Department of Vascular Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria.
Chirurgie Nierlich, Vienna Private Hospital, A-1090 Vienna, Austria.
Medicina (Kaunas). 2022 Sep 5;58(9):1225. doi: 10.3390/medicina58091225.
: The feasibility of endovascular treatment (EVT) for Trans-Atlantic Inter-Society Consensus (TASC) II C and D femoropopliteal artery lesions has been described, but no prospective study has performed a long-term follow-up. The aim of this study was to report the long-term results of nitinol stents (NS) for the treatment of long femoropopliteal lesions. : A single-center prospective, randomized controlled trial (RCT) comparing EVT with NS and vein bypass surgery was previously performed. The EVT group's follow-up was extended and separately analyzed with primary patency as the primary endpoint. The secondary endpoints were technical success, secondary patency, reinterventions, limb salvage, survival, complications, and clinical improvement. : Between 2016 and 2020, 109 limbs in 103 patients were included. A total of 48 TASC II C and 61 TASC II D lesions with a mean lesion length of 264 mm were reported. In 53% of limbs, the indication for treatment was chronic limb-threatening ischemia. The median follow-up was 45 months. Technical success was achieved in 88% of cases, despite 23% of the lesions being longer than 30 cm (retrograde popliteal access in 22%). At four-year follow-up, primary patency, secondary patency, and freedom from target lesion revascularizations were 35%, 48%, and 58%, respectively. Limb salvage and survival were 90% and 80% at 4 years. Clinical improvement of at least one Rutherford category at the end of follow-up was achieved in 83% of limbs. : This study reports the longest follow-up of endovascular treatment with nitinol stents in femoropopliteal TASC II C and D lesions. The results emphasize the feasibility of an endovascular-first strategy, even in lesions beyond 30 cm in length, and clarify its acceptable long-term durability and good clinical outcomes. Large multicenter RCTs with mid- and long-term follow-up are needed to investigate the role of different endovascular techniques in long femoropopliteal lesions.
: 腔内治疗（EVT）在跨大西洋腔内血管治疗协会（TASC）II C 和 D 股腘动脉病变中的可行性已被描述，但尚无前瞻性研究进行长期随访。本研究旨在报告治疗长段股腘动脉病变的镍钛诺支架（NS）的长期结果。: 此前进行了一项比较 EVT 与 NS 和静脉旁路手术的单中心前瞻性随机对照试验（RCT）。将 EVT 组的随访时间延长，并单独分析以主要通畅率作为主要终点。次要终点包括技术成功率、次要通畅率、再次介入、肢体挽救率、生存率、并发症和临床改善。: 2016 年至 2020 年，共纳入 103 例患者的 109 条肢体。共报告了 48 例 TASC II C 和 61 例 TASC II D 病变，病变长度平均为 264mm。53%的肢体存在慢性肢体威胁性缺血的治疗指征。中位随访时间为 45 个月。尽管 23%的病变长度超过 30cm（22%采用逆行腘动脉入路），但技术成功率仍达到 88%。在 4 年随访时，主要通畅率、次要通畅率和免于靶病变血运重建率分别为 35%、48%和 58%。4 年时肢体挽救率和生存率分别为 90%和 80%。在随访结束时，至少有一个 Rutherford 级别的临床改善达到 83%的肢体。: 本研究报告了最长的腔内治疗镍钛诺支架治疗 TASC II C 和 D 股腘动脉病变的随访结果。结果强调了腔内优先策略的可行性，即使在长度超过 30cm 的病变中也是如此，并明确了其可接受的长期耐久性和良好的临床结果。需要进行更大规模的多中心 RCT 并进行中期和长期随访，以研究不同腔内技术在长段股腘动脉病变中的作用。
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