Noory Elias, Böhme Tanja, Beschorner Ulrich, Jacques Börries, Bürgelin Karlheinz, Zürn Christina, Zeller Thomas
Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany.
Cardiol Cardiovasc Med. 2022;6(6):550-557. doi: 10.26502/fccm.92920298. Epub 2022 Dec 19.
To evaluate safety and efficacy of endoprosthesis implantation for the exclusion of popliteal artery aneurysm (PAA).
Elective asymptomatic patients with aneurysm > 20 mm and symptomatic patients with endovascular therapy of PAA were included. The proportion of patients with critical limb ischemia (presence of rest pain or tissue loss) was high at 32.1%, 21.6% of the patients had acute ischemia with symptoms persisting shorter than 14 days. The primary study endpoint was the target lesion revascularization (TLR) rate at 12 months. Secondary endpoints included technical success, periinterventional adverse events, primary patency at 6, 12 and 24 months, TLR rate at 24 months, predictors on reintervention, change in in clinical symptoms using the Rutherford-Becker classification (RBC), amputation and mortality rate. One hundred thirty-four patients (68.3±10.6 years, 88.8% male) were treated with a Viabahn endoprosthesis (W.L. Gore & Associates Inc., Flagstaff, AZ, USA).
The average aneurysm diameter was 2.5±0.87 cm. In 41%, occlusion of the aneurysm was present. TLR rate was 31.3% and 38.8% after 12 and 24 months, respectively. Primary patency rates were 69.1%, 52.3% and 42.6% at 6, 12 and 24 months, respectively. Univariate logistic regression analysis revealed age as a predictor of reintervention and in the multivariable analysis it was treatment with lysis. An improvement in RBC was seen at all-time points. Two major amputations (1.5%) were performed and the mortality rate at 24 months was 5.2%.
Primary patency rate after endovascular exclusion of PAA is low. However, limb salvage rate is high.
评估植入血管内假体治疗腘动脉瘤（PAA）的安全性和有效性。
纳入动脉瘤直径>20mm的择期无症状患者以及接受PAA血管内治疗的有症状患者。严重肢体缺血（存在静息痛或组织缺失）患者的比例较高，为32.1%，21.6%的患者有急性缺血，症状持续时间短于14天。主要研究终点是12个月时的靶病变血管重建（TLR）率。次要终点包括技术成功率、围手术期不良事件、6个月、12个月和24个月时的原发性通畅率、24个月时的TLR率、再次干预的预测因素、使用卢瑟福-贝克尔分类（RBC）评估临床症状的变化、截肢率和死亡率。134例患者（68.3±10.6岁，88.8%为男性）接受了Viabahn血管内假体（美国亚利桑那州弗拉格斯塔夫市W.L.戈尔联合公司）治疗。
动脉瘤平均直径为2.5±0.87cm。41%的患者动脉瘤闭塞。12个月和24个月时的TLR率分别为31.3%和38.8%。6个月、12个月和24个月时的原发性通畅率分别为69.1%、52.3%和42.6%。单因素逻辑回归分析显示年龄是再次干预的预测因素，多变量分析显示溶栓治疗是预测因素。在所有时间点RBC均有改善。进行了2例大截肢手术（1.5%），24个月时的死亡率为5.2%。
血管内治疗PAA后的原发性通畅率较低。然而，保肢率较高。
