METHODS: This single-center retrospective study comprised 154 consecutively hospitalized individuals with PAD who underwent EVT for de novo femoral-popliteal calcific lesions from January 2016 to July 2021. The predominant calcification patterns of IAC and MAC were assessed using a semi-quantitative computed tomography scoring system. The Kaplan-Meier method and Cox regression were conducted to evaluate the correlations between calcification patterns and medium- to long-term outcomes.
RESULTS: The distribution of calcification patterns was as follows: IAC in 111 patients (72%) and MAC in 43 patients (28%). No remarkable variation was noted between the IAC and MAC groups regarding age (P = .84) and gender (P = .23). The MAC group indicated lower rates of 4-year primary patency, assisted primary patency, secondary patency, and amputation-free survival (AFS) compared with the IAC group (24% ± 7% vs 40% ± 6%; P = .003; 30% ± 8% vs 51% ± 6%; P = .001; 51% ± 8% vs 65% ± 5%; P = .004; and 43% ± 9% vs 76% ± 5%; P < .001, respectively). There was no significant difference in the rate of freedom from clinically driven target lesion revascularization between the MAC and IAC groups (63% ± 10% vs 73% ± 5%; P = .26). Stepwise multivariable Cox regression analysis demonstrated that MAC was associated with poor patency (hazard ratio, 1.81; 95% confidence interval, 1.12-2.93; P = .016) and AFS (hazard ratio, 2.80; 95% confidence interval, 1.52-5.16; P = .001).
CONCLUSIONS: Compared with IAC, MAC is independently associated with lower medium- to long-term patency and AFS after EVT for de novo femoral-popliteal occlusive lesions.
方法:这项单中心回顾性研究纳入了154名连续住院的PAD患者,这些患者于2016年1月至2021年7月因新的股-pop钙化性病变接受EVT治疗。使用半定量计算机断层扫描评分系统评估IAC和MAC的主要钙化模式。采用Kaplan-Meier法和Cox回归方法评估钙化模式与中长期结局之间的相关性。
结果:钙化模式的分布如下:IAC为111例(72%),MAC为43例(28%)。在年龄(p=0.84)和性别(p=0.23)方面,IAC和MAC组之间没有明显差异。MAC组显示4年初级通畅率较低,辅助初级通畅,与IAC组相比,继发性通畅性和无截肢生存率(24±7%vs.40±6%,p=.003;30±8%vs.51±6%,p=.001;51±8%vs.65±5%,p=.004;43±9%vs.76±5%,p<.001)。MAC组和IAC组之间临床驱动的靶病变血运重建的发生率没有显着差异(63±10%vs.73±5%;p=.26)。逐步多变量Cox回归分析表明,MAC与通畅性差相关(风险比[HR],1.81;95%CI,1.12-2.93;p=0.016)和AFS(HR,2.80;95%CI,1.52-5.16;p=.001)。
结论:与IAC相比,对于从头股-pop闭塞性病变,在EVT后,MAC与较低的中长期通畅性和AFS独立相关。