Lin Yue, Pan Tianyue, Hong Shichai, Lu Weifeng, Fu WeiGuo, Wang LiXin, Hong Xiang, Chen Gang, Huang Yulong, Chen Yihui, Xie Xinsheng
Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Sci Prog. 2025 Apr-Jun;108(2):368504251345019. doi: 10.1177/00368504251345019. Epub 2025 May 27.
ObjectiveThe aim of this study was to evaluate the efficacy of hybrid therapy and endovascular therapy in the treatment of complex femoropopliteal Trans-Atlantic Inter-Society Consensus II D（TASC D） lesions involving the common femoral artery bifurcation.MethodsPatients with complex femoropopliteal TASC D lesions involving the bifurcation of the common femoral artery for atherosclerotic disease were retrospectively analyzed in our institution from July 2018 to July 2023. Patients were followed up at 1, 3, 6, and 12 months and then every year. Clinical data were collected, including perioperative and follow-up information. The patency rate and the rate of freedom from clinically driven target lesion revascularization (CD-TLR) were measured using the Kaplan-Meier method.ResultsA total of 29 patients with 31 limbs (mean age 73.5 ± 11.5 years; 20 men) were included, divided into the hybrid therapy group (20 limbs, Group 1) and endovascular treatment group (11 limbs, Group 2). The mean follow-up time was 22.5 ± 16.3 months (1-60 months), and the mean length of the lesion was 31.5 ± 11.6 cm. Between these two groups, there was no statistically significant difference on baseline data ＞.05）. Group 1 had more long-segment chronic total occlusive (CTO) lesions than Group 2（＜.05）. Totally, the 1- and 2-year patency rates of TASC D lesions were 74.6% and 55.2%, respectively; and the rate of freedom from CD-TLR was 81.2% and 70.3%, respectively. There was no statistically significant difference between these two groups in terms of 1-year primary patency rate（88.7% vs 100%） and freedom from CD-TLR of the common femoral artery (CFA) bifurcation（93.8% vs 100%）(＞.05).ConclusionsFor common femoral artery bifurcation lesions, both hybrid endarterectomy and endovascular treatment demonstrate favorable clinical outcomes. While these findings support their use, definitive conclusions on comparative efficacy remain conditional on confirmation from large-scale, long-term studies.
目的
本研究旨在评估杂交手术与血管内治疗在治疗累及股总动脉分叉处的复杂股腘动脉跨大西洋跨学会共识II D型（TASC D）病变中的疗效。
方法
对2018年7月至2023年7月在本机构接受治疗的因动脉粥样硬化疾病累及股总动脉分叉处的复杂股腘动脉TASC D病变患者进行回顾性分析。患者在术后1、3、6和12个月进行随访，之后每年随访一次。收集临床数据，包括围手术期和随访信息。采用Kaplan-Meier法测量通畅率和免于临床驱动的靶病变血运重建（CD-TLR）率。
结果
共纳入29例患者的31条肢体（平均年龄73.5±11.5岁；男性20例），分为杂交手术组（20条肢体，第1组）和血管内治疗组（11条肢体，第2组）。平均随访时间为22.5±16.3个月（1 - 60个月），病变平均长度为31.5±11.6 cm。两组间基线数据无统计学显著差异（P＞0.05）。第1组长节段慢性完全闭塞（CTO）病变比第2组多（P＜0.05）。总体而言，TASC D病变的1年和2年通畅率分别为74.6%和55.2%；免于CD-TLR率分别为81.2%和70.3%。两组在1年主要通畅率（88.7%对100%）和股总动脉（CFA）分叉处免于CD-TLR方面无统计学显著差异（93.8%对100%）（P＞0.05）。
结论
对于股总动脉分叉处病变，杂交内膜切除术和血管内治疗均显示出良好的临床效果。虽然这些结果支持其应用，但关于比较疗效的确切结论仍取决于大规模、长期研究的证实。
