Results of second-time angioplasty and stenting for femoropopliteal occlusive disease and factors affecting outcomes.
Results of second-time angioplasty and stenting for femoropopliteal occlusive disease and factors affecting outcomes.
复制标题
股腘闭塞性疾病第二次血管成形术和支架置入术的结果及影响结果的因素。
DOI：
10.1016/j.jvs.2010.09.020
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发表时间：
2011
影响因子：
4.3
通讯作者：
M. Belkin
中科院分区：
文献类型：
--
作者：
W. Robinson;L. Nguyen;R. Bafford;M. Belkin
重复经皮腔内介入治疗股腘动脉闭塞性疾病很常见，但其结果知之甚少。我们试图确定第二次股腘动脉经皮腔内血管成形术/支架植入术（SPTAS）的结果，并确定与成功或失败的持续腔内血运重建strategy.METHODSA回顾性审查的患者进行多次经皮腔内下肢介入治疗在一个单一的机构从2002年和2009年确定70 SPTAS在70肢。采用描述性统计量、Kaplan-Meier曲线和考克斯比例风险模型，分析患者合并症、疾病的解剖学严重程度和手术特征的结局。从SPTAS时开始测定通畅率。SPTAS患者包括37名男性（63%）和22名女性（27%），平均年龄70 ± 10岁。SPTAS的适应症包括54条肢体（77%）的跛行和16条肢体（23%）的严重肢体缺血（CLI）。从初始腔内介入到SPTAS的中位时间为330天。病变跨大西洋协会共识II（TASCII）分类为A级18例（25.7%）、B级18例（25.7%）、C级25例（35.7%）和D级9例（12.9%）。68例（97%）患者实现了技术成功，术中（10%）和术后（4%）并发症发生率较低，61例（87%）患者的初始临床改善。SPTAS术后中位随访时间为22.9个月，2年一期通畅率、二期通畅率、保肢率（CLI患者）和生存率分别为33% ± 7%、63% ± 7%、87% ± 9%和88% ± 5%。考克斯比例风险模型显示，初始血管内介入治疗后180天内的SPTAS是一期通畅率失败的唯一显著预测因素（风险比，2.65; 95%置信区间，1.4-5.2）和二期通畅率（风险比，3.1; 95%置信区间，结论第二次股腘动脉血管成形术/支架植入术具有良好的技术成功率，但中期一期和二期通畅率有限。初始血管内介入治疗的早期失败强烈预测SPTAS术后的不良结局，在该队列中，这比合并症、解剖因素或手术特征更重要。这些数据表明，在早期血管内失败后，应采用替代持续腔内策略。
OBJECTIVERepeat percutaneous endoluminal interventions for femoropopliteal occlusive disease are common, but the outcomes are poorly understood. We sought to determine the results of second-time femoropopliteal percutaneous transluminal angioplasty/stenting (SPTAS) and identify factors associated with success or failure of a continued endoluminal revascularization strategy.METHODSA retrospective review of patients undergoing multiple percutaneous endoluminal lower extremity interventions at a single institution from 2002 and 2009 identified 70 SPTAS in 70 limbs. Patient comorbidities, anatomic severity of disease, and procedural characteristics were analyzed with respect to outcomes with descriptive statistics, Kaplan-Meier curves, and Cox proportional hazards modeling. Patency rates were determined from the time of SPTAS.RESULTSPatients included 37 men (63%) and 22 women (27%) at a mean age of 70 ± 10 years. Indications for SPTAS included claudication in 54 limbs (77%) and critical limb ischemia (CLI) in 16 (23%). Median time from the initial endoluminal intervention to SPTAS was 330 days. Lesion TransAtlantic InterSociety Consensus II (TASCII) classification was A in 18 (25.7%), B in 18 (25.7%), C in 25 (35.7%), and D in 9 (12.9%). Technical success was achieved in 68 (97%) with low rates of intraprocedural (10%) and postprocedural (4%) complications as well as initial clinical improvement in 61 (87%) patients. Over a median follow-up of 22.9 months following SPTAS, 2-year primary patency, secondary patency, limb salvage (in patients with CLI), and survival were 33% ± 7%, 63% ± 7%, 87% ± 9%, and 88% ± 5%, respectively. Cox proportional hazard modeling showed that SPTAS within 180 days of the initial endovascular intervention was the only significant predictor of failure of primary patency (hazard ratio, 2.65; 95% confidence interval, 1.4-5.2) and secondary patency (hazard ratio, 3.1; 95% confidence interval, 1.4-7.1) of SPTAS.CONCLUSIONSSecond-time femoropopliteal angioplasty/stenting has excellent technical success but limited midterm primary and secondary patency. Early failure of the initial endovascular intervention strongly predicts poor outcome following SPTAS and in this cohort was more significant than comorbidities, anatomic factors, or procedural characteristics. These data suggest that after early endovascular failure, alternatives to a continued endoluminal strategy should be adopted.