Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
Ann Vasc Surg. 2023 Jan;88:100-107. doi: 10.1016/j.avsg.2022.07.032. Epub 2022 Sep 1.
Fasciotomy can increase the mobility of the superficial femoral artery and decrease the incidence of stent fractures. This study aimed to compare the long-term patency of drug-eluting nitinol stents with and without fasciotomy in patients with prolonged superficial femoral artery occlusions.
A randomized clinical trial was conducted in 60 (1:1) patients with long femoropopliteal steno-occlusive lesions >200 mm. Patients in group 1 (Zilver) underwent recanalization of femoropopliteal artery occlusion with stenting. In group 2 (ZilverFas), the femoropopliteal occlusion was recanalized with stenting and fasciotomy of Gunter's canal. The follow-up assessment of the patency took place after 6-12 months.
Twelve-month primary patency in Zilver and ZilverFas groups was 51% and 80%, respectively (P = 0.02). The freedom from target lesion revascularization in the Zilver and ZilverFas groups was 50% and 76%, respectively (P = 0.04). At 1 year, primary-assisted patency and secondary patency for the ZilverFas and Zilver groups were 83% vs. 62% (P = 0.07) and 86% vs. 65% (P = 0.05), respectively. In the Zilver and ZilverFas groups, the number of stent fractures was 14 and 7, respectively (P = 0.05). The multivariable Cox regression indicated that the stent fracture and diabetes mellitus were independent predictors of restenosis and reocclusion. Fasciotomy reduced the risk of reocclusion and restenosis by 2.94 times.
Our study has shown that decompressing the stented segment with fasciotomy significantly improves the patency of the femoropopliteal segment and significantly reduces the number and severity of stent fractures.
筋膜切开术可以增加股浅动脉的活动性，降低支架断裂的发生率。本研究旨在比较经皮腔内血管成形术联合药物洗脱镍钛诺支架置入治疗股浅动脉长段闭塞患者中筋膜切开术与未行筋膜切开术的长期通畅率。
在 60 例（1:1）股腘长段狭窄闭塞病变>200mm 的患者中进行了一项随机临床试验。组 1（Zilver）患者行股腘动脉闭塞开通及支架置入术，组 2（ZilverFas）患者行股腘动脉闭塞开通及支架置入联合筋膜切开术。术后 6-12 个月进行通畅率随访评估。
Zilver 组和 ZilverFas 组 12 个月的初始通畅率分别为 51%和 80%（P=0.02）。Zilver 组和 ZilverFas 组的免于靶病变血运重建率分别为 50%和 76%（P=0.04）。在 1 年时，ZilverFas 组和 Zilver 组的初始辅助通畅率和二级通畅率分别为 83%比 62%（P=0.07）和 86%比 65%（P=0.05）。Zilver 组和 ZilverFas 组的支架断裂分别为 14 例和 7 例（P=0.05）。多变量 Cox 回归分析表明，支架断裂和糖尿病是再狭窄和再闭塞的独立预测因素。筋膜切开术使再闭塞和再狭窄的风险降低了 2.94 倍。
本研究表明，筋膜切开术可显著改善股浅动脉段的通畅率，显著减少支架断裂的数量和严重程度。
