Elsayed Basel, Subahi Ahmed, Sattar Hamid, Abdelaziz Amged, Mohamed Tahir, Ali Omar E
College of Medicine, QU Health, Qatar University, Doha, Qatar.
Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
J Soc Cardiovasc Angiogr Interv. 2025 Mar 25;4(6):102617. doi: 10.1016/j.jscai.2025.102617. eCollection 2025 Jun.
Peripheral artery disease is a global health concern, with femoropopliteal disease being a common manifestation. Recent advancements in endovascular interventions (EVI), guided by intravascular ultrasound (IVUS), have introduced promising treatment options. This study aims to compare in-hospital outcomes and trends of surgical versus IVUS-guided EVI for femoropopliteal disease.
The National Inpatient Sample database (2016-2021) was analyzed. Procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes, and the Cochran-Armitage test was used to assess temporal trends. Propensity score matching balanced baseline characteristics between the surgical (weighted N = 6700) and IVUS-guided EVI (weighted N = 6700) groups. Multivariable regression analysis adjusting for matched covariates was conducted to compare outcomes.
Multivariable logistic regression revealed that in-hospital mortality was lower in the IVUS-guided EVI group (1.6%) compared to the surgical group (3.5%) (OR, 0.386; 95% CI, 0.216-0.692). IVUS-guided EVI also had significantly fewer periprocedural complications (20.6% vs 24.7%; OR, 0.767; 95% CI, 0.636-0.924), including lower rates of bleeding, shock, infections, wound disruption, and respiratory failure. Multivariable linear regression showed that the length of stay was shorter for the IVUS-guided EVI group (β = -1.7 days; 95% CI, -2.2 to -1.1). No statistically significant differences were observed in inflation-adjusted costs, cardiac complications, major amputation, stroke, or renal failure.
Intravascular ultrasound-guided EVI for femoropopliteal disease are associated with better in-hospital outcomes compared to surgical revascularization, including lower in-hospital mortality, periprocedural complications, and a shorter length of stay. However, future prospective studies are needed to validate these results.
外周动脉疾病是一个全球性的健康问题，股腘动脉疾病是其常见表现。在血管内超声（IVUS）引导下的血管内介入治疗（EVI）的最新进展带来了有前景的治疗选择。本研究旨在比较手术治疗与IVUS引导下的EVI治疗股腘动脉疾病的院内结局和趋势。
分析了国家住院样本数据库（2016 - 2021年）。使用国际疾病分类第十版临床修订版代码识别手术程序，并使用 Cochr an - Armitage检验评估时间趋势。倾向评分匹配平衡了手术组（加权N = 6700）和IVUS引导下的EVI组（加权N = 6700）之间的基线特征。进行多变量回归分析，对匹配的协变量进行调整以比较结局。
多变量逻辑回归显示，IVUS引导下的EVI组的院内死亡率（1.6%）低于手术组（3.5%）（OR，0.386；95% CI，0.216 - 0.692）。IVUS引导下的EVI围手术期并发症也显著更少（20.6%对24.7%；OR，0.767；95% CI，0.636 - 0.924），包括出血、休克、感染、伤口裂开和呼吸衰竭的发生率更低。多变量线性回归显示，IVUS引导下的EVI组的住院时间更短（β = -1.7天；95% CI，-2.2至-1.1）。在经通胀调整的成本、心脏并发症、大截肢、中风或肾衰竭方面未观察到统计学显著差异。
与手术血运重建相比，IVUS引导下的EVI治疗股腘动脉疾病与更好的院内结局相关，包括更低的院内死亡率、围手术期并发症和更短的住院时间。然而，需要未来的前瞻性研究来验证这些结果。
