主-髂、股腘及腘以下下肢动脉疾病血管内血运重建的临床特征与当前实践——来自RECCORD注册研究的见解

Clinical Characteristics and Current Practice of Endovascular Revascularization in Aorto-Iliac, Femoropopliteal and Infra-Popliteal Lower Extremity Artery Disease-Insights from the RECCORD Registry.

作者信息

Stella Jacqueline, Stausberg Jürgen, Lichtenberg Michael, Hoffmann Ulrich, Malyar Nasser M

机构信息

Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany.

Independent Researcher, 45276 Essen, Germany.

出版信息

J Clin Med. 2022 Oct 14;11(20):6074. doi: 10.3390/jcm11206074.

DOI:10.3390/jcm11206074

PMID:36294394

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9605640/

Abstract

BACKGROUND

Endovascular revascularization (EVR) is a pillar of therapeutic management in patients with symptomatic lower extremity artery disease (LEAD). Due to lack of scientific evidence, the approach of EVR type and the devices used at the different anatomic vascular segments of the lower limbs vary substantially between operators and centers. We analyzed data from the RECcording COurses of vasculaR Diseases (RECCORD) registry to assess the current real-world EVR treatment patterns in relation to anatomic vascular segments in symptomatic LEAD patients in Germany.

PATIENTS AND METHODS

RECCORD is an ongoing, prospective, multicenter, all-comers and entirely web-based registry platform. Baseline demographic and periprocedural data of patients undergoing EVR for symptomatic LEAD were assessed and performed EVRs were grouped according to the intervened anatomic vascular segment. We analyzed four EVR groups comprising either the aorto-iliac, femoropopliteal, or infrapopliteal segments (all these EVRs with or without a further intervention in another anatomic segment) or the infrapopliteal segment alone.

RESULTS

A total of 2210 EVR segments (in 1639 patients) were analyzed. Of those 616 (27.9%) were aorto-iliacal, 1346 (60.9%) femoropopliteal, 248 (11.2%) infrapopliteal and 104 (4.7%) only infrapopliteal segments. Aorto-iliac EVR was associated with younger age, smoking, claudication and simple lesions, while the distal infrapopliteal EVRs were related to advanced age, diabetes, multiple comorbidities, limb threatening ischemia and complex lesions. The use of different EVR devices at the aorto-iliac, femoropopliteal, infrapopliteal and only infrapopliteal segments were: only ballon-angioplasty: 8.3%, 12.9%, 58.1% and 63.5%; stenting: 82.3%, 45.3%, 16.9% and 12.5%; drug-coated balloon: 11.2%, 55.0%, 19.4% and 19.2%.

CONCLUSION

The RECCORD registry data demonstrate that in LEAD clinical and lesion characteristics are related to anatomic vascular segments. Despite the clear relationship between vascular segments and the current use of device types, prospective, segment-specific clinical studies are warranted to establish a consistent, evidence-based path for EVR in LEAD.

摘要

背景

血管内血运重建术（EVR）是有症状的下肢动脉疾病（LEAD）患者治疗管理的支柱。由于缺乏科学证据，不同操作者和中心在下肢不同解剖血管段进行EVR的方式及所使用的器械差异很大。我们分析了血管疾病记录（RECCORD）注册研究的数据，以评估德国有症状的LEAD患者中当前与解剖血管段相关的EVR实际治疗模式。

患者和方法

RECCORD是一个正在进行的、前瞻性、多中心、面向所有患者且完全基于网络的注册平台。对因有症状的LEAD接受EVR治疗的患者的基线人口统计学和围手术期数据进行评估，并根据介入的解剖血管段对已进行的EVR进行分组。我们分析了四个EVR组，分别包括腹主动脉-髂动脉段、股腘动脉段或腘动脉以下段（所有这些EVR无论是否在另一个解剖段进行了进一步干预）或仅腘动脉以下段。

结果

共分析了2210个EVR段（涉及1639例患者）。其中616个（27.9%）为腹主动脉-髂动脉段，1346个（60.9%）为股腘动脉段，248个（11.2%）为腘动脉以下段，104个（4.7%）为仅腘动脉以下段。腹主动脉-髂动脉EVR与年轻、吸烟、间歇性跛行和简单病变相关，而腘动脉以下远端EVR与高龄、糖尿病、多种合并症、肢体威胁性缺血和复杂病变相关。在腹主动脉-髂动脉段、股腘动脉段、腘动脉以下段和仅腘动脉以下段使用不同EVR器械的情况分别为：仅球囊血管成形术：8.3%、12.9%、58.1%和63.5%；支架置入术：82.3%、45.3%、16.9%和12.5%；药物涂层球囊：11.2%、55.0%、19.4%和19.2%。