Institutional Volume and Initial Results for Endovascular Treatment for Chronic Occlusive Lower-Extremity Artery Disease: A Report From the Japanese Nationwide Registry.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2024-10-01 Epub Date: 2023-03-19 DOI:10.1177/15266028231161242
Takahiro Tokuda, Mitsuyoshi Takahara, Osamu Iida, Shun Kohsaka, Yoshimitsu Soga, Yasuhiro Oba, Keisuke Hirano, Toshiro Shinke, Tetsuya Amano, Yuji Ikari
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引用次数: 0

Abstract

Purpose: Chronic total occlusion (CTO) remains as a major target for endovascular treatment (EVT) in improving symptomatic lower-extremity artery disease (LEAD). However, despite the technical demand and learning curve for the procedure, volume-outcome relationship of EVT targeted for CTO in symptomatic LEAD remains unclear.

Materials and methods: Data were obtained from a nationwide registry for EVT procedures limited to the Japanese Association of Cardiovascular Intervention and Therapeutics between January 2018 and December 2020 from 660 cardiovascular centers in Japan. In total, 96 099 patients underwent EVT for symptomatic LEAD, and 41 900 (43.6%) underwent CTO-targeted EVTs during the study period. Institutional volume was classified into quartiles. The association of institutional volumes with short-term outcomes was explored using the generalized linear mixed model using a logit link function, in which, interinstitution variability was used as a random effect.

Results: The median institutional volume for all EVT cases per quartile was 29, 68, 125, and 299 cases/year for the first, second, third, and fourth quartiles, respectively. With each model analysis, the adjusted odds ratios (ORs) for technical success were significantly lower in patients who underwent EVT in institutions within the first quartile (<52 cases/year) than in the other quartiles (P < .01, respectively). On the contrary, the adjusted ORs for procedural complications were significantly higher in the first and second quartiles than in the third and fourth quartiles (P < .01, respectively).

Conclusion: In contemporary Japanese EVT practice, a higher institutional volume but not operator volume was associated with a higher technical success rate and a lower procedural complication rate in patients with symptomatic LEAD involving CTO lesions.

Clinical impact: EVT for CTO lesions is still challenging for clinicians because of difficulties of wire/devise crossing or high procedural complications rate. Our study demonstrated that a higher institutional volume but not operator volume was associated with a higher technical success rate and a lower procedural complication rate in patients with symptomatic LEAD involving CTO lesions. In contemporary Japanese practice, a higher institutional experience has better impacts on short-term clinical outcomes. Future research should determine the relationship between institutional volume and long-term clinical outcomes.

慢性闭塞性下肢动脉疾病血管内治疗的机构数量和初步结果:来自日本全国登记处的报告。
目的:慢性全闭塞(CTO)仍是血管内治疗(EVT)改善无症状下肢动脉疾病(LEAD)的主要目标。然而,尽管该手术的技术要求和学习曲线很高,但针对无症状下肢动脉疾病(LEAD)CTO的EVT的容量-结果关系仍不明确:2018年1月至2020年12月期间,日本心血管介入与治疗协会(Japanese Association of Cardiovascular Intervention and Therapeutics)对日本660家心血管中心的EVT手术进行了全国范围的登记。在研究期间,共有 96 099 名患者因有症状的 LEAD 而接受了 EVT,其中 41 900 人(43.6%)接受了 CTO 靶向 EVT。机构容量被分为四等分。使用Logit链接函数的广义线性混合模型探讨了机构容量与短期结果的关系,其中机构间的变异性被用作随机效应:结果:第一、第二、第三和第四四分位数的所有EVT病例中位数分别为29、68、125和299例/年。通过各模型分析,在第一四分位数内的机构接受 EVT 的患者,其调整后的技术成功几率(ORs)显著较低(P < .01)。相反,第一和第二四分位数的手术并发症调整后的几率比(ORs)明显高于第三和第四四分位数(P < .01):结论:在当代日本的EVT实践中,对于涉及CTO病变的无症状LEAD患者,较高的机构数量与较高的技术成功率和较低的手术并发症发生率相关,而与较高的操作者数量无关:临床影响:CTO病变的EVT治疗对临床医生来说仍具有挑战性,因为导线/支架交叉困难或手术并发症发生率高。我们的研究表明,在涉及 CTO 病变的无症状 LEAD 患者中,较高的机构数量(而非操作者数量)与较高的技术成功率和较低的手术并发症发生率相关。在当代日本实践中,机构经验越丰富,对短期临床结果的影响越大。未来的研究应确定机构规模与长期临床结果之间的关系。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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