Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia - IDPC, Sao Paulo, Sao Paulo, Brazil.
Department of Vascular Surgery, Hospital Municipal Dr. Carmino Caricchio - HMCC, Sao Paulo, Sao Paulo, Brazil.
Eur J Vasc Endovasc Surg. 2022 Jul;64(1):41-48. doi: 10.1016/j.ejvs.2022.04.036. Epub 2022 May 7.
Great efforts have been made to choose between bypass surgery and angioplasty as the first choice for revascularisation in chronic limb threatening ischaemia (CLTI). Endovascular therapy predominates despite limited evidence for its advantages. The purpose of this observational cohort study was to investigate outcomes after open and endovascular infrapopliteal revascularisation in extensive infrainguinal arterial disease.
The medical records of 1 427 patients who underwent infrainguinal revascularisation exclusively for CLTI in the period January 2014 to February 2019 were reviewed. After detailed analysis, only infrapopliteal revascularisations classified as GLASS stage II or III were considered, resulting in 326 procedures. In total, 127 patients underwent endovascular therapy and 199 patients underwent bypass graft surgery (BGS). The primary endpoints included amputation free survival (AFS) and overall survival (OS). Secondary endpoints included the analyses of multiple factors related to long term AFS.
Regarding the primary endpoint, AFS was 75.2% and 65.2% at one and three years, respectively. OS at one and three years was 91.2% and 83.1%, respectively. In the univariable analysis, the hazard of the combined endpoint of major amputation or death was higher after bypass surgery than after endovascular therapy (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.13 - 2.89; p = .013). After either revascularisation method, TASC II femoropopliteal D was associated with a higher risk of amputation or death (HR 1.69, 95% CI 1.10 - 2.58; p = .015). Multivariable Cox regression analysis revealed no association between the variables analysed for AFS.
Patients with CLTI submitted to infrapopliteal revascularisation and classified as GLASS II and III had satisfactory AFS and OS rates after an individualised team conference decision. Furthermore, the revascularisation modality (endovascular or open) did not influence the AFS results.
在慢性肢体威胁性缺血（CLTI）中，人们已经做出了巨大的努力来选择旁路手术和血管成形术作为首选的血运重建方法。尽管腔内治疗的优势有限，但它仍占主导地位。本观察性队列研究的目的是探讨广泛下肢动脉疾病患者接受腘下腔内和血管外血运重建的结局。
回顾了 2014 年 1 月至 2019 年 2 月期间仅因 CLTI 接受下肢血运重建的 1427 例患者的病历。经过详细分析，仅考虑 GLASS 分期 II 或 III 的腘下血运重建，共 326 例。共 127 例患者接受腔内治疗，199 例患者接受旁路移植术（BGS）。主要终点包括免于截肢的生存率（AFS）和总生存率（OS）。次要终点包括与长期 AFS 相关的多种因素的分析。
在主要终点方面，1 年和 3 年的 AFS 分别为 75.2%和 65.2%。1 年和 3 年的 OS 分别为 91.2%和 83.1%。在单变量分析中，旁路手术后主要截肢或死亡的联合终点的风险高于腔内治疗（风险比 [HR] 1.80，95%置信区间 [CI] 1.13 - 2.89；p=0.013）。在任何一种血运重建方法后，TASC II 股腘型 D 与截肢或死亡风险增加相关（HR 1.69，95%CI 1.10 - 2.58；p=0.015）。多变量 Cox 回归分析显示，AFS 分析的变量之间没有关联。
接受腘下血运重建且分类为 GLASS II 和 III 的 CLTI 患者，在个体化团队会议决策后，具有令人满意的 AFS 和 OS 率。此外，血运重建方式（腔内或开放）不影响 AFS 结果。
