Mizoguchi Takahiro, Harada Takasuke, Takeuchi Yuriko, Samura Makoto, Kurazumi Hiroshi, Suzuki Ryo, Suehiro Kotaro, Hamano Kimikazu
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Vasc Specialist Int. 2025 Jul 31;41:18. doi: 10.5758/vsi.250027.
This study retrospectively evaluated the mid-term outcomes of thromboendarterectomy (TEA) for common femoral artery (CFA) disease in a Japanese cohort by comparing patients with chronic limb-threatening ischemia (CLTI) and intermittent claudication (IC).
Sixty-three TEA procedures performed between 2011 and 2024 were analyzed. The primary endpoints focused on procedure-related outcomes such as patency and limb salvage, whereas overall survival was assessed as a key secondary outcome. The patients were divided into the CLTI (n=20) and IC (n=43) groups; the anesthesia type, additional revascularization, blood loss, hospital stay, complications, and survival were compared. Multivariable Cox regression analysis was performed to identify independent predictors of mortality.
Patients with CLTI had higher rates of local anesthesia, additional revascularization (all performed concomitantly), greater blood loss, and longer hospital stays. Despite the 100% technical success in both groups, 30-day mortality and complications occurred only in the CLTI group. Kaplan-Meier analysis showed similar patency and limb salvage rates between groups, whereas survival rates were significantly lower in patients with CLTI (P=0.037). Multivariable analysis revealed that CLTI itself was not an independent predictor of mortality; rather, a worse systemic status (e.g., higher American Society of Anesthesiologists classification) showed a trend toward poorer outcomes (P=0.051). No significant differences were found between the patch types.
TEA provides effective mid-term outcomes in patients with CFA disease, particularly those with IC. Although patients with CLTI show poorer survival, this appears to be driven more by systemic comorbidities than by the limb status itself. Careful preoperative assessment and holistic management of general health are essential to optimize outcomes, particularly in high-risk populations.
本研究通过比较慢性肢体威胁性缺血（CLTI）患者和间歇性跛行（IC）患者，回顾性评估了日本队列中股总动脉（CFA）疾病行血栓内膜切除术（TEA）的中期结果。
分析了2011年至2024年间进行的63例TEA手术。主要终点集中在与手术相关的结果，如通畅率和肢体挽救情况，而总生存率作为关键的次要结果进行评估。患者分为CLTI组（n = 20）和IC组（n = 43）；比较了麻醉类型、额外的血管重建、失血量、住院时间、并发症和生存率。进行多变量Cox回归分析以确定死亡率的独立预测因素。
CLTI患者局部麻醉、额外血管重建（均同时进行）、失血量更大和住院时间更长的发生率更高。尽管两组技术成功率均为100%，但30天死亡率和并发症仅发生在CLTI组。Kaplan-Meier分析显示两组之间通畅率和肢体挽救率相似，而CLTI患者的生存率显著较低（P = 0.037）。多变量分析显示CLTI本身不是死亡率的独立预测因素；相反，较差的全身状况（如较高的美国麻醉医师协会分级）显示出预后较差的趋势（P = 0.051）。补片类型之间未发现显著差异。
TEA为CFA疾病患者，尤其是IC患者提供了有效的中期结果。尽管CLTI患者生存率较差，但这似乎更多是由全身合并症而非肢体状况本身导致的。术前仔细评估和全面的整体健康管理对于优化结果至关重要，尤其是在高危人群中。
