- 作者：Yoshimitsu Soga ; Osamu Iida ; Kenji Suzuki ; Keisuke Hirano ; Daizo Kawasaki ; Yoshiaki Shintani ; Nobuhiro Suematsu ; Terutoshi Yamaoka
- 刊名：Journal of Vascular Surgery
- 出版年：December, 2013
- 年：2013
- 卷：58
- 期：6
- 页码：1547-1555
- 全文大小：1984 K
Background
Intraluminal femoropopliteal stenting enables favorable dilation and good immediate results; however, whether this contributes to long-term patency is unclear. We compared patency after femoropopliteal stenting for a long occlusion using either an intraluminal or subintimal approach.Methods
Between January 2004 and December 2011, 902 endovascular procedures using either an intraluminal approach (651 procedures) or a subintimal approach (251 procedures) for long femoropopliteal occlusion were analyzed retrospectively. The outcomes of this study were periprocedural complication; primary, assisted-primary, and secondary patency; and overall survival.
Results
The mean follow-up period of survivors was 29 卤 16 months. Between the intraluminal and subintimal approach, technical success (91% vs 90%; P聽= .71) and periprocedural complications (11% vs 13%; P聽= .34) were similar. However, procedure time was significantly longer for the intraluminal approach (126聽卤 63 minutes vs 98聽卤 49 minutes; P聽= .003). The improvement of ankle-brachial index was also similar. A quarter of cases started with the intraluminal approach were switched to a subintimal approach. There was no significant difference in primary, assisted-primary and secondary patency at 3 years between the two groups (55% vs 53%; P聽= .30; 65% vs 74%; P聽= .11; and 80% vs 85%; P聽= .37). The 3-year overall survival also did not differ significantly between groups (84% vs 86%; P聽= .55). After adjusting for baseline differences, the subintimal approach was found to be similar to the intraluminal approach for primary patency (hazard ratio, 1.21; 95% confidence interval, 0.94-1.56; adjusted P聽= .14).
Conclusions
Initial result and 3-year patency was similar in both approaches. Given the longer procedure time and high crossover rate, we suggest that a subintimal approach may be preferred in the treatment of long femoropopliteal occlusions with stenting.