Nakama Tatsuya, Takahara Mitsuyoshi, Iwata Yo, Fujimura Naoki, Yamaoka Terutoshi, Suzuki Kenji, Obunai Kotaro
Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
JACC Cardiovasc Interv. 2022 Jul 25;15(14):1453-1463. doi: 10.1016/j.jcin.2022.03.010. Epub 2022 Jun 29.
Thromboendarterectomy (TEA) is the gold-standard treatment for common femoral artery (CFA). However, because of its low invasiveness and short hospitalization duration, CFA endovascular therapy (EVT) is performed in real-world practice. However, the clinical benefits and appropriate target population for CFA EVT remain unclear.
The aims of this study were to compare the clinical outcomes of TEA with those of EVT in patients with symptomatic CFA diseases and to identify the adequate target population for CFA EVT.
A total of 1,193 consecutive patients who underwent EVT (n = 761) or TEA (n = 432) for CFA were identified and retrospectively reviewed from a registry of 66 institutions. The primary outcome was 1-year primary patency compared between EVT and TEA using propensity score matching. An interaction analysis was performed to explore the appropriate target population for CFA EVT.
After propensity score matching, the 1-year primary patency rate was significantly higher in the TEA group (82.3% vs 96.6%; P < 0.001), whereas perioperative complications were more frequently observed in the TEA group (P = 0.047). Nonambulatory status attenuated the HR of EVT vs TEA for restenosis risk (P = 0.021), whereas the presence of nodular calcification significantly increased the HR (P = 0.040). In the EVT subgroup analysis for restenosis risk, stent use showed the lowest HR compared with plain balloon angioplasty and drug-coated balloon angioplasty (P < 0.001).
TEA showed superior 1-year patency compared with EVT in a nationwide multicenter study. Nonambulatory status attenuated the superiority, whereas the presence of nodular calcification enhanced it.
血栓内膜切除术（TEA）是股总动脉（CFA）的金标准治疗方法。然而，由于其侵入性低和住院时间短，CFA血管内治疗（EVT）在实际临床中得到应用。然而，CFA-EVT的临床益处和合适的目标人群仍不明确。
本研究旨在比较有症状CFA疾病患者TEA与EVT的临床结局，并确定CFA-EVT的合适目标人群。
从66家机构的登记处识别并回顾性分析了1193例连续接受CFA-EVT（n = 761）或TEA（n = 432）治疗的患者。主要结局是使用倾向评分匹配比较EVT和TEA之间的1年主要通畅率。进行交互分析以探索CFA-EVT的合适目标人群。
倾向评分匹配后，TEA组的1年主要通畅率显著更高（82.3%对96.6%；P < 0.001），而TEA组围手术期并发症更常见（P = 0.047）。非行走状态降低了EVT与TEA相比的再狭窄风险HR（P = 0.021），而结节状钙化的存在显著增加了HR（P = 0.040）。在EVT亚组再狭窄风险分析中，与普通球囊血管成形术和药物涂层球囊血管成形术相比，使用支架的HR最低（P < 0.001）。
在一项全国性多中心研究中，TEA显示出比EVT更好的1年通畅率。非行走状态削弱了这种优势，而结节状钙化的存在则增强了这种优势。
