.: ORİJİNAL ARAŞTIRMA
Subintimal ile İntraluminal Rekanalizasyonun Femoropopliteal Kronik Total Oklüzyonlarda 1 Yıllık SonuçlarınınKarşılaştırılması: Anadolu?dan Tek Merkez Deneyimi
Comparison of One Year Outcomes of Subintimal Versus Intraluminal Recanalization in Femoropopliteal Chronic Total Occlusions: Single Center Experience from Anatolia
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(1):20-8
doi: 10.5336/cardiosci.2019-70974
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Femoropopliteal kronik total oklüzyon (KTO) larda subintimal ile intraluminal rekanalizasyonun erken ve 1 yıllık sonuçlarının kendi merkezimiz düzeyinde prospektif gözlemsel olarak karşılaştırılmasıdır. Gereç ve Yöntemler: Anadolu?dan tek merkezden 85 intraluminal ve 151 subintimal yoldan başarılı revaskülarize edilmiş 236 ekstremite prospektif olarak çalışmaya dâhil edilerek analiz edildi. İşlem öncesinde, sırasında ve sonrası erken dönemde anjiyografik ve klinik sonuçları ile 1 yıllık primer, primer asiste edilmiş ve sekonder açıklık oranları belirlenerek her 2 yöntem karşılaştırıldı. Bulgular: Toplam işlem süresi-dk (35,4±7,5?e karşılık 39,1±11, p=0,006) ve fluoroskopi süresi-dk [27 (20,5-32)?e karşılık 28 (24-34), p=0,015] subintimal grupta daha uzun olarak belirlendi. İntraluminal ve subintimal revaskülarizasyon arasında; majör advers olay (serebrovasküler olay, miyokard infarktüsü ve ekstremite kaybı) (%4,7?ye karşılık %6,6, p=0,55), tüm nedenli ölüm (%2,4?e karşılık %2,6, p=0,89), kardiyovasküler ölüm (%1,2?ye karşılık %2,6, p=0,45) ve stent trombozu (%1,2?ye karşılık %0, p=0,18) açısından istatistiksel anlamlı fark saptanmadı.Bir yıllık primer (%82,4?e karşılık %78,8, p=0,52), primer asiste edilmiş (%92,9?a karşılık %90,7, p=0,54) ve sekonder açıklık (%97,6?ya karşılık %96, p=0,49) oranlarında da yine her 2 yaklaşım arasında anlamlı fark izlenmedi. Sonuç: Femoropopliteal KTO?larda lezyon özelliği ayırt etmeden yapılan subintimal rekanalizasyon da intimal yaklaşımla benzer ve oldukça yüksek 1 yıllık açıklık ve düşük komplikasyon oranlarına sahiptir.
Anahtar Kelimeler: Subintimal rekanalizasyon; femoropopliteal kronik total okluzyon
Amaç: Femoropopliteal kronik total oklüzyon (KTO) larda subintimal ile intraluminal rekanalizasyonun erken ve 1 yıllık sonuçlarının kendi merkezimiz düzeyinde prospektif gözlemsel olarak karşılaştırılmasıdır. Gereç ve Yöntemler: Anadolu?dan tek merkezden 85 intraluminal ve 151 subintimal yoldan başarılı revaskülarize edilmiş 236 ekstremite prospektif olarak çalışmaya dâhil edilerek analiz edildi. İşlem öncesinde, sırasında ve sonrası erken dönemde anjiyografik ve klinik sonuçları ile 1 yıllık primer, primer asiste edilmiş ve sekonder açıklık oranları belirlenerek her 2 yöntem karşılaştırıldı. Bulgular: Toplam işlem süresi-dk (35,4±7,5?e karşılık 39,1±11, p=0,006) ve fluoroskopi süresi-dk [27 (20,5-32)?e karşılık 28 (24-34), p=0,015] subintimal grupta daha uzun olarak belirlendi. İntraluminal ve subintimal revaskülarizasyon arasında; majör advers olay (serebrovasküler olay, miyokard infarktüsü ve ekstremite kaybı) (%4,7?ye karşılık %6,6, p=0,55), tüm nedenli ölüm (%2,4?e karşılık %2,6, p=0,89), kardiyovasküler ölüm (%1,2?ye karşılık %2,6, p=0,45) ve stent trombozu (%1,2?ye karşılık %0, p=0,18) açısından istatistiksel anlamlı fark saptanmadı.Bir yıllık primer (%82,4?e karşılık %78,8, p=0,52), primer asiste edilmiş (%92,9?a karşılık %90,7, p=0,54) ve sekonder açıklık (%97,6?ya karşılık %96, p=0,49) oranlarında da yine her 2 yaklaşım arasında anlamlı fark izlenmedi. Sonuç: Femoropopliteal KTO?larda lezyon özelliği ayırt etmeden yapılan subintimal rekanalizasyon da intimal yaklaşımla benzer ve oldukça yüksek 1 yıllık açıklık ve düşük komplikasyon oranlarına sahiptir.
Anahtar Kelimeler: Subintimal rekanalizasyon; femoropopliteal kronik total okluzyon
ABSTRACT
Objective: The aim of this study was to compare prospective observational early and first year outcomes of subintimal and intraluminal recanalization in femoropopliteal chronic total occlusions at the level of our center. Material and Methods: 85 intraluminal and 151 subintimal successfully revascularized extremities were analyzed prospectively from single center of Anatolia. The angiographic and clinical results of the patients before, during and after the procedure were determined. One year primary, primary assisted and secondary patency rates were compared between both methods. Results: Total procedure time-min. (35.4±7.5 vs 39.1±11, p=0.006) and fluoroscopy time min. [27 (20.5-32) vs 28 (24-34), p=0.015] were determined longer in the subintimal group. Major advers events (cerebrovascular disease, myocardial infarction and amputation) (4.7% vs 6.6%, p=0.55), all cause death (2.4% vs 2.6%, p=0.89), cardiovascular death (1.2% vs 2.6%, p=0.45) and stent thrombosis (1.2% vs 0%, p=0.18) were similar statistically in both group. As well as one year primary (82.4% vs 78.8%, p=0.52), primary assisted (92.9% vs 90.7%, p=0.54) and secondary patency (97.6% vs 96%, p=0.49) rates were similar in both group. Conclusion: Subintimal recanalization in femoropopliteal CTO without distinguishing lesion feature is similar to intimal approach and has very high 1-year patency and low complication rates.
Keywords: Subintimal recanalisation; femoropopliteal chronic total occlusion
Objective: The aim of this study was to compare prospective observational early and first year outcomes of subintimal and intraluminal recanalization in femoropopliteal chronic total occlusions at the level of our center. Material and Methods: 85 intraluminal and 151 subintimal successfully revascularized extremities were analyzed prospectively from single center of Anatolia. The angiographic and clinical results of the patients before, during and after the procedure were determined. One year primary, primary assisted and secondary patency rates were compared between both methods. Results: Total procedure time-min. (35.4±7.5 vs 39.1±11, p=0.006) and fluoroscopy time min. [27 (20.5-32) vs 28 (24-34), p=0.015] were determined longer in the subintimal group. Major advers events (cerebrovascular disease, myocardial infarction and amputation) (4.7% vs 6.6%, p=0.55), all cause death (2.4% vs 2.6%, p=0.89), cardiovascular death (1.2% vs 2.6%, p=0.45) and stent thrombosis (1.2% vs 0%, p=0.18) were similar statistically in both group. As well as one year primary (82.4% vs 78.8%, p=0.52), primary assisted (92.9% vs 90.7%, p=0.54) and secondary patency (97.6% vs 96%, p=0.49) rates were similar in both group. Conclusion: Subintimal recanalization in femoropopliteal CTO without distinguishing lesion feature is similar to intimal approach and has very high 1-year patency and low complication rates.
Keywords: Subintimal recanalisation; femoropopliteal chronic total occlusion
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