Comparison of the clinical efficacy of endovascular reconstruction versus bypass sur-gery for trans-atlantic inter-society consensus Ⅱ C/D femoropopliteal artery lesion resulted from arteriosclerosisobliterans / 北京大学学报(医学版)

ABSTRACT

Objective:To study the clinical effects of endovascular reconstruction versus bypass surgery for TASC Ⅱ( trans-atlantic inter-society consensus Ⅱ) C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans. Methods:One hundred and three patients(119 limbs) accepted bypass surgery or endovascular therapy for TASCⅡC/D femoropopliteal artery lesion between January 2002 and Decem-ber 2012 at our institution were retrospectively assessed. All the patients were diagnosed with arterioscle-rosis obliterins, and all their Rutherford classifications were from 2 to 5 degrees. Among them there were 71 limbs treated by endovascular reconstruction and the other 48 limbs were treated with bypass surgery. We evaluated the short term clinical effect according to the condition when patients left the hospital, and evaluated the long term clinical effect according to the results of the patients' latest follow-up in 2014. Their clinical data before treatment, complication rates, death rates, hospital stays, short term and long term effects, reoperation rates, 1 to 10 years primary and secondary accumulative patency rates and limb salvage rates were compared. Results:There was no significant difference between the bypass group and the endovascular group on the mean age and ankle brachial index before treatment [(67. 1 ± 7. 1) years (51 to 80 years) vs. (68. 0 ± 9. 4) years (49 to 91 years),P=0. 561;(0. 41 ± 0. 23) vs. (0. 40 ± 0 . 26 ) , P=0 . 928 ] . There were more TASCⅡD patients in the bypass group than those in the endovas-cular group ( P<0 . 001 ) , and the rutherford classification was higher in the endovascular group than that in the bypass group. The difference in the mean follow-up between the bypass group and the endovascular group was not significant[(41. 7 ± 23. 6) months vs. (59. 5 ± 41. 6) months,P =0. 065]. Five peri-operative complication cases occurred in the bypass group, including 2 cases of acute thrombosis,1 case of infection and 2 cases of heart failure, and only 1 complication case occurred in the endovascular group that was heart failure. The complication rate was higher in the bypass group than that in the endovascular group [10. 4% vs. 1. 4%, P=0. 039]. And there was no death in both the groups. Compared with the endovascular group, the bypass group had a longer hospital stays [(13. 2 ± 4. 7) d vs. (6. 5 ± 3. 1) d, P<0. 001],a higher reoperation rate (58. 3% vs. 31. 0%,P =0. 003), a better short term, obvious, and effective rate (25. 0% vs. 9. 9%, P =0. 027),a worse long term deterioration rate (37. 5% vs. 18. 3%,P=0. 019) and higher 1 to 10 years primary and secondary accumulative patency rates( P =0 . 001 , P=0 . 001 ) . There was no significant difference between the two groups on the increase of ankle brachial index[(0. 34 ± 0. 28) vs. (0. 31 ± 0. 23), P=0. 371], and short term and long term total ef-fective rates (89. 6% vs. 84. 5%, P=0. 426;45. 8% vs. 56. 3%, P=0. 260), and limb salvage rate (83. 3% vs. 94. 4%,P =0. 051). Conclusion:Endovascular therapy is a safe, effective and minimally invasive therapy for TASCⅡ C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans.