通畅率分别为 84.1±8.4%、84.1±8.4%、84.1±8.4%和 72.1±13.3%。对照组的主通畅率分别为 87.0±7.0%、82.4±8.0%、82.4±8.0%和 82.4±8.0%。两组之间无显著差异（P=0.81）。对照组无再次介入治疗。在 HP 组中，5 条肢体（25.0%）发生内漏，3 条（15.0%）发生血栓形成，1 条（5.0%）发生支架断裂后血栓形成。对照组有 2 条肢体（8.3%）发生血栓形成，另有 2 例（8.3%）发生支架移位。两组均未发生支架感染或急性腘动脉栓塞。总体而言，HP 组支架相关并发症的发生率明显更高（P=0.04）。HP 组在术后 1、2、3 和 5 年的无事件生存率分别为 75.0±9.7%、69.6±10.4%、61.9±11.8%和 29.0±12.8%。对照组相应的生存率分别为 79.2±8.3%、79.2±8.3%、79.2±8.3%和 79.2±8.3%。两组之间无显著差异（P=0.20）。
支架-移植物穿过腘动脉 HP 会增加支架相关并发症和再次介入的风险，但不会降低支架通畅率或无事件生存率。
