覆盖和裸金属支架治疗股腘动脉粥样硬化疾病的中期结果

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular Pub Date : 2025-09-11 DOI:10.1177/17085381251379289

Margaret Kurop, Andrew Bedford, Sara Beudoin, Jennifer Huffman, Chase Schlesselman, Todd R Vogel, Steven Cheung, Jonathan Bath

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CS patients had undergone more prior SFA interventions (p = 0.03) and were younger (62 vs. 66 years; p = 0.04). Regarding anatomic and operative characteristics, CS patients had more TASC C/D lesions (69 vs. 47%; p = 0.006) less severe calcification (8 vs.17%; p = 0.0006) and more often underwent angioplasty and stenting (90 vs 51%; p < 0.0001) and less often angioplasty, DCB and stenting (5 vs. 43%; p < 0.0001). CS patients had larger SFA (5.7 vs 4; p < .0001), longer lesions (119 vs. 89 mm; p = 0.0008), higher popliteal runoff score (8.3 vs. 6.4; p = 0.02), longer surgery (140 vs. 118 min; p = 0.03), less fluoroscopy time (21 vs. 26 min; p = 0.03), larger SFA stent (6.2 vs. 5.6 mm; p < 0.0001), and longer stented length (260 vs. 171 mm; p < 0.0001). There were no differences in concomitant iliac/tibial treatment between groups (p = 0.3). 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引用次数: 0

摘要

目的外周血管介入治疗（PVI）采用的血管内方式多种多样。对于覆盖支架（CS）和裸金属支架（BMS）用于SFA的长期疗效研究甚少。方法在一个学术机构确定接受CS和BMS到SFA的患者（2017-2021）。采用比较统计学和Kaplan-Meier分析对分组结果进行评价。结果纳入支架置入患者119例，CS 60例（50%），BMS 59例（50%）。两组间性别（p = 0.5）、术前ABI （p = 0.2）、手术指征（p = 0.8）均无差异。CS患者既往接受SFA干预较多（p = 0.03），且年龄较小（62岁vs 66岁；p = 0.04）。在解剖和手术特征方面，CS患者有更多的TASC C/D病变（69比47%，p = 0.006），更少的严重钙化（8比17%，p = 0.0006），更频繁地接受血管成形术和支架植入术（90比51%，p < 0.0001），更少的血管成形术、DCB和支架植入术（5比43%，p < 0.0001）。CS患者SFA较大（5.7 vs. 4; p < 0.0001），病变较长（119 vs. 89 mm; p = 0.0008），腘沟流评分较高（8.3 vs. 6.4; p = 0.02），手术时间较长（140 vs. 118 min; p = 0.03），透视时间较短（21 vs. 26 min; p = 0.03）， SFA支架较大（6.2 vs. 5.6 mm; p < 0.0001），支架长度较长（260 vs. 171 mm; p < 0.0001）。两组间髂/胫骨联合治疗无差异（p = 0.3）。在结果方面，两组患者在截肢方面没有差异（CS 10 vs BMS 10.2%, p = 1），但CS患者的总死亡率较低（8 vs 22%, p = 0.04），急性肢体缺血的死亡率较低（17 vs 34%, p = 0.03）。未经调整分析，CS患者进行血管内再干预（p = 0.03）和开放再干预（p = 0.005）较少，但首次血管内再干预时间较短（5.6个月对17.8个月；p = 0.0002）。Kaplan-Meier估计CS患者48个月生存率为83%，BMS患者为75% （p = 0.28）。在36个月时，CS的初级通畅率为35%，BMS为41% (p = 0.09)， CS的初级辅助通畅率为57%，BMS为68% (p = 0.04)， CS的次级通畅率为61%，BMS为61% （p = 0.99）。结论：在这一系列研究中，CS的再干预率低于BMS，尽管TASC分级更高，病变时间更长，腘窝径流评分更高。CS更常用于挽救先前的SFA干预。然而，在3年时，两组之间的通畅程度相似。这些数据表明CS在血管内挽救失败的SFA干预方面优于BMS，并且可能是比BMS更复杂的SFA病变的首选方式。

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Mid-term outcomes of covered and bare metal stents for femoropopliteal atherosclerotic disease.

ObjectiveEndovascular modality used in peripheral vascular intervention (PVI) varies widely. Long-term outcomes are poorly studied between covered stents (CS) and bare metal stents (BMS) for the SFA.MethodsPatients (2017-2021) undergoing CS and BMS to the SFA were identified at an academic institution. Comparative statistics and Kaplan-Meier analysis were used to evaluate outcomes by group.ResultsOne hundred and nineteen patients undergoing stenting were included with 60 patients undergoing CS (50%) and BMS in 59 (50%). There were no differences in sex (p = 0.5), preoperative ABI (p = 0.2) or indication for surgery between groups (p = 0.8). CS patients had undergone more prior SFA interventions (p = 0.03) and were younger (62 vs. 66 years; p = 0.04). Regarding anatomic and operative characteristics, CS patients had more TASC C/D lesions (69 vs. 47%; p = 0.006) less severe calcification (8 vs.17%; p = 0.0006) and more often underwent angioplasty and stenting (90 vs 51%; p < 0.0001) and less often angioplasty, DCB and stenting (5 vs. 43%; p < 0.0001). CS patients had larger SFA (5.7 vs 4; p < .0001), longer lesions (119 vs. 89 mm; p = 0.0008), higher popliteal runoff score (8.3 vs. 6.4; p = 0.02), longer surgery (140 vs. 118 min; p = 0.03), less fluoroscopy time (21 vs. 26 min; p = 0.03), larger SFA stent (6.2 vs. 5.6 mm; p < 0.0001), and longer stented length (260 vs. 171 mm; p < 0.0001). There were no differences in concomitant iliac/tibial treatment between groups (p = 0.3). Regarding outcomes, there were no differences in amputation (CS 10 vs. BMS 10.2%; p = 1) but overall mortality was lower in CS patients (8 vs 22%; p = 0.04) as was acute limb ischemia (17 vs. 34%; p = 0.03). CS patients underwent fewer endovascular (p = 0.03) and open reinterventions (p = 0.005) but a shorter time to first endovascular reintervention (5.6 vs. 17.8 months; p = 0.0002) on unadjusted analysis. Kaplan-Meier estimated survival at 48 months was 83% for CS and 75% for BMS (p = 0.28). At 36 months, primary patency was 35% for CS vs. 41% for BMS (p = 0.09), primary-assisted patency was 57% for CS vs. 68% for BMS (p = 0.04) and secondary patency for CS was 61% vs. 61% for BMS (p = 0.99).ConclusionsIn this series, CS was associated with lower reintervention rates than BMS despite higher TASC classification, longer lesions, and higher popliteal runoff scores. CS was more often used to salvage previous SFA intervention. At 3 years, however, patency was similar between groups. These data suggest some advantages for CS over BMS in endovascular salvage of failed SFA intervention and potentially a preferred modality for more complex SFA lesions than BMS.

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来源期刊

Vascular 医学-外周血管病

CiteScore

2.30

自引率

9.10%

发文量

196

审稿时长

6-12 weeks

期刊介绍： Vascular provides readers with new and unusual up-to-date articles and case reports focusing on vascular and endovascular topics. It is a highly international forum for the discussion and debate of all aspects of this distinct surgical specialty. It also features opinion pieces, literature reviews and controversial issues presented from various points of view.