Gordon I L, Conroy R M, Tobis J M, Kohl C, Wilson S E
Department of Surgery, University of California, Orange.
Am J Surg. 1994 Aug;168(2):115-9. doi: 10.1016/s0002-9610(94)80048-0.
Patients undergoing percutaneous recanalization of chronically occluded superficial femoral arteries were studied to determine which factors correlated with 1-year patency. Immediate change in ankle:brachial index (ABI), length of occlusion, tibial run-off, and the performance of supplemental catheter atherectomy were evaluated.
Eligible patients had at least one patient tibial run-off vessel and the absence of limb-threatening ischemia. Recanalization was performed via passage of a guidewire followed by balloon angioplasty. Tibial run-off was scored based on a modification of the angiogram scoring system of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery. Supplemental transcutaneous extraction catheter atherectomy was randomly assigned to a sub-group of patients after initial experience with the recanalization technique. Clinical follow-up was employed to determine patency.
Forty-two of 57 attempts (74%) at recanalization were immediately successful. Overall 1-year patency was 40% in 40 limbs that could be followed. In limbs with balloon angioplasty alone (n = 23), patency was 43% compared with 35% in those having supplemental atherectomy. Tibial run-off did not vary significantly between patent and occluded groups. When ABI increased by 0.3 or more, patency was 56% compared with 26% when the ABI increase was less than or equal to 0.1 (P = 0.13). Occlusion length averaged 18.1 +/- 10.6 cm for all limbs and did not vary significantly between early successes and failures. Limbs with short occlusions (less than or equal to 5 cm, n = 8) had 63% patency compared with 38% patency for limbs with long occlusions (greater than 25 cm, n = 16), but the difference was not significant by analysis of variance.
An initial change in ABI was most predictive for patency, whereas no correlation with tibial run-off was demonstrated. Atherectomy did not increase patency. Short occlusions were more likely to remain patent than long ones, but overall patency was lower than described in other series.
对接受慢性闭塞性股浅动脉经皮再通术的患者进行研究，以确定哪些因素与1年通畅率相关。评估了踝肱指数（ABI）的即刻变化、闭塞长度、胫动脉流出道情况以及是否进行了补充性导管斑块旋切术。
符合条件的患者至少有一条胫动脉流出道血管且不存在威胁肢体的缺血情况。通过导丝通过后进行球囊血管成形术来实现再通。根据血管外科学会和国际心血管外科学会血管造影评分系统的修改版本对胫动脉流出道进行评分。在初步掌握再通技术后，将补充性经皮抽吸导管斑块旋切术随机分配给一组患者。采用临床随访来确定通畅情况。
57次再通尝试中有42次（74%）即刻成功。在40条可随访的肢体中，总体1年通畅率为40%。仅接受球囊血管成形术的肢体（n = 23），通畅率为43%，而接受补充性斑块旋切术的肢体通畅率为35%。在通畅和闭塞的组之间，胫动脉流出道情况没有显著差异。当ABI增加0.3或更多时，通畅率为56%，而当ABI增加小于或等于0.1时，通畅率为26%（P = 0.13）。所有肢体的闭塞长度平均为18.1 +/- 10.6厘米，早期成功和失败之间没有显著差异。短闭塞（小于或等于5厘米，n = 8）的肢体通畅率为63%，长闭塞（大于25厘米，n = 16）的肢体通畅率为38%，但通过方差分析差异不显著。
ABI的初始变化对通畅率的预测性最强，而未显示与胫动脉流出道情况相关。斑块旋切术并未提高通畅率。短闭塞比长闭塞更有可能保持通畅，但总体通畅率低于其他系列报道。
