Annals of vascular surgery · 2026
Impact of Chronic Kidney Disease Severity and Drug-Coated Devices on 2-Year Clinically Driven Target Lesion Revascularization After Femoropopliteal Endovascular Intervention.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Pan Jun, Peng Yanrong, Yu Qingyuan, Zheng Jianghua, Yong Xi, Zhu Jiang, Yuan Liangxi
Аннотация
BACKGROUND: This study evaluated the association of estimated glomerular filtration rate (eGFR)-based renal function severity and drug-coated device use with 2-year clinically driven target lesion revascularization (CD-TLR) after femoropopliteal endovascular intervention.
METHODS: Patients who underwent femoropopliteal endovascular intervention at 3 centers between January 2018 and June 2023 were retrospectively reviewed. Renal function was stratified into eGFR-based categories: stage I, eGFR ≥90 mL/min/1.73 m2; stage II, eGFR 60-89 mL/min/1.73 m2; stage III, eGFR 30-59 mL/min/1.73 m2; and stage IV/severe renal dysfunction, defined as eGFR <30 mL/min/1.73 m2 or dialysis dependence. Drug-coated devices included drug-coated balloons and drug-eluting stents. The primary end point was 2-year CD-TLR. Predictors of CD-TLR were assessed using Cox proportional hazards regression models.
RESULTS: A total of 589 patients were included; 229 patients (38.9%) were treated with drug-coated devices and 360 patients (61.1%) with conventional devices. Severe renal dysfunction/stage IV was associated with a higher risk of 2-year CD-TLR compared with stage I (hazard ratio [HR], 5.43; 95% confidence interval [CI], 2.80-10.51; P < 0.001). Drug-coated device use was associated with a lower risk of 2-year CD-TLR compared with conventional-device treatment (HR, 0.56; 95% CI, 0.35-0.91; P = 0.020). In secondary outcome analysis, patients with severe renal dysfunction/stage IV had worse overall survival.
CONCLUSION: More advanced renal dysfunction was associated with an increased risk of 2-year CD-TLR after femoropopliteal endovascular intervention. Drug-coated device use was associated with a lower risk of CD-TLR in the overall cohort. Findings in the severe renal dysfunction subgroup should be interpreted cautiously because of the retrospective design, small subgroup size, and potential treatment-selection bias.
METHODS: Patients who underwent femoropopliteal endovascular intervention at 3 centers between January 2018 and June 2023 were retrospectively reviewed. Renal function was stratified into eGFR-based categories: stage I, eGFR ≥90 mL/min/1.73 m2; stage II, eGFR 60-89 mL/min/1.73 m2; stage III, eGFR 30-59 mL/min/1.73 m2; and stage IV/severe renal dysfunction, defined as eGFR <30 mL/min/1.73 m2 or dialysis dependence. Drug-coated devices included drug-coated balloons and drug-eluting stents. The primary end point was 2-year CD-TLR. Predictors of CD-TLR were assessed using Cox proportional hazards regression models.
RESULTS: A total of 589 patients were included; 229 patients (38.9%) were treated with drug-coated devices and 360 patients (61.1%) with conventional devices. Severe renal dysfunction/stage IV was associated with a higher risk of 2-year CD-TLR compared with stage I (hazard ratio [HR], 5.43; 95% confidence interval [CI], 2.80-10.51; P < 0.001). Drug-coated device use was associated with a lower risk of 2-year CD-TLR compared with conventional-device treatment (HR, 0.56; 95% CI, 0.35-0.91; P = 0.020). In secondary outcome analysis, patients with severe renal dysfunction/stage IV had worse overall survival.
CONCLUSION: More advanced renal dysfunction was associated with an increased risk of 2-year CD-TLR after femoropopliteal endovascular intervention. Drug-coated device use was associated with a lower risk of CD-TLR in the overall cohort. Findings in the severe renal dysfunction subgroup should be interpreted cautiously because of the retrospective design, small subgroup size, and potential treatment-selection bias.
Предметные рубрики MeSH
HumansRetrospective StudiesFemaleMalePopliteal ArteryTime FactorsRisk FactorsAgedFemoral ArteryCoated Materials, BiocompatibleDrug-Eluting StentsSeverity of Illness IndexPeripheral Arterial DiseaseGlomerular Filtration RateTreatment OutcomeRisk AssessmentRenal Insufficiency, ChronicEndovascular ProceduresAged, 80 and overKidneyProsthesis DesignMiddle AgedAngioplasty, Balloon