Buscar en
Angiología
Toda la web
Inicio Angiología Cirugía endovascular como tratamiento de elección en el sector femoropoplíteo...
Información de la revista
Vol. 54. Núm. 4.
Páginas 308-316 (Enero 2002)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 54. Núm. 4.
Páginas 308-316 (Enero 2002)
Acceso a texto completo
Cirugía endovascular como tratamiento de elección en el sector femoropoplíteo y distal en isquemia crónica de miembros inferiores en un servicio de angiología y cirugía vascular (1995–2001)
Endovascular surgery as first choice treatment in the femoral-popliteal and distal sector in chronic ischemia of the lower limbs in an angiology and vascular surgery service (1995–2001)
Cirugia endovascular como tratamiento de primeira escolha no sector femoro-poplío e distal na isquemia crónica dos membros inferiores num serviço de angiologia e cirurgia vascular (1995–2001)
Visitas
2489
A. Arruabarrena-Oyarbide
Autor para correspondencia
ecano@hmservet.insalud.es

correspondence: Servicio de Angiología y Cirugía Vascular. Hospital Universitario Miguel Servet. Paseo Isabel la Católica, 1-3. E-50009 Zaragoza
, E. Cano-Trigueros, I. Soguero-Valencia, A. Sesma-Gutiérrez, B. Viviens-Redondo, M.A. Marco-Luque
Servicio de Angiología, Cirugía Vascular y Endovascular. Hospital Universitario Miguel Servet. Zaragoza, España.
Este artículo ha recibido
Información del artículo
Summary
Aim

To analyse our experience in endovascular treatment of chronic arteriosclerotic ischemia of the lower limbs.

Patients and methods

Retrospective study of the period January 1995 to December 2001. 46 procedures (43 patients). Average age: 63.2±10.2 years. Diabetes: 34.8%. Indication: critical ischemia, 80.4%. Disabling claudication: 19.6%. Topographical indication: type A-B lesions (n=45) and type C (n=1); stenosis, 54.3%, and occlusions, 45.7%. Run-off: 0-1 vessels, 39.1%; 2-3 vessels, 60.9%. Isolated angioplasty, 78.2%, and angioplasty+stent, 21.8%. Follow-up: 0.5-66 months (average, 19.1 months). We calculated the primary and secondary permeability, limb salvage and actuarial survival in terms of six variables: topographical sector, type of lesion, clinical degree, type of procedure, run-off and diabetes. Statistical tests: Kaplan-Meier, log-rank. SPSS statistical package.

Results

At 30 days: primary permeability, 93.4%; secondary, 95.6%; limb salvage, 93.4%. Survival, 100%. Late: overall primary permeability, 59.4% (run-off: 0-1 vessels, 40.3%; 2-3 vessels, 70.6%; p>0.05; the rest of the variables are not significant). Overall secondary permeability, 66.6% (runoff: 0-1 vessels, 48.3%; 2-3 vessels, 78.6%; p>0.05). There is no significant relation between the rest of the variables and secondary permeability. Overall limb conservation, 74% (claudicators, 100%; pain at rest, 85.8%; trophic lesions, 46.9%; p>0.05. In run-off: 0-1 vessels, 19.7%; 2-3 vessels, 100%; p>0.05). Overall survival, 80% at 5.5 years.

Conclusions

We consider endovascular surgery to be the first choice treatment in critical ischemia of the lower limbs with type A and B morphologies. In our series outlet drainage (2-3 vessels) is the most important prognostic factor for the success of this technique.

Key words:
Angioplasty
Chronic ischemia
Endovascular surgery
Femoral-popliteal
Run-off
Vascular surgery
Resumen
Objetivo

Analizar nuestra experiencia en el tratamiento endovascular de la isquemia crónica arteriosclerosa de miembros inferiores.

Pacientes y métodos

Estudio retrospectivo: enero 1995-diciembre 2001. 46 procedimientos (43 pacientes). Edad media: 63,2±10,2 años. Diabetes: 34,8%. Indicación: isquemia crítica, 80,4%. Claudicación in capacitante: 19,6%. Indicación topográfica: lesiones tipo A-B (n=45) y tipo C (n=1); estenosis, 54,3%, y obstrucciones, 45,7%. Run-off: 0-1 vasos, 39,1%; 2-3 vasos, 60,9%. Angioplastia aislada, 78,2%, y angioplastia+stent, 21,8%. Seguimiento: 0,5-66 meses (media, 19,1 meses). Calculamos la permeabilidad primaria, secundaria, salvamento de la extremidad y supervivencia actuariales en función de seis variables: sector topográfico, tipo de lesión, grado clínico, tipo de procedimiento, run-off y diabetes. Tests estadísticos: Kaplan-Meier, log-rank Paquete estadístico SPSS. Resultados. A 30 días: permeabilidad primaria, 93,4%; secundaria, 95,6%; salvamento de la extremidad, 93,4%. Supervivencia, 100%. Tardíos: permeabilidad primaria global, 59,4% (run-off: 0-1 vasos, 40,3%; 2-3 vasos, 70,6%; p>0,05; el resto de variables no son significativas). Permeabilidad secundaria global, 66,6% (run-off: 0-1 vasos, 48,3%; 2-3 vasos, 78,6%; p>0,05). No existe ninguna relación significativa entre el resto de las variables y la permeabilidad secundaria. Conservación de la extremidad global, 74% (claudicantes, 100%; dolor en reposo, 85,8%; lesiones tróficas, 46,9%; p>0,05. En runoff: 0-1 vasos, 19,7%; 2-3 vasos, 100%; p>0,05). Supervivencia global, 80% a 5,5 años.

Conclusiones

Consideramos la cirugía endovascular como el tratamiento de elección en la isquemia crítica de miembros inferiores en lesiones con morfologías tipo A y B. El drenaje de salida (2-3 vasos) es el factor pronóstico más importante en nuestra serie para el éxito de esta técnica.

Palabras clave:
Angioplastia
Cirugía endo-vascular
Cirugía vascular
Femoropoplítea
Isquemia crónica
Run-off
Resumo
Objetivo

Analisar a nossa experiéncia no tratamento endovascular da isquemia crónica arteriosclerótica dos membros inferiores.

Doentes e métodos

Estudo retrospectivo: Janeiro 1995-Dezembro 2001. 46 procedimentos (43 doentes). Idade média: 63,2±10,2 anos. Diabetes: 34,8%. Indicação: isquemia crítica, 80,4%. Claudicação incapacitante: 19,6%. Indicação topográfica: lesões tipo A-B (n=45) e tipo C (n=1); estenose, 54,3%, e obstruções, 45,7%. Run-off: 0-1 vasos, 39,1%; 2-3 vasos, 60,9%. Angioplastia isolada, 78,2%, e angioplastia+stent, 21,8%. Seguimento: 0,5-66meses (média, 19,1 meses). Calculámos a permeabilidade primária, secundária, recuperação da extremidade e sobrevivência actuarial em função de seis variáveis: sector topográfico, tipo de lesão, grau clínico, tipo de procedimento, run-off e diabetes. Testes estatísticos: Kaplan-Meier, log-rank Pacote estatístico SPSS. Resultados. A 30 dias: permeabilidade primária, 93,4%; secundária, 95,6%; salvamento da extremidade, 93,4%. Sobrevivencia, 100%. Tardios: permeabilidade primária global, 59,4% (run-off: 0-1 vasos, 40,3%; 2-3 vasos, 70,6%; p>0,05; as restantes variáveis não são significativas). Permeabilidade secundária global, 66,6% (run-off: 0-1 vasos, 48,3%; 2-3 vasos, 78,6%; p>0,05). Não existe qualquer relação significativa entre as restantes variáveis e a permeabilidade secundária. Conservação da extremidade global, 74% (claudicantes, 100%; dor em repouso, 85,8%; lesões tróficas, 46,9%;p>0,05. Em run-off: 0-1 vasos, 19,7%; 2-3 vasos, 100%; p<0,05). Sobrevivência global, 80% aos 5,5 anos.

Conclusões

Consideramos que a cirurgia endovascular seja o tratamento de primeira escolha na isquemia crítica dos membros inferiores em lesões com morfologias tipo A e B. A drenagem de saída (2-3 vasos) é o factor prognóstico mais importante na nossa série para o êxito desta técnica.

Palavras chave:
Angioplastia
Cirurgia endovascular
Cirurgia vascular
Femoropoplitea
Isquemia crónica
Run-off
El Texto completo está disponible en PDF
Bibliografía
[1.]
TransAtlantic Inter-Society Consensus (TASC) Working Group.
Management of peripheral arterial disease.
J Vasc Surg., 31 (2000), pp. 1-300
[2.]
Dotter C.T., Judkins M..
Transluminal treatment of arteriosclerotic obstructions. Description of new technique and preliminary report of its application.
Circulation, 30 (1964), pp. 634
[3.]
Murray J.G., Apthorp L.A., Wilkins R.A..
Longsegment (≥10 cm) femoropopliteal angioplasty: improved technical success and long- term patency.
Radiology, 195 (1995), pp. 158-162
[4.]
Largiader J., Schneider E..
Endovascular and open reconstructive treatment of arterial occlusive disease of lower extremity in critical ischemia stage.
Chirurgie, 66 (1995), pp. 86-92
[5.]
Ray S.A., Minty I., Buckenham T.M., Belli A.M., Taylor R.S., Dormandy J.A..
Clinical outcome and restenosis following percutaneous transluminal angioplasty for ischemic pain or ulceration.
Br J Surg., 82 (1995), pp. 1217-1221
[6.]
Schneider P.A., Rutherford R.B..
Endovascular interventions in the management of lower extremity ischemia,
[7.]
Wolf G.L., Wilson S.E., Cross A.P., Deupree R.H., Stason W.B..
Surgery or balloon angioplasty for peripheral vascular disease: a randomized clinical trial: Veterans Administration Cooperative Study No 199.
J Vasc Interv Radiol, 4 (1993), pp. 639-648
[8.]
Holm J., Arfvidssom B., Lennart J., Lundgre F., Lundholm K., Schersten T., et al.
Chronic lower limb ischemia. A prospective randomised controlled study comparing the 1-year results of vascular surgery and percutaneous transluminal angioplasty (PTA).
Eur J Vasc Surg., 5 (1991), pp. 517-522
[9.]
Becquemin J.P., Cavillon A., Allaire E., Haiduc F., Desgranges P..
Iliac and femoropopliteal lesions.
Evaluation of balloon angioplasty and classical surgery. J Endovasc Surg., 2 (1995), pp. 42-50
[10.]
Jackson M.J., Wolfe J.H..
Are infra-inguinal angioplasty and surgery comparable?.
Acta Chirurg Belg, 101 (2001), pp. 6-10
[11.]
Hunink M.G., Wong J.B., Donaldson M.C., Meyerovitz M.F., Harrington D.P..
Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease.
Med Decis Making, 14 (1994), pp. 71-81
[12.]
Matsi P.J., Manninen H.I..
Impact of different patency criteria on long-term results of femoropopliteal angioplasty: analysis of 106 consecutive patients with claudication.
J Vasc Interv Radiol, 6 (1995), pp. 159-163
[13.]
Hunink M.G., Donaldson M.C., Meyerovitz M.F., Polak J.F., Whittelmore A.D., Kandarpa K..
Risks and benefits of femoropopliteal percutaneous balloon PTA.
J Vasc Surg., 17 (1993), pp. 183-194
[14.]
Lofberg A.M., Karacagil S., Ljungman C., Westman B., Bostrom A., Hellberg A., Ostholm G..
Percutaneous transluminal angioplasty of the femoropopliteal arteries in limbs with chronic critical lower limb ischemia.
J Vasc Surg., 34 (2001), pp. 114-121
[15.]
Morgenstern B.R., Getrajdman G.I., Laffey K.J., Bixon R., Martin E.C..
Total occlusions of the femoropopliteal arteries: high technical success rate of the conventional balloon angioplasty.
Radiology, 172 (1989), pp. 937-940
[16.]
Capek P., McLean G.K., Berkowitz H.D..
Femoropopliteal angioplasty: factors influencing long term success.
Circulation, 83 (1991), pp. 70-80
[17.]
Clark T.W., Groffsky J.L., Soulen M.C..
Predictors of long-term patency after femoropopliteal angioplasty: results from the STAR registry.
J Vasc Interv Radiol, 12 (2001), pp. 923-933
[18.]
Bakal C.W., Sprayregen S., Scheinbaum K., Cynamon J., Veith F.J..
Percutaneous transluminal angioplasty of the infrapopliteal arteries: results in 53 patients.
Am J Roentgenol, 154 (1990), pp. 171-174
[19.]
Chetter I.C., Spark J.I., Kent P.J., Berridge D.C., Scott D.J., Kester R.C..
Percutaneous transluminal angioplasty for intermittent claudication: evidence on which to base the medicine.
Eur J Endovasc Surg., 16 (1998), pp. 477-484
[20.]
Whyman M.R., Fowkes F.G., Kerracher E.M., Gillespie I.N., Lee A.J., Housley E., et al.
Is intermittent claudication improved by percutaneous transluminal angioplasty? A randomized controlled trial.
J Vasc Surg., 26 (1997), pp. 551-557
[21.]
Cox G.S., Hertzer N.R., Young J.R., O'Hara P.J., Krajewski L.P., Piedmonte M.R., et al.
Nonoperative treatment of superficial femoral artery disease: long -term follow up.
J Vasc Surg., 17 (1993), pp. 172-182
[22.]
van Damme H., Quarniers J., Limet R..
Should we correct stenosis of the superficial femoral artery in patient with claudication?.
Rev Med Liege, 56 (2001), pp. 639-649
[23.]
Jensen L.P..
Intermittent claudication.
Conservative treatment, endovascular repair or open surgery for femoropopliteal disease. Ann Chir Gynaecol, 87 (1998), pp. 137-140
[24.]
Fernández J.I., Gutiérrez J.M., Llaneza J.M., Menéndez M.A., Yoldi R., Vallina M., et al.
Angioplastia transluminal percutánea del sector femoropoplíteo en la isquemia crítica.
Angiología, 5 (1995), pp. 257-264
[25.]
Tonnesen K.H., Holstein P., Rordam L., Burlow J., Helgstrand U., Dreyer M..
Early results of percutaneous transluminal angioplasty (PTA) of failing bellow knee bypass.
Eur J Vasc Endovasc Surg., 15 (1998), pp. 51-56
[26.]
Avino A.J., Bandyk D.F., Gonsalves A.J., Johnson B.L., Black T.J., Zwiebel B.R., et al.
Surgical and endovascular intervention for infrainguinal vein graft stenosis.
J Vasc Surg., 29 (1999), pp. 60-71
[27.]
Favre J.P., Malouki I., Sobhy M., Gay J.L., Gournier J.P., Barral X..
Angioplasty of distal venous bypasses: is it worth the cost?.
J Cardiovasc Surg (Torino), 37 (1996), pp. S59-S65
[28.]
Marco-Luque M.A., Cano-Trigueros E., Baquer-Miravete M..
Procedimientos quirúrgicos y endoquirúrgicos en la oclusión.
Reintervenciones en el sector femoropoplíteo y distal, pp. 187-196
[29.]
Conroy R.M., Gordon I.L., Tobis J.M., Hiro T., Kasaoka S., Stemmer E.A., et al.
Angioplasty and stent placement in chronic occlusion of superficial femoral artery: technique and results.
J Vasc Radiol, 11 (2000), pp. 1009-1020
[30.]
Cheng S.W., Ting A.C., Wong J..
Endovascular stenting of superficial femoral artery stenosis and occlusions: results and risk factor analysis.
Cardiovasc Surg., 9 (2001), pp. 133-140
[31.]
Cejna M., Schoder M., Lammer J..
PTA vs stent femoropopliteal obstruction.
Radiologie, 39 (1999), pp. 144-150
[32.]
Zdanowski Z., Albrechtsson U., Lundin A., Jonung T., Ribbe E., Thorne J., et al.
Percutaneous transluminal angioplasty with or without stenting for the femoropopliteal occlusions? A randomized controlled study.
Int Angiol, 18 (1999), pp. 251-255
[33.]
Cejna M., Thurnher S., Illiasch H., Horvath W., Waldenberger P., Hornik K., et al.
J Vasc Interv Radiol, 12 (2001), pp. 23-31
[34.]
Grimm J., Muller-Husbeck S., Jahnke T., Hilbert C., Brossmann J., Heller M..
Randomized study to compare PTA alone versus PTA with Palmaz stent placement for the femoropopliteal lesions.
J Vasc Interv Radiol, 12 (2001), pp. 935-942
[35.]
White G.H., Liew S.C., Waugh R.C., Stephens M.S., Harris J.P., Kidd J., et al.
Early outcome and intermediate follow-up of vascular stents in the femoral and popliteal arteries without long-term anticoagulation.
J Vasc Surg., 21 (1995), pp. 270-281
Copyright © 2002. SEACV
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos