Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany.
Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany.
J Vasc Surg. 2024 Dec;80(6):1813-1822.e1. doi: 10.1016/j.jvs.2024.07.099. Epub 2024 Aug 5.
When antegrade recanalization of femoropopliteal and/or infrapopliteal occlusions fails, retrograde access has become an established option. To evaluate the results of combined antegrade and retrograde recanalization of femoropopliteal and infrapopliteal occlusions, patients undergoing secondary retrograde recanalization attempts were analyzed retrospectively.
The primary end point was the success of the procedure (successful occlusion crossing using the antegrade/retrograde technique). Secondary end points include complication rate, primary patency and target lesion revascularization (TLR) rate, amputation rate, changes in ankle-brachial index, and Rutherford-Becker class. Predictors for procedure failure and TLR were analyzed.
We included 888 patients: 362 with femoropopliteal (group 1), 353 with infrapopliteal (group 2), and 173 with multilevel (group 3) recanalization. Critical limb-threatening ischemia was present in group 1, 2, and 3 in 36%, 62%, and 76% of patients, respectively. The intervention was successful in 92.5%, 93.8%, and 90.8% of the respective cases (P = .455). The overall peri-interventional complication rate was 7.2%. At 6, 12, and 24 months, primary patency was highest in group 1 (63.9%, 45.8%, and 33.3%), followed by group 3 (59.8%, 46.1%, and 33.3%), and group 2 (58.5%, 43.1%, and 30.4%; P = .537). The risk of undergoing repeated TLR within 24 months was 31.4% for group 1, 39.1% for group 2, and 45.7% for group 3. At 24 months, the survival rates in groups 1, 2, and 3 were 93.8%, 79.4%, and 87.5%, respectively. Over 24 months, 75 patients (8.4%) had to undergo amputation. Significant improvements in both ankle-brachial index and Rutherford-Becker class were present at discharge as well as at 6, 12, and 24 months (P < .001). Dialysis dependency was a predictor of unsuccessful antegrade/retrograde recanalization (P = .048). Lesion length (P = .0043), dialysis (P = .033), and recanalization level (P = .013) increase the risk of TLR.
Using a combined antegrade/retrograde access, recanalization of occluded femoropopliteal and/or infrapopliteal arteries can be achieved in a large number of cases. Owing to the high rate of repeated TLR across all lesion localizations, the indication for antegrade and retrograde recanalization may be limited to patients with critical limb-threatening ischemia.
当顺行开通股腘和/或腘下动脉闭塞失败时，逆行入路已成为一种既定的选择。为了评估股腘和腘下动脉闭塞的顺行和逆行联合再通的结果，回顾性分析了接受二次逆行再通尝试的患者。
主要终点是手术的成功（使用顺行/逆行技术成功通过闭塞部位）。次要终点包括并发症发生率、一期通畅率和靶病变血运重建（TLR）率、截肢率、踝肱指数和 Rutherford-Becker 分级的变化。分析了手术失败和 TLR 的预测因素。
我们纳入了 888 例患者：362 例股腘（第 1 组）、353 例腘下（第 2 组）和 173 例多节段（第 3 组）再通。第 1、2 和 3 组中分别有 36%、62%和 76%的患者存在严重肢体缺血。相应病例的手术成功率分别为 92.5%、93.8%和 90.8%（P=0.455）。总的围手术期并发症发生率为 7.2%。在 6、12 和 24 个月时，第 1 组的一期通畅率最高（63.9%、45.8%和 33.3%），其次是第 3 组（59.8%、46.1%和 33.3%）和第 2 组（58.5%、43.1%和 30.4%；P=0.537）。第 1 组在 24 个月内再次 TLR 的风险为 31.4%，第 2 组为 39.1%，第 3 组为 45.7%。24 个月时，第 1、2 和 3 组的生存率分别为 93.8%、79.4%和 87.5%。24 个月以上，75 例（8.4%）患者需要截肢。出院时以及在 6、12 和 24 个月时，踝肱指数和 Rutherford-Becker 分级均显著改善（P<0.001）。透析依赖性是顺行/逆行再通失败的预测因素（P=0.048）。病变长度（P=0.0043）、透析（P=0.033）和再通水平（P=0.013）增加 TLR 的风险。
使用顺行/逆行联合入路，可以在大量病例中成功开通闭塞的股腘和/或腘下动脉。由于所有病变部位的 TLR 复发率都很高，顺行和逆行再通的适应证可能仅限于严重肢体缺血的患者。
