Primary stenting for TASC C and D femoropopliteal lesions: one-year results from a multicentric trial on 203 patients

被引:19
作者
Brouillet, Julie [1 ]
Deloose, Koen [2 ,3 ]
Goueffic, Yann [4 ]
Poirier, Mathieu [5 ]
Midy, Dominique [1 ]
Caradu, Caroline [1 ]
Ducasse, Eric [1 ]
机构
[1] Bordeaux Univ, Unit Vasc Surg, Bordeaux, France
[2] Unit Vasc Surg, Dendermonde, Belgium
[3] Unit Vasc Surg, Bonheiden, Belgium
[4] Nantes Univ, Unit Vasc Surg, Nantes, France
[5] Unit Vasc Surg, Mt De Marsan, France
关键词
Femoral artery; Wounds and lesions; Stents; SUPERFICIAL FEMORAL-ARTERY; CONSENSUS-II C; ENDOVASCULAR THERAPY; INFRAINGUINAL BYPASS; RANDOMIZED-TRIAL; SAPHENOUS-VEIN; COATED BALLOON; NITINOL STENT; ANGIOPLASTY; OUTCOMES;
D O I
10.23736/S0021-9509.16.09282-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Recent advances in endovascular techniques have made it a seductive choice in the management of TASC C and D lesions. Currently, this tendency remains controversial, despite high success rates. The aim of the study was to regroup and harmonize the results of three surgical teams in 5 centers in order to obtain the largest series ever published on TASC C and D femoro-popliteal lesions primary stenting. METHODS: Two hundred and three patients and 209 lower limbs were included from March 2008 to October 2013. Each patient underwent primary stenting for TASC C or D femoro-popliteal lesions. RESULTS: Mean age was 701:10; 71.4% were male with a 39.8% rate of coronary heart disease, 20.1% of renal insufficiency and 35.9% of diabetes; 57,4% suffered from claudication and 42.6% from critical limb ischemia (CLI); 61.8% of the 144 limbs analyzed for run-off presented with 3 patent infra-popliteal arteries. Four hundred and three stents were implanted in the 209 limbs included. Median stented length was 252 mm. Associated procedures were performed in 35 patients (17.0%) including 4.3% minor amputations. The 30-day mortality rate was 1.4% (3 patients). Major complications occurred in 19 patients (93%) including 7 patients (3.4%) presented with early in-stent thrombosis. Median follow-up duration was 12 months (range 9.5-17.2 months). The 12-month mortality rate was 11.8% (24 patients). The 3, 6 and 12 months primary patency rates according to Kaplan Meier estimates were 98.1 +/- 0.9, 85.2 +/- 2.5 and 67.0 +/- 3.3% respectively. Secondary patency rates were 96.1 +/- 1.9, 89.3 +/- 3.0 and 75.7 +/- 4.2% respectively. A subgroup analysis reported significantly higher patency rates for TASC C lesions compared to TASC D lesions (82.1% vs. 44% respectively, P.009). The 12-month in-stent thrombosis and restenosis rates were 19.6% and 13.9% respectively. A subgroup analysis showed higher rates of in-stent restenosis for TASC D lesions compared to TASC C lesions (35% vs. /0% respectively, P=0.005). The stent fracture rate was equal to 10.2% (30 stents). Occurrence of in-stent thrombosis and restenosis were associated with 3 and 5 cases of stent fracture (type II to IV) respectively. Freedom from TLR was 70.5%. Rutherford class decreased from 3.7 to 0.9 (3.52 +/- 1.06 to 0.75 +/- 1.24) (P<0.0001). At 12 months 61.3% were asymptomatic, 33.3% suffered from claudication (21.3% Rutherford 1) and 5.4% suffered from CLI. Healing rates were 63.9% with a limb salvage rate of 95.5% and a major amputation rate of 3.8%. CONCLUSIONS: This is the largest series of TASC C and D femoro-popliteal lesions primary stenting to our knowledge. The results are encouraging with acceptable primary patency and clinical improvement at 12 months. Results from mid- to long-term follow-up are awaited.
引用
收藏
页码:392 / 404
页数:13
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