Long-term clinical outcomes and cause of death after endovascular treatment for femoropopliteal artery lesions.
Long-term clinical outcomes and cause of death after endovascular treatment for femoropopliteal artery lesions.
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股腘动脉病变血管内治疗后的长期临床结果和死亡原因。
DOI：
10.1016/j.jjcc.2020.11.008
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发表时间：
2020
期刊：
影响因子：
2.5
通讯作者：
Minamino T.
中科院分区：
文献类型：
--
作者：
Fukase T;Dohi T;Kato Y;Chikata Y;Takahashi N;Endo H;Doi S;Nishiyama H;Okai I;Iwata H;Okazaki S;Isoda K;Miyauchi K;Daida H;Minamino T.
研究背景股动脉疾病的血管内治疗(EVT)在临床上很常见。然而，对其预后因素、死亡原因和长期临床结果却知之甚少。方法对2009-2018年间因股动脉疾病首次行EVT的285例患者(平均年龄72±8岁，男性占73%)进行研究。根据出现的严重肢体缺血(CLI)将患者分为两组。我们评估了主要不良肢体事件(男性)的发生率，包括临床驱动的靶血管重建术和靶肢体大部截肢，以及全原因死亡。非CLI组205名患者(72%)，CLI组80名患者(28%)。与非CLI组相比，CLI组的高敏C反应蛋白(hs-CRP)水平和血液透析率更高。在平均3.5年的随访期中，有62例死亡(21.8%)，包括心血管(32.3%)、感染(32.3%)和与恶性肿瘤相关的死亡(22.6%)。卡普兰-迈耶分析显示，慢性阻塞性肺炎组的男性死亡率和全因死亡率显著较高(分别为对数等级和0.001)。CLI组的主要死因是与心血管和感染相关的死亡；非CLI组的主要死因是与恶性肿瘤相关的。在多变量COX风险分析中，血液透析、TASC II分类C/D病变和CLI是男性的显著预测因素(p<；0.001，p=0.005，p=0.012)。血液透析、年龄、高hs-C反应蛋白水平和CLI是全因死亡的显著预测因素(p<；0.001，p=0.003，p=0.009和p=0.021)。结论尽管腔内静脉移植治疗股动脉疾病可行，手术成功率高，但男性和全原因死亡的发生率很高。需要进一步的研究来改善CLI患者的预后。
BackgroundEndovascular treatment (EVT) for femoropopliteal artery disease is common in clinical practice. However, little is known about its prognostic factors, causes of death, and long-term clinical outcomes.MethodsTwo hundred eighty-five consecutive patients (mean age, 72±8 years, 73% men) undergoing their first EVT for de-novo femoropopliteal artery disease from 2009 to 2018 were studied. Patients were divided in two groups according to the presence of critical limb ischemia (CLI). We evaluated the incidence of major adverse limb events (MALE) including clinically driven target vessel revascularization and target limb major amputation, and all-cause death.ResultsThe procedure was successful in 97.9% of cases. The non-CLI group comprised 205 patients (72%), and the CLI group comprised 80 patients (28%). The CLI group exhibited higher high-sensitivity C-reactive protein (hs-CRP) levels and a higher rate of hemodialysis than the non-CLI group. During the median follow-up period of 3.5 years, there were 62 deaths (21.8%) including cardiovascular (32.3%), infection (32,3%), and malignancy-related (22.6%) deaths. Kaplan-Meier analysis revealed that the CLI group had a significantly higher incidence of MALE and all-cause death (log-rank, bothp<0.001, respectively). The leading causes of death in the CLI group were cardiovascular- and infection-related death; the leading cause of death in the non-CLI group was malignancy-related. On multivariate Cox hazard analysis, hemodialysis, TASC II classification C/D lesions, and CLI were significant predictors of MALE (p<0.001,p=0.005, andp=0.012, respectively). Hemodialysis, age, higher hs-CRP levels, and CLI were significant predictors of all-cause death (p<0.001,p=0.003,p=0.009, andp=0.021, respectively).ConclusionsAlthough EVT for femoropopliteal artery disease appears feasible with a high rate of procedural success, a high incidence of MALE and all-cause death was observed. Further studies are needed to improve the outcomes in patients with CLI.
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DOI：
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发表时间：
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期刊：
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