Risk of Mortality Related to Recurrent Limb Events After Endovascular Revascularization of the Superficial Femoral Artery for Peripheral Artery Disease: The Boston Femoral Artery Endovascular Revascularization Outcomes (Boston FAROUT) Study.
Risk of Mortality Related to Recurrent Limb Events 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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因外周动脉疾病进行股浅动脉血管内血运重建后，与复发性肢体事件相关的死亡风险：波士顿股动脉血管内血运重建结果（波士顿 FAROUT）研究。
DOI：
10.1016/j.amjcard.2023.07.172
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Kinlay,Scott
中科院分区：
文献类型：
--
作者：
Evans,Peter;Sobieszczyk,Piotr;Eisenhauer,AndrewC;Ostrowski,Simon;Todoran,ThomasM;Kinlay,Scott
股浅动脉血管内血运重建术(SFA)可导致复发的缺血综合征、血运重建或截肢。这些事件对死亡率的影响尚不清楚。我们跟踪了在马萨诸塞州波士顿的两个心血管(CV)科行SFA血管内重建术治疗跛行或慢性肢体威胁缺血的患者。初次SFA血运重建术后肢体复发事件包括：复发跛行(67%)、肢体溃疡或坏疽(13%)、重复血管内血运重建术(61%)、外科血管重建术(15%)、大截肢(9%)或小截肢(8%)。我们将数据与国家死亡指数联系起来，以确定按心血管死亡率或非心血管死亡率分组的死因。COX比例风险分析的风险比(HR)和95%可信区间(95%CI)以及Fine-Gray竞争风险分析的亚HR按患者分组。总体而言，共有202名患者进行了253项指征肢体血管内治疗。再发肢体事件123条(49%)，93例(46%)。有和没有肢体复发事件的患者在随访期间的死亡人数相似(分别为76例[62%]对71例[55%])。在多变量模型中，肢体复发事件与全因死亡(HR=0.92，95%CI=0.64~1.33)、心血管死亡(HR=1.29，95%CI=0.72~1.30)或非心血管死亡(HR=0.65，CI=0.39~1.07)无关。相互竞争的风险分析表明，男性性别和慢性肢体威胁缺血与心血管死亡的相关性更强，而慢性肾脏疾病与非心血管死亡的相关性更强。总而言之，导致患者发病率的肢体复发事件不会增加全因或特定原因死亡的风险，也不应阻止为缓解症状或缺血而重复血管重建术。
Endovascular revascularization of the superficial femoral artery (SFA) may lead to recurrent ischemic syndromes, revascularization, or amputation. The impact of these events on mortality is unknown. We followed all patients having SFA endovascular revascularization for claudication or chronic limb-threatening ischemia in 2 cardiovascular (CV) divisions in Boston, Massachusetts. Any recurrent limb event after the initial SFA revascularization included recurrent claudication (67%), limb ulceration or gangrene (13%), repeat endovascular revascularization (61%), surgical revascularization (15%), or major (9%) or minor amputation (8%). We linked data to the National Death Index to ascertain cause of death grouped into CV mortality, or non-CV mortality. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) from Cox proportional hazards and sub-HRs from Fine-Gray competing risks analyses were clustered by patient. Overall, there were 202 patients with 253 index limb endovascular procedures. A recurrent limb event occurred in 123 limbs (49%) and 93 patients (46%). Patients with and without recurrent limb events had similar numbers of deaths over follow-up (76 [62%] vs 71 [55%], respectively). In multivariable models, recurrent limb event was not related to all-cause death (HR 0.92, 95% CI 0.64 to 1.33), CV death (HR 1.29, 95% CI 0.72 to 1.30), or non-CV death (HR 0.65, CI 0.39 to 1.07). Competing risk analyses suggested male gender and chronic limb-threatening ischemia were more strongly related to CV death, and chronic kidney more strongly related to disease to non-CV death. In conclusion, recurrent limb events, which contribute to patient morbidity, do not increase the risk of all-cause or cause-specific mortality, and should not discourage repeat revascularization to relieve symptoms or ischemia.
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影响因子：
24
作者：
Gerhard-Herman, Marie D.;Gornik, Heather L.;Walsh, M. Eileen
通讯作者：
Walsh, M. Eileen
2017 年 ESC 外周动脉疾病诊断和治疗指南，与欧洲血管外科学会 (ESVS) 合作：涵盖颅外颈动脉和椎动脉、肠系膜动脉、肾动脉、上肢动脉和下肢动脉的动脉粥样硬化疾病的文件
影响因子：
39.3
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Agu Obiekezie
影响因子：
9.6
作者：
Golledge, J.;Moxon, J. V.;Morris, D. R.
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Morris, D. R.
影响因子：
158.5
作者：
Bonaca, Marc P.;Bauersachs, Rupert M.;Hiatt, William R.
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Hiatt, William R.
影响因子：
37.8
作者：
Gray, William A.;Jaff, Michael R.;Lyden, Sean P.
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