Iwata Yo, Takahara Mitsuyoshi, Nakama Tatsuya, Fujimura Naoki, Suzuki Kenji, Yamaoka Terutoshi, Fukuzawa Shigeru
Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan.
Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
J Endovasc Ther. 2025 Feb;32(1):77-86. doi: 10.1177/15266028231165697. Epub 2023 Apr 11.
To compare the outcomes of thromboendarterectomy (TEA) and endovascular therapy (EVT) with stenting for patients with atherosclerotic common femoral artery (CFA) occlusive disease.
From a retrospective registry of 1193 consecutive patients with CFA treatment performed between 2018 and 2020 at 66 institutions in Japan, we identified patients who underwent TEA (n=432) or stent implantation (n=157). The primary outcome measures were the 1-year primary patency of TEA versus stenting with propensity score matching. The secondary outcome measures were perioperative complications, length of hospital stay, any reintervention, limb salvage, and overall survival. Interaction analysis for primary patency was performed with propensity score stratification to determine the appropriate target population for CFA stenting.
Propensity score matching extracted 101 pairs (101 patients in the EVT group and 253 patients in the TEA group). The 1-year primary patency rate was significantly higher in the TEA cohort (92.8% vs 84.6%, p=0.006). The freedom from reintervention rate was also significantly higher in the TEA cohort (94.0% vs 89.9%, p=0.030). However, the 1-year limb salvage (98.7% vs 100.0%, p=0.32), 1-year overall survival (90.8% vs 85.0%, p=0.14), and frequency of perioperative complications were not significantly different between the cohorts (6.9% vs 14.2%, p=0.10). Based on interaction analysis, the superiority of TEA over EVT in terms of patency was less apparent in patients with advanced age and chronic heart failure.
Thromboendarterectomy was superior to stenting in terms of primary patency and freedom from revascularization at 1 year. There was no significant difference in the incidence of perioperative complications between both groups. Thromboendarterectomy may be recommended as the standard treatment strategy for patients with atherosclerotic CFA disease, whereas stenting may be considered for patients with advanced age and chronic heart failure.
Thromboendarterectomy compared to stenting was the preferred revascularization strategy for patients with CFA disease in terms of primary patency and freedom from target lesion revascularization during the 1st year. The difference was attenuated in subgroups with advanced age (85 years or older) or chronic heart failure, thus stenting may be considered in patients with these backgrounds.
比较血栓内膜切除术（TEA）和血管内治疗（EVT）联合支架置入术治疗动脉粥样硬化性股总动脉（CFA）闭塞性疾病患者的疗效。
从2018年至2020年日本66家机构连续进行的1193例CFA治疗患者的回顾性登记中，我们确定了接受TEA治疗的患者（n = 432）或支架植入术的患者（n = 157）。主要结局指标是通过倾向评分匹配比较TEA与支架置入术的1年主要通畅率。次要结局指标包括围手术期并发症、住院时间、任何再次干预、肢体挽救率和总生存率。采用倾向评分分层对主要通畅率进行交互分析，以确定CFA支架置入术的合适目标人群。
倾向评分匹配提取出101对（EVT组101例患者，TEA组253例患者）。TEA队列的1年主要通畅率显著更高（92.8%对84.6%，p = 0.006）。TEA队列的无再次干预率也显著更高（94.0%对89.9%，p = 0.030）。然而，两组间的1年肢体挽救率（98.7%对100.0%，p = 0.32）、1年总生存率（90.8%对85.0%，p = 0.14）和围手术期并发症发生率无显著差异（6.9%对14.2%，p = 0.10）。基于交互分析，在老年和慢性心力衰竭患者中，TEA在通畅性方面优于EVT的优势不太明显。
血栓内膜切除术在1年的主要通畅率和免于血管再通方面优于支架置入术。两组围手术期并发症发生率无显著差异。对于动脉粥样硬化性CFA疾病患者，血栓内膜切除术可推荐作为标准治疗策略，而对于老年和慢性心力衰竭患者可考虑支架置入术。
与支架置入术相比，血栓内膜切除术在第1年的主要通畅率和免于靶病变血管再通方面是CFA疾病患者首选的血管再通策略。在老年（85岁及以上）或慢性心力衰竭亚组中这种差异减弱，因此对于有这些背景的患者可考虑支架置入术。
