Kasa Kentaro, Ohki Takao, Shukuzawa Kota, Fukushima Soichiro, Ozawa Hirotsugu, Omori Makiko, Chono Yoshihiko, Tachihara Hiromasa
Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Ann Vasc Dis. 2025;18(1). doi: 10.3400/avd.oa.24-00115. Epub 2025 Jan 21.
Surgical thrombectomy has been established as an effective treatment for acute limb ischemia (ALI). Nevertheless, manipulation via the common femoral artery (CFA) to retrieve thrombus in the infra-popliteal artery sometimes proves less effective. We retrospectively reviewed patients undergoing surgical thrombectomy for infra-inguinal ALI from January 2010 to December 2022. The primary endpoint was the rate of amputation. Secondary endpoints were technical and clinical success rates, incidence of distal embolism, and freedom from reintervention. A total of 35 patients underwent surgical thrombectomy where the popliteal artery or below is occluded. The CFA approach was utilized in 13, and the below-knee popliteal artery (BKPA) approach in 22. There were no differences in background between groups. The reintervention rate was lower in the BKPA group (BKPA group: 0% vs. CFA group: 30.8%; = 0.01). The BKPA group showed a significantly lower incidence of distal embolism (BKPA group: 4.5% vs. CFA group: 38.5%; = 0.02) and freedom from reintervention (BKPA group 100% at 12 months vs. CFA group: 68.7% at 12 months; log-rank = 0.01). The BKPA approach-first strategy for surgical thrombectomy in the management of ALI is feasible with better outcomes compared with the CFA approach.
手术取栓术已被确立为治疗急性肢体缺血（ALI）的有效方法。然而，通过股总动脉（CFA）进行操作以取出腘下动脉血栓有时效果欠佳。我们回顾性分析了2010年1月至2022年12月期间接受腹股沟下ALI手术取栓术的患者。主要终点是截肢率。次要终点是技术成功率和临床成功率、远端栓塞发生率以及无需再次干预。共有35例患者接受了腘动脉或其以下部位闭塞的手术取栓术。13例采用CFA入路，22例采用膝下腘动脉（BKPA）入路。两组患者的基线情况无差异。BKPA组的再次干预率较低（BKPA组：0% vs. CFA组：30.8%；P = 0.01）。BKPA组远端栓塞发生率显著较低（BKPA组：4.5% vs. CFA组：38.5%；P = 0.02），且无需再次干预（BKPA组12个月时为100%，而CFA组12个月时为68.7%；对数秩检验P = 0.01）。在ALI治疗中，采用BKPA入路优先的手术取栓策略是可行的，与CFA入路相比效果更好。
