Migliara Bruno, Feriani Giovanni, Mirandola Mattia, Griso Andrea, Cappellari Tania Francesca, Nicoletti Cristian
Vascular and Endovascular Unit, Department of Surgery, Pederzoli Hospital, Ospedale Pederzoli, Via Monte Baldo, 26, 37019, Peschiera del Garda, Verona, Italy.
Diabetic Foot Unit, Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy.
Cardiovasc Intervent Radiol. 2024 Dec;47(12):1727-1736. doi: 10.1007/s00270-024-03828-4. Epub 2024 Aug 14.
In some patients, revascularization is not possible or is not effective. For these, percutaneous deep vein arterialization (p-DVA) could be considered an alternative treatment. The aim of this study is to evaluate the long-term results of an intravascular ultrasound (IVUS)-guided technique that has only one percutaneous access.
This is a prospective monocentric study on 18 no-option CLTI limbs treated with an IVUS-guided p-DVA. The primary outcome measures are: the freedom from major adverse events (MAEs) and survival at 30 days; limb salvage and amputation free survival (AFS) at 30 days, 6 months, 12 months and 24 months. The secondary outcome measures are: procedural success, survival, patency and wound healing.
We treated 14 patients with no-option CLTI, carrying out 18 p-DVA. Median age was 74,4 years (60-87). All these patients had a previous failed angioplasty of the tibial and foot arteries. Procedural success rate, defined as the establishment of arterial flow into the venous system of the foot, was 100%. No deaths and MAEs recorded at 30 days. Survival was 100%, 83.4% and 77.8%; limb salvage was 88.9%, 77.8% and 77.8%; AFS was 88.9%, 61.1% and 55.6% at 6, 12 and 24 months. Complete wound healing was 18.7% at 6 months, 80.0% at 12 months and 100% at 24 months.
Based on these results, the IVUS-guided p-DVA seems to be safe and effective for no-option CLTI patients, with no mortality related to the intervention, an acceptable limb salvage rate and amputation free survival.
在一些患者中，血管重建术无法实施或无效。对于这些患者，经皮深静脉动脉化（p-DVA）可被视为一种替代治疗方法。本研究的目的是评估一种仅需单次经皮穿刺的血管内超声（IVUS）引导技术的长期效果。
这是一项对18条接受IVUS引导下p-DVA治疗的无可选择的慢性肢体威胁性缺血（CLTI）肢体进行的前瞻性单中心研究。主要观察指标为：30天时无重大不良事件（MAE）及生存情况；30天、6个月、12个月和24个月时的肢体挽救及无截肢生存（AFS）情况。次要观察指标为：手术成功率、生存率、通畅率及伤口愈合情况。
我们对14例无可选择的CLTI患者进行了18次p-DVA治疗。中位年龄为74.4岁（60 - 87岁）。所有这些患者先前的胫动脉和足部动脉血管成形术均失败。定义为足部静脉系统建立动脉血流的手术成功率为100%。30天时无死亡及MAE记录。生存率分别为100%、83.4%和77.8%；肢体挽救率分别为88.9%、77.8%和77.8%；6个月、12个月和24个月时的AFS分别为88.9%、61.1%和55.6%。6个月时完全伤口愈合率为18.7%，12个月时为80.0%，24个月时为100%。
基于这些结果，IVUS引导下的p-DVA对于无可选择的CLTI患者似乎是安全有效的，无干预相关死亡率，肢体挽救率和无截肢生存率可接受。
