Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions
Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions
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DOI：
10.1016/j.jvs.2008.04.059
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发表时间：
2008-09-01
影响因子：
4.3
通讯作者：
Rhee, Robert Y.
中科院分区：
文献类型：
--
作者：
Baril, Donald T.;Marone, Luke K.;Rhee, Robert Y.
目的：评价血管内介入治疗股动脉闭塞症的疗效，确定跨大西洋社会共识(TASC)11、B和C级病变再狭窄的预测因素。方法：回顾分析2003年5月至2007年7月接受血管内介入治疗的所有股动脉闭塞症患者。分析患者的人口学特征、手术前后的踝臂指数(ABI)和解剖因素(包括TASC 11分类、病变长度和径流血管状况)。评估结果包括无再狭窄、无再次介入、完全通畅和辅助通畅。结果：在回顾期间共治疗了237条肢体。研究组125例，TASC B 108条，TASC C 32条(平均年龄73.1±10.4岁，男性：59%)。71%的患者Rutherford分级为2/3，其余29%的患者为Rutherford分级4/5。平均随访12.7个月(范围1~52个月)。41条肢体发生再狭窄或闭塞，平均8个月(1~24个月)。12个月时再狭窄/闭塞发生率为58.9%，24个月时为47.9%。再狭窄的预测因素包括术前ABI<；0.5(危险比[HR]3.05，95%可信区间[CI]1.36~6.86，P=0.007)和高胆固醇血症(HR 2.42，95%CI 1.11~5.25，P=0.025)。病变长度作为一个连续变量(每厘米)也与较高的再狭窄风险相关(HR 1.06，95%CI 1.00-1.12，P=0.057)。术后3年的辅助一次通畅率和二次通畅率分别为87%和94%，TASC B和TASC C患肢之间无显著差异。结论：TASC I、I、B和C病变的血管内介入治疗与再狭窄/闭塞率相关，至少与既往文献中公开的股静脉旁路手术的再狭窄/闭塞率相同。此外，总体辅助通畅率是很好的，尽管术前ABI低仍然与较差的结果相关。
Objective: To evaluate outcomes of endovascular interventions on femoropopliteal occlusive disease and determine predictors of restenosis of Trans Atlantic Inter-Societal Consensus (TASC) 11 B and C lesions.Methods: All patients undergoing endovascular interventions for femoropopliteal occlusive disease between May 2003 and July 2007 were reviewed. Patient demographics, pre- and post-procedure ankle-brachial indices (ABI), and anatomic factors (including categorization by TASC 11 classification, lesion length, and runoff vessel status) were analyzed. Outcomes evaluated included freedom from restenoses, freedom from re-intervention, overall patency, and assisted-patency.Results: A total of 237 total limbs were treated during the period reviewed. The study group included 108 TASC B and 32 TASC C limbs in 125 patients (mean age 73.1 +/- 10.4 years, male sex: 59%). Seventy-one percent of patients were Rutherford classification 2/3 while the remaining 29% were Rutherford classification 4/5. Mean follow-tip period was 12.7 months (range, 1-52 in). Forty-one (41) limbs experienced restenosis or occlusion at a mean time of 8 months (range, 1-24 in). Freedom front restenosis/occlusion was 58.9% at 12 months and 47.9% at 24 months. Predictors of restenosis included a preoperative ABI < 0.5 (hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.36-6.86, P = .007) and hypercholesterolemia (HR 2.42, 95% Cl 1.11-5.25, P = .025). Lesion length as a Continuous variable (per centimeter) also correlated with a higher risk of restenosis (HR 1.06, 95% CI 1.00-1.12, P = .057). The overall assisted-primary and secondary-patency rates were 87% and 94% respectively at 3 years with no significant differences between TASC B and TASC C limbs.Conclusion: Endovascular interventions for TASC I I B and C lesions are associated with restenosis/occlusion rates that are at least as good as those of open femoropopliteal bypass surgery from historical, previously published series. Furthermore, overall assisted-patency rates are excellent, although low preoperative ABIs continue to be associated with worse outcomes.