Gersbach P A, Argitis V, Gardaz J-P, von Segesser L K, Haesler E
Department of Cardiovascular Surgery, University Hospital (CHUV), 1011 Lausanne, Switzerland.
Eur J Vasc Endovasc Surg. 2007 Jun;33(6):717-24. doi: 10.1016/j.ejvs.2006.12.012. Epub 2007 Feb 12.
To determine whether the initial benefits of spinal cord stimulation (SCS) treatment for critical limb ischemia (CLI) persist over years.
Analysis of data prospectively collected for every CLI patient receiving permanent SCS. Follow-up range 12 to 98 months (mean 46+/-23, median 50 months).
87 patients (28% stage III, 72%stage IV) with unreconstructable CLI due (83%) or not (17%) to atherosclerosis and with an initial sitting/supine transcutaneous pO2 gradient >15 mmHg.
Assessment of actuarial patient survival (PS), limb salvage (LS) and amputation-free patient survival (AFPS). Analysis of the impact of 15 risk factors on long-term outcomes using the Fischer's exact test for categorical variables and the t test for continuous variables.
Follow-up was complete for patient and limb survival. A single non-atherosclerotic patient died during follow-up. Among atherosclerotic patients PS decreased from 88% at 1y, to 76% at 3y, 64% at 5y and 57% at 7y. LS reached 84% at 1y, 78% at 2y, 75% at 3y and remained stable thereafter. Diabetes was found to affect LS (p<0.05) and heart disease to reduce PS (p<0.01). AFPS was reduced in heart patients (p<0.01), diabetics (p<0.05) and in patients with previous stroke (p<0.05).
In CLI patients the beneficial effects of SCS persist far beyond the first year of treatment and major amputation becomes infrequent after the second year.
确定脊髓刺激（SCS）治疗严重肢体缺血（CLI）的初始益处是否能持续数年。
对每例接受永久性SCS治疗的CLI患者前瞻性收集的数据进行分析。随访时间为12至98个月（平均46±23个月，中位数50个月）。
87例患者（28%为III期，72%为IV期），因动脉粥样硬化（83%）或非动脉粥样硬化（17%）导致不可重建的CLI，初始坐位/仰卧位经皮氧分压梯度>15 mmHg。
评估患者精算生存率（PS）、肢体保全率（LS）和无截肢患者生存率（AFPS）。使用Fischer精确检验分析15个风险因素对长期结局的影响，分类变量采用Fischer精确检验，连续变量采用t检验。
患者和肢体生存的随访完整。1例非动脉粥样硬化患者在随访期间死亡。在动脉粥样硬化患者中，PS从1年时的88%降至3年时的76%、5年时的64%和7年时 的57%。LS在1年时达到84%，2年时为78%，3年时为75%，此后保持稳定。发现糖尿病影响LS（p<0.05），心脏病降低PS（p<0.01）。心脏病患者、糖尿病患者和既往有中风的患者AFPS降低（p<0.01、p<0.05、p<0.05）。
在CLI患者中，SCS的有益效果在治疗的第一年之后仍持续存在，第二年之后大截肢很少发生。
