比较行普通股总动脉血栓内膜切除术患者是否应用补片成形术的临床转归。
Comparison of Clinical Outcomes in Patients Undergoing Common Femoral Thromboendarterectomy With or Without Patch Angioplasty.
机构信息
Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
出版信息
Eur J Vasc Endovasc Surg. 2023 Jun;65(6):870-877. doi: 10.1016/j.ejvs.2023.03.034. Epub 2023 Mar 24.
OBJECTIVE
Surgical thromboendarterectomy (TEA) is the standard treatment for an occlusive lesion of the common femoral artery (CFA). However, there is limited knowledge on the need for patch angioplasty in CFA TEA. The objective of this study was to compare the peri-operative and two year results of CFA TEA with or without patch angioplasty.
METHODS
A multicentre retrospective observational study was performed at 34 Japanese centres. Comparisons were made between patients undergoing CFA TEA with or without patch angioplasty after propensity score matching (PSM). The primary endpoints were primary patency and freedom from target lesion revascularisation (TLR) of the TEA lesion. The secondary endpoints were hospital outcomes, limb salvage, and overall survival.
RESULTS
Between 2018 and 2020, 428 TEA procedures (237 with patch angioplasty and 191 with primary closure) were performed. PSM extracted 151 pairs with no significant intergroup differences in baseline characteristics. Peri-operative death and complications occurred in 0.7% vs. 1.3% (p = 1.0) and 6.0% vs. 6.6% (p = 1.0), respectively. The follow up rate was 96% over a median follow up of 14.9 months (interquartile range 8.3, 24.3). Loss of primary patency occurred in 18 patients. The two year primary patency of patch angioplasty cases was statistically significantly higher than that of primary closure cases (97.0% vs. 89.9%; p = .021). TLR was performed in 14 patients. The two year freedom from TLR in patch angioplasty cases was also statistically significantly higher than in primary closure cases (98.6% vs. 92.9%; p = .003). During follow up, seven limbs required major amputation and 40 patients died. There was no statistically significant difference in limb salvage and survival between the two groups after PSM.
CONCLUSIONS
This is the first report to show that patch angioplasty may decrease re-stenosis and target lesion revascularisation of CFA TEA lesions.
目的
外科血栓内膜切除术（TEA）是治疗股总动脉（CFA）闭塞性病变的标准治疗方法。然而，关于 CFA TEA 中是否需要补片血管成形术的知识有限。本研究的目的是比较 CFA TEA 行或不行补片血管成形术的围手术期和两年结果。
方法
在 34 个日本中心进行了一项多中心回顾性观察研究。在行倾向评分匹配（PSM）后，比较了 CFA TEA 行补片血管成形术与不行补片血管成形术的患者。主要终点是 TEA 病变的一期通畅率和免于靶病变血运重建（TLR）。次要终点是住院结局、肢体存活率和总体生存率。
结果
2018 年至 2020 年，共进行了 428 例 TEA 手术（237 例行补片血管成形术，191 例行直接缝合）。PSM 提取了 151 对无组间基线特征差异的配对。围手术期死亡和并发症的发生率分别为 0.7%和 1.3%（p=1.0），6.0%和 6.6%（p=1.0）。中位随访 14.9 个月（四分位距 8.3，24.3）时，随访率为 96%。18 例患者发生一期通畅率丧失。补片血管成形术组的两年一期通畅率明显高于直接缝合组（97.0%比 89.9%；p=0.021）。14 例患者行 TLR。补片血管成形术组的两年免于 TLR 率也明显高于直接缝合组（98.6%比 92.9%；p=0.003）。随访期间，7 条肢体需要大截肢，40 例患者死亡。PSM 后两组的肢体存活率和生存率无统计学差异。
结论
这是第一项表明补片血管成形术可能降低 CFA TEA 病变再狭窄和 TLR 的报告。
Zotero 插件