Objective:To investigate the mid- to long-term outcomes of endovascular treatment with Supera interwoven nitinol stents in patients with chronic limb-threatening ischemia (CLTI).Methods:From April 2017 to December 2020, clinical data from 303 CLTI patients aged over 50 years and treated with Supera stent were collected and analyzed retrospectively at three centers including Department of Vascular Surgery of Zhongshan Hospital of Fudan University, Department of Vascular Diseases of Shanghai TCM-Integrated Hospital, and Department of Vascular Surgery of Wenling Hospital of Traditional Chinese Medicine of Zhejiang Province. Among them, there were 205 males and 98 females, with an age of (74.0±10.1) years. Telephone follow-up and collected the overall survival, clinically driven target lesion revascularization (CD-TLR), major amputation, and wound healing. The Kaplan-Meier method was used to draw survival curves and the Log rank test was used to compare the survival differences between the two groups of patients.Results:Follow-up was obtained in 296 patients, with a follow-up duration of (23.6± 2.9) months. Kaplan-Meier survival curves showed that the overall survival rates at 6, 12, 24, and 36 months were 99.0%, 96.2%, 86.1%, and 77.4%, respectively. The proportions of patients without CD-TLR at 12, 24, and 36 months were 94.2%, 91.1%, and 89.6%, respectively. During the follow-up period, 15 patients underwent major amputations, with a total limb salvage rate of 92.7% (281/303) and an effective limb salvage rate of 94.9% (281/296). Among 268 patients with preoperative wounds, 203 healed, with a wound healing rate of 75.7%. The Kaplan-Meier survival curve indicated that patients with wounds healed had a higher survival rate compared to those whose wounds did not heal, with a statistically significant difference (Log-rank χ2=32.894, P<0.01). Meanwhile, in terms of diabetes, Meggitt Wagner classification, Rutherford classification, the number of lesions and the number of preoperative outflow tracts, there were statistically significant differences between the wound healing group and the non-healing group ( P values were 0.025, 0.007, 0.005, 0.049 and 0.004, respectively). Conclusions:The utilization of Supera interwoven nitinol stents in CLTI patients demonstrates clinical benefits in improving wound healing rates and limb preservation.
To improve the efficacy of endovascular treatment of arteriosclerosis obliterans of the lower extremities, it is first necessary to correctly evaluate and distinguish the nature of the lesion, select the appropriate vascular preparation method and make a correct evaluation of its results. On this basis, it can be decided whether to use a drug-coated balloon or implant a stent. If the latter option is chosen, it is necessary to understand the performance and characteristics of each stent and select the most suitable one according to the nature of the lesion. This follows the idea of "leave the right thing behind".
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.
The endovascular treatment of lower extremity arteriosclerosis obliterans (ASO) has flourished and become the preferred treatment option. With the advancement of devices and technology, this kind of treatment is applied in expanded indications with improving effectiveness. This article introduces some hot topics in the endovascular treatment of lower extremity ASO.
