Berengoltz-Zlochin S N, Mali W P, Borst C, van der Tweel I, Robles de Medina E O
Department of Cardiology, University Hospital Utrecht, The Netherlands.
J Vasc Interv Radiol. 1994 Sep-Oct;5(5):689-96. doi: 10.1016/s1051-0443(94)71584-0.
To compare the prolonged effect of subintimal versus intraluminal recanalization of occluded femoropopliteal arteries.
Recanalization of an occluded femoropopliteal artery was attempted in 63 patients (51 men, 12 women; mean age, 63 years) with lifestyle-limiting claudication and at least one patent distal artery. After assessment of baseline clinical and angiographic variables, mechanical passage was first attempted with use of a laser catheter with a 2.2-mm- diameter hemispherical contact probe that was connected to a neodymium: yttrium-aluminum-garnet laser. In case of failure, the laser was activated at 1-second pulses of 15 W. In some cases additional guide-wire and catheter manipulations were used. Successful recanalization was followed by standard balloon dilation. An intense antithrombotic regimen was used.
The occluded artery could be entered in 62 of 63 patients. The catheter was assumed to have followed a subintimal course in 20 patients (group A) and an intraluminal course in 42 patients (group B). Successful recanalization was achieved in 17 patients (85%) of group A and in 36 (86%) of group B. No significant differences were found in clinical and angiographic follow-up measurements between the two groups. The angiographic cumulative primary patency rate (open vs closed) at 1 year was 93% +/- 6 in group A and 93% +/- 4 in group B. The cumulative restenosis/reocclusion-free patency rate was 63% +/- 13 and 65% +/- 9 for groups A and B, respectively. Median length of the original occlusion (8.0 cm in group A vs 4.5 cm in group B) was the only distinguishing baseline variable between the groups (P < .02) and was also the single independent predictor of recurrent flow limitation (P = .0017). Significant complications were distal embolization in three patients, followed by death in one patient and puncture site bleeding in two patients.
The 1-year clinical and angiographic results of assumed subintimal and intraluminal recanalization are comparable. Thus, a subintimal course per se should not be regarded as a failure of the procedure.
比较闭塞性股腘动脉内膜下与管腔内再通的长期效果。
对63例（51例男性，12例女性；平均年龄63岁）因生活方式受限而出现间歇性跛行且至少有一条远端动脉通畅的患者尝试进行闭塞性股腘动脉再通。在评估基线临床和血管造影变量后，首先尝试使用连接钕钇铝石榴石激光的直径2.2毫米半球形接触探头的激光导管进行机械通路建立。若失败，则以15瓦的1秒脉冲激活激光。在某些情况下，还使用了额外的导丝和导管操作。成功再通后进行标准球囊扩张。采用强化抗血栓治疗方案。
63例患者中有62例成功进入闭塞动脉。导管被认为在20例患者（A组）中走行于内膜下，在42例患者（B组）中走行于管腔内。A组17例患者（85%）和B组36例患者（86%）成功实现再通。两组在临床和血管造影随访测量中未发现显著差异。A组1年时血管造影累积原发性通畅率（开通与闭塞）为93%±6，B组为93%±4。A组和B组的累积无再狭窄/再闭塞通畅率分别为63%±13和65%±9。原始闭塞的中位长度（A组为8.0厘米，B组为4.5厘米）是两组之间唯一有区别的基线变量（P<0.02），也是复发性血流受限的唯一独立预测因素（P = 0.0017）。严重并发症包括3例患者发生远端栓塞，随后1例患者死亡，2例患者穿刺部位出血。
假定的内膜下和管腔内再通的1年临床和血管造影结果具有可比性。因此，内膜下走行本身不应被视为手术失败。
