背景:radial特异性设备的引入使经radial(TR)主动脉(AI)血管内治疗(EVT)更加方便。
目的:作者旨在研究TR方法在接受AIEVT治疗有症状的外周动脉疾病患者中的围手术期结局。
方法:COMFORT(当代主动脉干预策略)注册是前瞻性的,多中心,观察性研究纳入2021年1月至2023年6月期间接受AIEVT的有症状外周动脉疾病患者.主要结果是围手术期并发症,而次要结局包括核心实验室评估的残余狭窄>30%,止血时间,步行时间,30天通畅,和30天的肢体症状。在倾向评分匹配后,比较了TR和非TRAIEVT之间的这些结果。
结果:对947例患者中的231例(24.3%)选择了TR方法。踝臂指数较高的患者更多选择TR入路,慢性完全闭塞,主动脉病变,裸镍钛诺支架植入,和普通血管成形术,而在透析患者中选择较少,AIEVT的历史,慢性威胁肢体缺血,双侧钙化,同时进行腹股沟下EVT(均P<0.05)。在倾向得分匹配后,围手术期并发症的发生率两组间无显著差异(TR组:6.0%vs非TR组:5.1%;P=0.69).残余狭窄的比例,30天通畅,30天肢体症状无显著差异(均P>0.05);TR组的止血时间和下床时间均较短(均P<0.05)。
结论:非TRAIEVT和使用放射状特异性设备的TRAIEVT与围手术期并发症的风险相似。TR方法有助于缩短止血和下床活动所需的时间。
BACKGROUND: The introduction of radial-specific equipment has made transradial (TR) aortoiliac (AI) endovascular therapy (EVT) more convenient.
OBJECTIVE: The authors aimed to investigate the perioperative outcomes of the TR approach in patients undergoing AI EVT for symptomatic peripheral artery disease.
METHODS: The COMFORT (Contemporary Strategy for Aortoiliac Intervention) registry was a prospective, multicenter, observational study enrolling patients with symptomatic peripheral artery disease undergoing AI EVT between January 2021 and June 2023. The primary outcome was perioperative complications, whereas the secondary outcomes included core laboratory-evaluated residual stenosis >30%, time to hemostasis, time to ambulation, 30-day patency, and 30-day limb symptoms. These outcomes were compared between TR and non-TR AI EVT after propensity score matching.
RESULTS: The TR approach was selected for 231 of the 947 patients (24.3%). The TR approach was chosen more in patients with a higher ankle-brachial index, chronic total occlusion, aortic lesion, bare nitinol stent implantation, and plain angioplasty, whereas it was chosen less in patients with dialysis, a history of AI EVT, chronic limb-threatening ischemia, bilateral calcification, and simultaneous infrainguinal EVT (all P < 0.05). After propensity score matching, the incidence of perioperative complications did not differ significantly between the groups (TR group: 6.0% vs non-TR group: 5.1%; P = 0.69). The proportions of residual stenosis, 30-day patency, and 30-day limb symptoms were not significantly different (all P > 0.05); however, the time to hemostasis and the time to ambulation were shorter in the TR group (both P < 0.05).
CONCLUSIONS: Non-TR AI EVT and TR AI EVT using radial-specific equipment were associated with a similar risk of perioperative complications. The TR approach helps shorten the time required for hemostasis and ambulation.