Korzets Asher, Ori Yaacov, Rathaus Mauro, Plotnik Nora, Baytner Shlomo, Gafter Uzi, Isakov Eli
Institute of Nephrology and Hypertension, Rabin Medical Center (Golda Campus), Petah Tiqva, Israel.
Isr Med Assoc J. 2003 Jul;5(7):501-5.
Lower limb critical ischemia is a major problem in dialysed patients.
To evaluate the results of revascularization procedures, amputations and prosthetic rehabilitation in dialysed amputees.
In this retrospective study we examined the charts of selected dialysis patients. Forty-eight patients had undergone major amputation (4.5% of the dialysis population), and 24 patients entered the rehabilitation program. Widespread arterial calcification was common and led to falsely elevated ankle-brachial pressure indices in 9 of 14 limbs. Eight patients underwent revascularization. Subsequent major amputation was carried out 4 +/- 4.5 months after the revascularization (above knee in 5 patients and below knee in 3). Of the 16 patients who underwent primary amputation, only 2 were above-knee amputees. Seven patients with toe or metatarsal amputation went on to a major amputation 1.8 +/- 1.2 months after the distal amputation.
No differences were found between diabetic and non-diabetic patients regarding the number of revascularization operations performed, the level of major amputation, or overall survival. Prosthetic rehabilitation was considered successful in 12 patients, partially successful in 8, and failed in 4 patients. Patient survival time was shortest in those patients with failed rehabilitation. A younger age confirmed favorable rehabilitation results, while long-standing diabetics and bilateral amputees were poor rehabilitation candidates. Patients who underwent primary amputation had more successful rehabilitation. A comparison between 24 dialysed amputees and 138 non-uremic amputees revealed similar rehabilitation results, although hospitalization time was longer in the dialysed patients.
Early definitive therapy is essential when dealing with critical ischemia. After diagnostic angiography, proximal revascularization should be performed where feasible. Primary amputation is indicated in patients with extensive foot infection or gangrene. Prosthetic rehabilitation is warranted in most dialysed amputees.
下肢严重缺血是透析患者面临的一个主要问题。
评估透析患者截肢后血管重建手术、截肢及假肢康复的效果。
在这项回顾性研究中，我们查阅了部分透析患者的病历。48例患者接受了大截肢手术（占透析人群的4.5%），24例患者进入康复项目。广泛的动脉钙化很常见，导致14条肢体中有9条的踝肱压力指数假性升高。8例患者接受了血管重建手术。血管重建术后4±4.5个月进行了后续大截肢手术（5例为膝上截肢，3例为膝下截肢）。在16例接受初次截肢的患者中，只有2例为膝上截肢者。7例接受趾或跖骨截肢的患者在远端截肢后1.8±1.2个月进行了大截肢手术。
在血管重建手术的次数、大截肢的部位或总体生存率方面糖尿病患者和非糖尿病患者之间未发现差异。12例患者的假肢康复被认为成功，8例部分成功，4例失败。康复失败的患者生存时间最短。年龄较小的患者康复效果较好，而长期糖尿病患者和双侧截肢者是康复的不良候选者。接受初次截肢的患者康复更成功。24例透析截肢患者与138例非尿毒症截肢患者的比较显示，尽管透析患者的住院时间更长，但康复结果相似。
处理严重缺血时早期明确治疗至关重要。诊断性血管造影后，可行时应进行近端血管重建。广泛足部感染或坏疽的患者应行初次截肢。大多数透析截肢患者有必要进行假肢康复。
