Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
Department of Biostatistics Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Ann Vasc Surg. 2024 Feb;99:252-261. doi: 10.1016/j.avsg.2023.08.018. Epub 2023 Oct 4.
Treatment of Trans-Atlantic Inter-Society Consensus (TASC) II D aortoiliac occlusive disease (AIOD D) remains a controversial topic. Although current recommendations support conventional surgical treatment, several recent studies have reported promising results with endovascular and hybrid strategies. The purpose of this work was to describe the outcomes of endovascular and hybrid management of AIOD D and to investigate the influence of perioperative factors on patency.
This was a retrospective single-center study covering the period from 2016 to 2021. The primary end point was primary patency at 12 months. Secondary endpoints included technical success rate, 30-day mortality, early major complication rate, primary assisted and secondary patency at 12 months, and primary patency at 24 months. After descriptive statistical analysis, a survival analysis was conducted using the Kaplan-Meier method. Eighteen perioperative factors potentially associated with primary patency were studied by univariate and multivariate analysis adjusted by a Cox regression model.
In all, 82 patients (112 limbs) had undergone an attempt at endovascular (n = 55, 67%) or hybrid (n = 27, 33%) treatment for AIOD D over the study period. The technical success rate was 99%. The 30-day mortality rate was 3%. The early major complication rate was 11%. The primary patency rates at 12 and 24 months were 87.9% [80.3; 96.3] and 77% [66.3; 89.3], respectively. The primary assisted and secondary patency rates at 12 months were 92.6% [86.3; 99.2] and 96% [91.4; 100]. Among the perioperative factors studied, the heavily calcified nature of the target lesions was the only variable significantly associated with primary patency loss in the multivariate analysis (P = 0.021).
Although the results of endovascular and hybrid treatment of AOID D are acceptable, future studies should focus on improving patency rates in heavily calcified lesions. Specific tools of endovascular preparation (intravascular lithotripsy, atherectomy) may represent interesting ways of research.
经跨大西洋腔内治疗协会共识（TASC）Ⅱ D 型主髂动脉闭塞性疾病（AIOD D）的治疗仍然是一个有争议的话题。尽管目前的建议支持传统的手术治疗，但最近的几项研究报告了腔内和杂交策略的有希望的结果。本研究的目的是描述 AIOD D 的腔内和杂交治疗结果，并研究围手术期因素对通畅率的影响。
这是一项回顾性单中心研究，涵盖了 2016 年至 2021 年的时间。主要终点是 12 个月时的初始通畅率。次要终点包括技术成功率、30 天死亡率、早期主要并发症发生率、12 个月时的初始辅助通畅率和次要通畅率以及 24 个月时的初始通畅率。在描述性统计分析后，使用 Kaplan-Meier 方法进行生存分析。通过单因素和多因素分析，研究了 18 个可能与初始通畅率相关的围手术期因素，并通过 Cox 回归模型进行了调整。
在研究期间，共有 82 例（112 条肢体）接受了 AIOD D 的腔内（n=55，67%）或杂交（n=27，33%）治疗。技术成功率为 99%。30 天死亡率为 3%。早期主要并发症发生率为 11%。12 个月和 24 个月时的初始通畅率分别为 87.9%[80.3；96.3]和 77%[66.3；89.3]。12 个月时的初始辅助通畅率和次要通畅率分别为 92.6%[86.3；99.2]和 96%[91.4；100]。在研究的围手术期因素中，只有靶病变严重钙化的性质是多因素分析中与初始通畅率丧失显著相关的唯一变量（P=0.021）。
尽管 AIOD D 的腔内和杂交治疗结果可以接受，但未来的研究应侧重于提高严重钙化病变的通畅率。腔内准备的特定工具（血管内碎石术、旋切术）可能是研究的有趣途径。
