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Vol. 54. Núm. 4.
Páginas 308-316 (Enero 2002)
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Vol. 54. Núm. 4.
Páginas 308-316 (Enero 2002)
DOI: 10.1016/S0003-3170(02)74757-3
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
...
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.
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
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