Uso de estatina pré-procedimento de angioplastia periférica dos membros inferiores e seus efeitos na patência primária e amputação

Abstract

Atherosclerotic Peripheral Artery Disease (PAD) can progress to critical limb ischemia, with a risk of loss of the limb and the need for revascularization. For lower limb revascularization, we can opt for open surgery or endovascular treatment, but one of the problems related to this is the lower long-term patency, mainly due to restenosis. This is mainly caused by intimal hyperplasia at the expense of an intense inflammatory response and oxidative stress induced by endothelial injury associated with angioplasty. Statins, which are lipid-lowering medications, have pleiotropic effects, having anti-inflammatory, antiproliferative, antioxidant, endothelial protection, antithrombotic action, inhibiting intimal hyperplasia and consequently restenosis, being potentially beneficial for use before, during and after percutaneous interventions. To date, there are few data in the literature regarding outcomes associated with use of statins in the endovascular treatment of patients with critical limb ischemia caused by PAD. A systematic review and meta-analysis study was conducted with the inclusion of 10 studies, which showed that pre-procedure statin therapy was associated with significant improvement in primary patency and survival and decreased limb loss in patients undergoing peripheral angioplasty. In addition, a retrospective cohort study was conducted in vascular surgery patients at the University Hospital of Santa Maria who were hospitalized for critical ischemia of the lower limbs caused by PAD and who underwent percutaneous transluminal angioplasty, in which use of pre-procedure statin was not related to improvement of primary patency and amputation rate in patients undergoing peripheral angioplasty. Therefore, the results of studies on the effects of pre-procedure statin use on improving primary patency and reducing amputation in patients undergoing peripheral angioplasty are conflicting, and further studies are needed in this regard.