Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
University of Pittsburgh School of Medicine, Pittsburgh, PA.
J Vasc Surg. 2023 Aug;78(2):483-489.e1. doi: 10.1016/j.jvs.2023.04.014. Epub 2023 Apr 17.
Peripheral arterial disease (PAD) is a common and highly morbid disease. Although there have been recent advancements in the endovascular modalities to treat PAD, comparisons of these strategies, especially in the popliteal region, remain underinvestigated. The objective of this study was to compare midterm outcomes in patients with PAD undergoing treatment with both novel and SS compared with drug-coated balloon (DCB) angioplasty.
All patients at a multi-institution health system treated for PAD in the popliteal region from 2011 to 2019 were identified. Presenting features, operative details, and outcomes were included in the analysis. Patients who underwent popliteal revascularization with stents were compared with DCB. SS were compared separately with novel dedicated stents. Two-year primary patency was the primary outcome.
We included 408 patients (72.7 ± 11.8 years old; 57.1% men) in the analysis. There were 221 (54.7%) patients who underwent popliteal stenting and 187 (45.3%) who underwent popliteal DCB. There were high rates of tissue loss in both groups (57.9% vs 50.8%; P = .14). Stented patients had longer lesions (112.4 ± 3.2 vs 100.2 ± 5.8 mm; P = .03) and higher rates of concomitant superficial femoral artery treatment (88.2% vs 39.6%; P < .01). Chronic total occlusions accounted for the majority of lesions treated (stent 62.4%, DCB 64.2%). Perioperative complications were similar between groups. Primary patency for the stented group was higher at two years than the DCB group (61.0% vs 46.1%; P = .03). When evaluating stented patients only, SS had higher 2-year patency than novel stents in the popliteal segment (69.6% vs 51.4%; P = .04). On multivariable analysis, stenosis, as opposed to chronic total occlusion, was associated with improved patency (hazard ratio, 0.49; 95% confidence interval, 0.25-0.96; P = .04), whereas novel stents were associated with worse primary patency (hazard ratio, 2.01; 95% confidence interval, 1.09-3.73; P = .03).
In a population of patients with severe vascular disease, stents do not have inferior patency and limb salvage rates compared with DCB angioplasty when treating the popliteal region. For patients with advanced vascular disease, and especially tissue loss, stents and DCB are both beneficial when treating popliteal lesions.
外周动脉疾病（PAD）是一种常见且高度病态的疾病。尽管腔内治疗 PAD 的方法最近有了进展，但这些策略的比较，尤其是在腘动脉，仍研究不足。本研究的目的是比较接受新型和 SS 药物涂层球囊（DCB）血管成形术治疗的 PAD 患者的中期结果。
在 2011 年至 2019 年期间，在一个多机构医疗系统中，确定了所有在腘动脉接受治疗的 PAD 患者。纳入分析的有临床表现、手术细节和结果。接受腘动脉支架治疗的患者与 DCB 进行比较。SS 与新型专用支架分别进行比较。主要通畅率为主要终点。
我们分析了 408 名患者（72.7±11.8 岁；57.1%为男性）。221 名（54.7%）患者接受了腘动脉支架治疗，187 名（45.3%）患者接受了腘动脉 DCB 治疗。两组均有较高的组织丢失率（57.9% vs 50.8%；P=0.14）。支架组的病变较长（112.4±3.2 毫米 vs 100.2±5.8 毫米；P=0.03），同时合并股浅动脉治疗的比例较高（88.2% vs 39.6%；P<.01）。慢性完全闭塞占治疗病变的大多数（支架 62.4%，DCB 64.2%）。两组围手术期并发症相似。支架组两年内主要通畅率高于 DCB 组（61.0% vs 46.1%；P=0.03）。仅评估支架治疗患者时，SS 在腘动脉段的两年通畅率高于新型支架（69.6% vs 51.4%；P=0.04）。多变量分析显示，与慢性完全闭塞相比，狭窄与改善通畅率相关（风险比，0.49；95%置信区间，0.25-0.96；P=0.04），而新型支架与较差的主要通畅率相关（风险比，2.01；95%置信区间，1.09-3.73；P=0.03）。
在严重血管疾病患者人群中，支架治疗与 DCB 血管成形术相比，在治疗腘动脉时不会降低通畅率和肢体挽救率。对于患有晚期血管疾病，特别是组织丢失的患者，支架和 DCB 在治疗腘动脉病变时均有益。
