Joseph Ansan, Valakkada Jineesh, Ayappan Anoop, Kannath Santhosh, Shivanesan Pitchai
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Department of Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Indian J Radiol Imaging. 2023 Dec 4;34(2):254-261. doi: 10.1055/s-0043-1777015. eCollection 2024 Apr.
The best option among the endovascular options in long, complex femoropopliteal (FP) lesions, and factors affecting the patency have yet to be well described. There are few studies describing the mid- and long-term patency of endovascular stents in long-segment FP occlusions. This study aimed to determine the technical success and mid-term patency of subintimal angioplasty with vasculomimetic stenting in Trans-Atlantic Inter-Society Consensus II (TASC) C and D FP disease. The patient and imaging factors that affect primary patency were also analyzed. A single-center prospective study was performed on 52 consecutive patients undergoing endovascular treatment for TASC C and D FP disease from 2017 to 2021. Angioplasty with stenting was performed in all patients and followed up for 36 months. Endpoints were primary patency rates and amputation-free survival of the limb. Kaplan-Meier curves were used to see patency rates and amputation-free survival rates. A total of 52 patients underwent stenting with a technical success rate of 100% if the sub-intimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique was used. Primary stent patency at 6, 12, 18, 24, and 36 months was 89.8, 81.4, 76.2, 71.4, and 62.5%, respectively. Amputation-free survival was 98, 95.6, 91.8, and 85.7% at 12, 24, 30, and 36 months, respectively. Cox proportional regression analysis showed smoking and vessel wall calcium score more than 270 degrees as independent predictors of loss of primary patency (hazard ratio 0.35 confidence interval [CI]: 0.003-0.448) and 0.102 (CI: 0.022-0.47), respectively. Subintimal angioplasty with vasculomimetic stent has good midterm patency in and amputation-free survival in long-segment FP occlusions. Smoking and severe vessel wall calcification adversely affect patency.
在长段、复杂的股腘（FP）病变的血管内治疗方案中，最佳选择以及影响通畅率的因素尚未得到充分描述。很少有研究描述血管内支架在长段FP闭塞中的中长期通畅情况。本研究旨在确定在跨大西洋两岸血管外科学会共识II（TASC）C和D级FP疾病中，采用血管模拟支架的内膜下血管成形术的技术成功率和中期通畅率。还分析了影响原发性通畅的患者和影像学因素。对2017年至2021年连续52例接受TASC C和D级FP疾病血管内治疗的患者进行了单中心前瞻性研究。所有患者均接受了支架血管成形术，并随访36个月。终点指标为原发性通畅率和肢体无截肢生存率。采用Kaplan-Meier曲线观察通畅率和无截肢生存率。如果采用顺行-逆行介入内膜下动脉梳理（SAFARI）技术，共有52例患者接受了支架置入术，技术成功率为100%。支架在6、12、18、24和36个月时的原发性通畅率分别为89.8%、81.4%、76.2%、71.4%和62.5%。在12、24、30和36个月时，无截肢生存率分别为98%、95.6%、91.8%和85.7%。Cox比例回归分析显示，吸烟和血管壁钙化评分超过270°分别是原发性通畅丧失的独立预测因素（风险比0.35，置信区间[CI]：0.003-0.448）和0.102（CI：0.022-0.47）。采用血管模拟支架的内膜下血管成形术在长段FP闭塞中具有良好的中期通畅率和无截肢生存率。吸烟和严重的血管壁钙化会对通畅率产生不利影响。
