Shifting paradigms in the treatment of lower extremity vascular disease - A report of 1000 percutaneous interventions
Shifting paradigms in the treatment of lower extremity vascular disease - A report of 1000 percutaneous interventions
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DOI：
10.1097/sla.0b013e31814699a2
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发表时间：
2007-09-01
影响因子：
9
通讯作者：
Kent, K. Craig
中科院分区：
文献类型：
--
作者：
DeRubertis, Brian G.;Faries, Peter L.;Kent, K. Craig
目的：基于导管的血运重建已成为下肢血管疾病手术旁路的替代方法，并且是血管外科医生常用的工具。在这项研究中，我们报告了1000例由单一血管外科部门进行的经皮腹股沟下介入治疗的当代结局。方法：我们对2001年至2006年期间1000例连续经皮腹股沟下介入治疗跛行的前瞻性数据库进行了评估（46.3%）或威胁肢体的缺血（52.7%; 27.7%的静息痛和72.3%的组织损失）。治疗包括血管成形术，有或没有支架，激光血管成形术，和旋切术的股骨，腘，胫骨vessel.Results：平均年龄为71.4岁，57.3%是男性;合并症包括高血压（84%），冠状动脉疾病（51%），糖尿病（58%），吸烟（52%），慢性肾功能不全（39%）。总体30天死亡率为0.5%。跛行患者的2年一期和二期通畅率及截肢率分别为62.4%、79.3%和0.5%。对于威胁肢体缺血的患者，2年一期和二期通畅率和保肢率分别为37.4%、55.4%和79.3%。通过多变量考克斯PH建模，肢体威胁作为手术适应症（P < 0.0001）、糖尿病（P = 0.003）、高胆固醇血症（P = 0.001）、冠状动脉疾病（P = 0.047）和跨大西洋学会共识D病变复杂性（P = 0.050）是疾病复发的独立预测因素。对于出现复发疾病的患者，7.5%无需进一步干预，60.3%成功接受经皮再干预，11.7%接受旁路手术，20.5%接受截肢。通畅率是相同的初始程序和随后的再干预（P = 0.97）。结论：经皮治疗外周血管疾病的死亡率最低，并可以实现2年的二次通畅率近80%的跛行患者。尽管肢体威胁患者的通畅性降低，但2年时的保肢率仍接近80%。经皮腹股沟下血运重建术的发病率和死亡率较低，应被视为慢性下肢缺血患者的一线治疗。
Objectives: Catheter-based revascularization has emerged as an alternative to surgical bypass for lower extremity vascular disease and is a frequently used tool in the armamentarium of the vascular surgeon. In this study we report contemporary outcomes of 1000 percutaneous infra-inguinal interventions performed by a single vascular surgery division.Methods: We evaluated a prospectively maintained database of 1000 consecutive percutaneous infra-inguinal interventions between 2001 and 2006 performed for claudication (46.3%) or limb-threatening ischemia (52.7%; rest pain in 27.7% and tissue loss in 72.3%). Treatments included angioplasty with or without stenting, laser angioplasty, and atherectomy of the femoral, popliteal, and tibial vessels.Results: Mean age was 71.4 years and 57.3% were male; comorbidities included hypertension (84%), coronary artery disease (51%), diabetes (58%), tobacco use (52%), and chronic renal insufficiency (39%). Overall 30-day mortality was 0.5%. Two-year primary and secondary patencies and rate of amputation were 62.4%, 79.3%, and 0.5%, respectively, for patients with claudication. Two-year primary and secondary patencies and limb salvage rates were 37.4%, 55.4%, and 79.3% for patients with limb-threatening ischemia. By multivariable Cox PH modeling, limb-threat as procedural indication (P < 0.0001), diabetes (P = 0.003), hypercholesterolemia (P = 0.001), coronary artery disease (P = 0.047), and Transatlantic Inter-Society Consensus D lesion complexity (P = 0.050) were independent predictors of recurrent disease. For patients that developed recurrent disease, 7.5% required no further intervention, 60.3% underwent successful percutaneous reintervention, 11.7% underwent bypass and 20.5% underwent amputation. Patency rates were identical for the initial procedure and subsequent reinterventions (P = 0.97).Conclusion: Percutaneous therapy for peripheral vascular disease is associated with minimal mortality and can achieve 2-year secondary patency rates of nearly 80% in patients with claudication. Although patency is diminished in patients with limb-threat, limb-salvage rates remain reasonable at close to 80% at 2 years. Percutaneous infra-inguinal revascularization carries a low risk of morbidity and mortality, and should be considered first-line therapy in patients with chronic lower extremity ischemia.