Mid- and long-term clinical outcomes of endovascular treatment for TASC-II grade D aortoiliac occlusive disease
李佳亮 1张永保 1房杰 1施焘 1曲诚家 2滕乐群 1沈晨阳 3王丽萍
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作者信息
1. 1中国医学科学院 北京协和医学院 阜外医院血管外科，北京 100037
2. 2北京积水潭医院血管外科，北京 100037
3. 3首都医科大学附属天坛医院血管外科，北京 100037
折叠
摘要
目的 探讨腔内治疗复杂主髂动脉闭塞症（AIOD）的临床疗效。 方法 回顾性分析2016年1月至2022年10月北京阜外医院血管外科采用腔内治疗的71例泛大西洋外周动脉疾病诊疗多学会专家共识第二版（TASC-Ⅱ）分级为D级的AIOD患者的临床资料。其中男性66例，女性5例，年龄（64.4±8.9）岁（范围：39~88岁）。观察腔内治疗的手术疗效及随访结果。通过单因素及多因素Logistic回归分析影响术后血管通畅率的危险因素，采用Kaplan-Meier曲线比较分析重度钙化和非重度钙化组患者生存率情况。 结果 χ 71例患者中，60例患者行一期支架植入，11例行置管溶栓后二期支架植入，技术成功率为100%（71/71）。包括“对吻”覆膜支架51例，单纯裸支架7例，髂动脉支架+股动脉膜剥脱2例，覆膜支架+裸支架11例。患者术后踝肱指数（0.92±0.21）较术前（0.53±0.26）提高，差异有统计学意义（t=27.305，P<0.01）。术后发生急性支架内血栓形成2例，穿刺部位血肿3例，髂外动脉破裂1例。65例患者获得随访，随访时间为（42.5±21.8）个月（范围：6~82个月），随访期内12例出现支架内再狭窄，1例于术后1个月行膝上截肢术。一期通畅率为81.5%（53/65），二期通畅率为100%（3/3），保肢率为98.5%（64/65）。多因素Logistic回归分析显示，重度钙化病变是影响患者术后通畅率的独立影响因素（OR=9.56，95%CI：1.76~51.77，P=0.01）。Kaplan-Meier生存曲线显示，重度钙化患者的通畅率较非重度钙化患者低，差异有统计学意义（Log-rank 2=10.038，P=0.01）。 结论 腔内治疗复杂AIOD具有较好的中远期通畅率。重度钙化病变是影响术后靶血管通畅率的独立影响因素。 Objective To investigate the clinical outcomes of endovascular treatment of complex aortoiliac artery occlusion (AIOD). Method The data of 71 AIOD patients admitted to the Department of Vascular Surgery of Fuwai Hospital from January 2016 to December 2022 were retrospectively analyzed. All of them, 66 males and 5 females with a age of (64.4±8.9) years(range: 39-38 years), were identified as grade D in the second edition of Trans-Alantic Inter-Society Consensus (TASC-II). All patients underwent aortoiliac artery endovascular intervention and their follow-up results were obtained. Univariate and multivariate logistic regression analysis was applied to screen the risk factors affecting post-operative patency rate, and Kaplan-Meier curve was used to analyze the survival rates. Results Sixty patients received first-stage stent implantation and 11 patients received second-stage stent implantation after catheter-directed thrombolysis with a technical success rate of 100%. Among them, 51 patients received kissing stent implantation,7 bare metal stent implantation,2 iliac artery stent implantation combined with fermoral endarerectomy, and 11 covered stent combined with bare metal stent implantation. The average preoperative ankle-brachial index(ABI) was 0.53 ± 0.26, and the postoperative ABI was 0.92 ± 0.21, which was significantly improved (t=27.305,P<0.01). Among the 71 patients, acute stent thrombosis occurred in 2 cases, puncture complications in 3 cases and external iliac artery ruputure in 1 case. A number of 65 cases were followed (91.5%). The median follow-up time was (42.5±21.8) months, during which in-stent restenosis occurred in 12 cases and 1 patient underwent above-knee amputation 1 month after the surgery. The primary patency rate was 81.5% (53/65), the secondary patency rate was 100% and the limb salvage rate was 99% (64/65). Multivariate logistic regression analysis showed that severe calcification was an independent factor affecting postoperative patency rate (OR=9.56,95%CI:1.76~51.77,P=0.01). Kaplan-Meier survival curve showed that the patency rate of patients with severe calcification was lower than that of patients without severe calcification, and the difference was statistically significant (Log-rank χ2=10.038,P=0.01). Conclusion Endovascular treatment of complex AIOD has a high long-term patency rate. Long-term patency rate can be affected by severe calcification.
Abstract
Objective To investigate the clinical outcomes of endovascular treatment of complex aortoiliac artery occlusion (AIOD). Method The data of 71 AIOD patients admitted to the Department of Vascular Surgery of Fuwai Hospital from January 2016 to December 2022 were retrospectively analyzed. All of them, 66 males and 5 females with a age of (64.4±8.9) years(range: 39-38 years), were identified as grade D in the second edition of Trans-Alantic Inter-Society Consensus (TASC-II). All patients underwent aortoiliac artery endovascular intervention and their follow-up results were obtained. Univariate and multivariate logistic regression analysis was applied to screen the risk factors affecting post-operative patency rate, and Kaplan-Meier curve was used to analyze the survival rates. Results Sixty patients received first-stage stent implantation and 11 patients received second-stage stent implantation after catheter-directed thrombolysis with a technical success rate of 100%. Among them, 51 patients received kissing stent implantation,7 bare metal stent implantation,2 iliac artery stent implantation combined with fermoral endarerectomy, and 11 covered stent combined with bare metal stent implantation. The average preoperative ankle-brachial index(ABI) was 0.53 ± 0.26, and the postoperative ABI was 0.92 ± 0.21, which was significantly improved (t=27.305,P<0.01). Among the 71 patients, acute stent thrombosis occurred in 2 cases, puncture complications in 3 cases and external iliac artery ruputure in 1 case. A number of 65 cases were followed (91.5%). The median follow-up time was (42.5±21.8) months, during which in-stent restenosis occurred in 12 cases and 1 patient underwent above-knee amputation 1 month after the surgery. The primary patency rate was 81.5% (53/65), the secondary patency rate was 100% and the limb salvage rate was 99% (64/65). Multivariate logistic regression analysis showed that severe calcification was an independent factor affecting postoperative patency rate (OR=9.56,95%CI:1.76~51.77,P=0.01). Kaplan-Meier survival curve showed that the patency rate of patients with severe calcification was lower than that of patients without severe calcification, and the difference was statistically significant (Log-rank χ2=10.038,P=0.01). Conclusion Endovascular treatment of complex AIOD has a high long-term patency rate. Long-term patency rate can be affected by severe calcification.
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