Patient and limb outcomes 10 years after endovascular revascularization of the superficial femoral artery for peripheral artery disease: The Boston Femoral Artery Endovascular Revascularization Outcomes (Boston FAROUT) study.
Patient and limb outcomes 10 years after endovascular revascularization of the superficial femoral artery for peripheral artery disease: The Boston Femoral Artery Endovascular Revascularization Outcomes (Boston FAROUT) study.
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DOI：
10.1177/1358863x231174052
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发表时间：
2023-08
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我们的目的是描述慢性下肢外周动脉疾病（PAD）血管内血运重建后十年的患者和肢体结局。我们评估了2003年至2011年在两个中心进行股浅动脉血管内血运重建的患者的结局，并随访了中位9.3年（25-75%：6.8，11.1）。结局包括死亡、心肌梗死、卒中、重复肢体血运重建和截肢。我们使用竞争风险分析和患者聚类来确定患者的风险比（HR）和95% CI，以及死亡原因、心血管事件和主要不良肢体事件（MALE）的手术特征。202例患者中有253例首次肢体血运重建，平均随访9.3年。患者接受了强化药物治疗，90%接受他汀类药物治疗，80%接受β受体阻滞剂治疗。在随访期间，有57例（28%）心血管死亡和62例（31%）非心血管死亡。在253条肢体中，227条（90%）在随访期间无MALE，93条（37%）有MALE或轻微重复血运重建。在多变量模型中，心血管死亡与严重肢体缺血（HR = 3.21，95% CI = 1.84，5.61）和慢性肾脏疾病（HR = 2.69，95% CI = 1.68，4.30）和吸烟（HR = 2.75，95% CI = 1.01，7.52）的非心血管死亡显著相关。与严重肢体缺血（HR = 1.43，95% CI = 0.84，2.43）、吸烟（HR = 2.49，95% CI = 1.26，4.90）和病变长度> 200 mm（HR = 1.51，95% CI = 0.98，2.33）相关的男性或轻度重复血运重建。在接受强化药物治疗的患者中，非心血管死亡的风险很高，与心血管死亡相似。血管内介入治疗可获得可接受的长期结果。未来的研究应该评估减少心血管和非心血管死亡的策略。
We aimed to describe patient and limb outcomes in the decade after endovascular revascularization for chronic lower-extremity peripheral artery disease (PAD). We assessed outcomes in patients having endovascular revascularization of the superficial femoral artery in two centers between 2003 and 2011 and followed for a median 9.3 (25–75%: 6.8, 11.1) years. Outcomes included death, myocardial infarction, stroke, repeat limb revascularizations, and amputations. We used competing risks analysis with clustering by patient to determine the hazard ratios (HR) and 95% CI for patients, and procedural characteristics for cause of death, cardiovascular events, and major adverse limb events (MALE). There were 253 index limb revascularizations in 202 patients followed for a median 9.3 years. Patients had intensive medical treatment with 90% on statins and 80% on beta-blockers. During follow up there were 57 (28%) cardiovascular deaths and 62 (31%) noncardiovascular deaths. Of the 253 limbs, 227 (90%) were free of MALE over follow up and 93 (37%) had MALE or minor repeat revascularization. In multivariable models, cardiovascular death significantly associated with critical limb ischemia (HR = 3.21, 95% CI = 1.84, 5.61) and noncardiovascular death with chronic kidney disease (HR = 2.69, 95% CI = 1.68, 4.30), and smoking (HR = 2.75, 95% CI = 1.01, 7.52). MALE or minor repeat revascularization associated with critical limb ischemia (HR = 1.43, 95% CI = 0.84, 2.43), smoking (HR = 2.49, 95% CI = 1.26, 4.90), and lesion length > 200 mm (HR = 1.51, 95% CI = 0.98, 2.33). Among patients with intensive medical therapy, the risk of noncardiovascular death was high and similar to cardiovascular death. Endovascular intervention can have acceptable long-term results. Future studies should evaluate strategies to reduce both cardiovascular and noncardiovascular deaths.