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.
目的 探讨髂静脉压迫综合征(IVCS)继发下肢静脉溃疡的愈合情况及诊治体会.方法 收集2018年4月至2021年9月就诊于上海市中西医结合医院的54例IVCS合并下肢静脉溃疡患者的临床资料,观察患者的病变长度、溃疡愈合情况、凝血功能指标[D-二聚体、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(Fib)]等,分析腔内治疗IVCS后的溃疡愈合情况.结果 所有患者中,单纯左侧髂静脉受压患者的影像学表现主要为左侧髂总静脉被前方的右髂总动脉及后方腰椎压迫引起狭窄,术中数字减影血管造影(DSA)下可见管腔狭窄、血液流速缓慢或大量侧支循环;部分患者左侧髂静脉完全狭窄,可见血流通过侧支循环至右侧髂静脉回流至下腔静脉.所有患者中,左侧髂静脉共植入支架89枚,平均病变长度为115.56 mm;右侧髂静脉共植入支架19枚,平均病变长度为62.63 mm.髂静脉开通成功率为100％,结合介入术后创面处理,仅有1例患者创面未愈合,主要与患者溃疡面积过大、病程过久有关,其余患者的创面均已愈合.术后复查凝血功能及下肢静脉超声,无患者发生下肢深静脉血栓形成.围手术期无死亡患者,无肾功能不全等严重并发症发生.术后当天,患者的D-二聚体、Fib水平均较术前升高,差异均有统计学意义(P<0.05).术后当天与术前的APTT、INR、TT、PT比较,差异均无统计学意义(P>0.05).结论 对于IVCS继发下肢静脉性溃疡患者,早期解除髂静脉压迫,可缩短愈合周期,减少溃疡复发,增加患者获益.
下肢动脉硬化闭塞症的传统外科手术治疗创伤较大，术后并发症发生率高。介入治疗具有微创、高效、并发症低、可重复治疗等优点，逐渐成为治疗该疾病的首选。本文就下肢动脉硬化闭塞症的外科治疗现状及前景做一综述。
