Poelmann, F.B. (2013) Patency van een heparine gebonden ePTFE-gecoverde endograft in vergelijking met een niet-heparine gebonden ePTFE-gecoverde endograft bij chronisch obstructief vaatlijden van de arteria femoralis superfialis. thesis, Medicine.
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Abstract
Background: Occlusive vascular disease of the superficial femoral artery (SFA) is often the cause of ischemia of the lower extremity. Revascularization is necessary for wound healing and limb salvage. Minimal invasive revascularization is emerging as an treatment option for chronic occlusive peripheral arterial disease in the femoro-popliteal segment. The purpose of this study was to assess the 2-year patency rates of non-heparin bonded ePTFE-covered endograft (NH-endograft) versus heparin bonded ePTFE-coverd endografts (H-endograft) in the treatment of chronic occlusive disease of the superficial femoral artery (SFA). Materials and methods: All patients who received endovascular revascularization of the femoro-popliteal segment between 2001 and 2012 were included in this retrospective cohort study. Patients received a NH-endograft or a H-endograft. Treatment took place on an operating room or an radiology intervention room. If there was a concomitant stenosis of the Common Femoral Artery (CFA) endarteriectomie was performed in the same session. Results: A total of 327 limbs were treated in 307 patients. 172 patients received a NH-endograft and 155 received a H-endograft. All patients included had clinical symptoms of critical limb ischemia (Fontaine III or IV) (n = 112) or intermittend claudication (Fontaine IIB) (n=215). Patients in the NH-endograft group were significant younger than patients in the H-endograft group (67,3 ± 9,8 versus 70,9 ± 10,2 year, P=0,001). The average ankle brachial index was significant higher in the NH-endograft group versus the H-endograft group (0,67 ± 0,16 versus 0,58 ± 0,15, P=0,000). There was a significant difference between the diameter of the NH-endograft versus the H-endograft: 5 mm 3 versus 19; 6 mm 142 versus 112; 7 mm 26 versus 20, P=0,001. TASC II classification in the NH-endograft group was TASC A/B/C/D: 54/55/32/31 and in the H-endograft group: 22/38/30/65, P=0,000. After 2 years the patency between NH-endograft versus H-endograft were: primary patency 64,5% versus 62,8% (P=0,331); secondary patency 87,1% versus 83,7% (P=0,603). Multivariate Cox regression analyses shows that age (P=0,006), TASC II classification type D (P=0,006) and the diameter of the endograft (P=0,002) have significant influence on the primary patency after 2 years. Patency isn’t influenced by heparin bonding to the stent, P=0,774. Conclusion: Although the baseline characteristics were not equal between both groups, there was no difference in patency ratio between the NH-endograft and the H-endograft. The 2 year patency of DM patients were equal to those of non-DM patients. The 2 year patency in CLI patients were equal to that of claudicants. Multivariate Cox regression analyses shows that TASC-II type D lesions, age and most important the diameter of the endograft influence the primary patency after 2 years. Endovascular revascularization in the femoro-popliteal segment with a NH- or H-endograft is a good minimal invasive treatment option and must be considered for patients with chronic occlusive vascular disease.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kruse, Drs. R.R. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1384 |
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