Department of Cardiovascular Medicine, Sendai Kousei Hospital, 4-15 Hirose-Cho, Aoba-Ku, Sendai, Miyagi, 980-0873, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Heart Vessels. 2023 Sep;38(9):1117-1129. doi: 10.1007/s00380-023-02271-8. Epub 2023 May 23.
Isolated atherosclerotic popliteal lesions (IAPLs) have been considered challenging. This study aimed to investigate the efficacy of endovascular therapy (EVT) using the newer devices for IAPLs. This retrospective multicenter registry analyzed patients with lower extremity artery disease having IAPLs who underwent EVT using the newer devices between 2018 and 2021. The primary outcome was primary patency 1 year after EVT. A total of 392 consecutive patients undergoing EVT for IAPLs were enrolled. The Kaplan-Meier analysis showed that the primary patency and the freedom from target lesion revascularization were 80.9% and 87.8% 1 year after EVT, respectively. The multivariate Cox proportional hazards regression analysis showed that the clinical features that were independently associated with restenosis risk were drug-coated balloon (DCB) use for younger age (< 75 years old; adjusted hazard ratio, 3.08 [95% confidence interval 1.08-8.74]; P = 0.035), non-ambulatory status (2.74 [95% confidence interval 1.56-4.81]; P < 0.001), cilostazol use (0.51 [95% confidence interval 0.29-0.88]; P = 0.015), severe calcification (1.86 [95% confidence interval 1.18-2.94]; P = 0.007), and small external elastic membrane (EEM) area measured by intravascular ultrasound (IVUS) (< 30 mm) (2.07 [95% confidence interval 1.19-3.60]; P = 0.010). From the univariate analysis, among patients treated with DCB, younger patients (n = 141) were associated with more comorbidities including smoking (P < 0.001), diabetes mellitus (P < 0.001), end-stage renal disease (P < 0.001), history of revascularization (P = 0.046) and small EEM area (P = 0.036), compared to older patients (n = 140). Moreover, smaller post-procedural minimum lumen area measured by IVUS after DCB dilatation was observed in younger patients (12 ± 4 vs. 14 ± 4 mm, P = 0.033). This retrospective study demonstrated that the current EVT provided an acceptable 1-year primary patency rate in patients with IAPLs. The primary patency was lower following DCB in younger patients, likely due to the higher rates of comorbidities in this patient population.
孤立性动脉粥样硬化性腘动脉病变（IAPL）一直被认为是具有挑战性的。本研究旨在探讨使用新型装置进行腘动脉腔内治疗（EVT）的疗效。本回顾性多中心研究分析了 2018 年至 2021 年间使用新型装置治疗 IAPL 的下肢动脉疾病患者。主要结局是 EVT 后 1 年的一期通畅率。共纳入 392 例连续接受 IAPL EVT 的患者。Kaplan-Meier 分析显示，EVT 后 1 年的一期通畅率和免于靶病变血运重建率分别为 80.9%和 87.8%。多变量 Cox 比例风险回归分析显示，与再狭窄风险相关的临床特征为：年轻（<75 岁）时使用药物涂层球囊（DCB；调整后的危险比，3.08 [95%置信区间 1.08-8.74]；P=0.035）、非活动状态（2.74 [95%置信区间 1.56-4.81]；P<0.001）、西洛他唑的使用（0.51 [95%置信区间 0.29-0.88]；P=0.015）、严重钙化（1.86 [95%置信区间 1.18-2.94]；P=0.007）和血管内超声（IVUS）测量的小外弹性膜（EEM）面积（<30mm）（2.07 [95%置信区间 1.19-3.60]；P=0.010）。单因素分析显示，在接受 DCB 治疗的患者中，年轻患者（n=141）与更多合并症相关，包括吸烟（P<0.001）、糖尿病（P<0.001）、终末期肾病（P<0.001）、再血管化史（P=0.046）和小 EEM 面积（P=0.036），与老年患者（n=140）相比。此外，年轻患者接受 DCB 扩张后 IVUS 测量的术后最小管腔面积较小（12±4 比 14±4mm，P=0.033）。这项回顾性研究表明，目前的 EVT 为 IAPL 患者提供了可接受的 1 年一期通畅率。年轻患者接受 DCB 治疗后一期通畅率较低，可能是由于该患者人群的合并症发生率较高。
