Kalbaugh Corey A, Taylor Spence M, Cull David L, Blackhurst Dawn W, Gray Bruce H, Langan Eugene M, Dellinger Matthew B, McClary Guy E, Jackson Mark R, Carsten Christopher G, Snyder Bruce A, York John W, Youkey Jerry R
Department of Bioengineering, Clemson University, Greenville, SC 29605, USA.
J Vasc Surg. 2004 Jun;39(6):1268-76. doi: 10.1016/j.jvs.2004.02.009.
The invasive treatment of chronic lower extremity peripheral arterial disease (PAD) has become inconsistent. To standardize treatment at our institution, the Lower Extremity Grading System (LEGS) score was devised, based on arteriographic findings, symptoms, functional status, comorbid conditions, and technical factors. The scoring system was used to direct the invasive treatment approach in patients with lower extremity PAD. The purpose of this study was to prospectively assess outcomes of invasive treatment of lower extremity ischemia as directed by LEGS.
From March 2002 through December 2002, 332 limbs in 227 patients with indications for intervention were scored and treated according to the LEGS score and followed for 6 months. Of the 227 patients, 66.1% were male; median age was 65 years. Diabetes mellitus was present in 44.9% of patients, claudication in 48.5%, and limb-threatening ischemia in 51.5%. Results of treatment as directed by LEGS were judged with the treatment outcome measures of reconstruction patency, limb salvage, mortality, change in ambulatory status, change in independent living status, and change in the short-form health survey (SF-36).
Of 332 limbs, 61.5% with a score of 10 to 19 underwent endovascular therapy; 34% with a score of 0 to 9 underwent open revascularization; and 4.5% with a score greater than 20 underwent primary limb amputation. Interventions for the entire cohort as directed by LEGS resulted in 6-month primary reconstruction patency of 82.4%; secondary reconstruction patency, 92.6%; limb salvage, 90%; survival, 89.1%; maintenance of ambulatory status, 85.6%; maintenance of independent living, 88.4%; and statistically significant improvement in health assessment, regardless of treatment type, as determined with the SF-36. There was no statistically significant variability when comparing results according to treatment (open surgery, 0-9 vs endovascular therapy, 10-19) or smaller score group categories (0-5, 6-9, 10-13, 14-19).
At 6 months, treatment as directed by LEGS score resulted in acceptable outcomes. This project is the first reported prospectively confirmed standardization tool for treatment of lower extremity PAD, and, pending independent confirmation by others, provides a comparative baseline against which other standardization efforts can be measured.
慢性下肢外周动脉疾病（PAD）的侵入性治疗方法并不统一。为了规范我院的治疗，基于血管造影结果、症状、功能状态、合并症及技术因素设计了下肢分级系统（LEGS）评分。该评分系统用于指导下肢PAD患者的侵入性治疗方法。本研究的目的是前瞻性评估由LEGS指导的下肢缺血侵入性治疗的结果。
2002年3月至2002年12月，对227例有干预指征的患者的332条肢体根据LEGS评分进行评分和治疗，并随访6个月。227例患者中，66.1%为男性；中位年龄为65岁。44.9%的患者患有糖尿病，48.5%有间歇性跛行，51.5%有肢体威胁性缺血。根据重建通畅率、肢体挽救率、死亡率、步行状态变化、独立生活状态变化以及简短健康调查（SF - 36）等治疗结果指标来判断LEGS指导下的治疗结果。
332条肢体中，评分10至19分的61.5%接受了血管内治疗；评分0至9分的34%接受了开放血管重建术；评分大于20分的4.5%接受了一期肢体截肢术。LEGS指导下对整个队列的干预导致6个月时的一期重建通畅率为82.4%；二期重建通畅率为92.6%；肢体挽救率为90%；生存率为89.1%；步行状态维持率为85.6%；独立生活维持率为88.4%；并且根据SF - 36评估，无论治疗类型如何，健康评估均有统计学显著改善。根据治疗方式（开放手术，0 - 9分与血管内治疗，10 - 19分）或较小评分组类别（0 - 5分、6 - 9分、10 - 13分、14 - 19分）比较结果时，没有统计学显著差异。
6个月时，根据LEGS评分指导的治疗取得了可接受的结果。该项目是首个前瞻性报告的经证实的下肢PAD治疗标准化工具，在未经他人独立证实之前，提供了一个可用于衡量其他标准化努力的比较基线。
