Suding Paul N, McMaster William, Hansen Edward, Hatfield Arthur W, Gordon Ian L, Wilson Samuel Eric
Surgical Health Care Group, Veterans Affairs Medical Center, Long Beach, CA & the Department of Surgery, University of California, Irvine.
Ann Vasc Surg. 2008 Mar;22(2):195-9. doi: 10.1016/j.avsg.2007.12.002.
Progression of peripheral vascular disease may lead to major amputations. We sought to understand whether more frequent endovascular angioplasty and stenting in patients with limb-threatening ischemia would affect the number of major amputations. We retrospectively reviewed the effects of implementing more frequent endovascular intervention for the 4 years 2003-2006 at the Veterans Affairs Medical Center in Long Beach, California. During this interval angioplasty became the preferred method for the treatment of infrainguinal vascular disease. Open bypass procedures were performed for patients with limb-threatening ischemia and extensive lesions that could not be treated by angioplasty. Patients were on average 68 +/- 1 years, and 96% were male. The patients were 45% active smokers, with 43% diabetics. There was 0% 30-day mortality for both groups over the 4 years. the number of below-the-knee, above-the-knee, and transmetatarsal amputations for fiscal years 2003, 2004, 2005, and 2006 were, 42, 50, 62, and 41, respectively. Concurrently, there has been a reduction in open femoral to popliteal or trifurcation vessel bypasses with 37, 43, 28, and 14 procedures for 2003, 2004, 2005, and 2006. Angioplasty and stenting increased from 12, 12, 24, to 59 over the same period. Patients who had a femoral to distal bypass were more likely to have an amputation than those undergoing angioplasty (odds ratio = 4.2, 95% confidence interval 1.6-11.5) for those with at least 1 year of follow-up, likely due to these patients having more severe disease. Increasing the frequency of angioplasty for infrainguinal vascular lesions did not increase the number of major lower extremity amputations in our stable patient population.
外周血管疾病的进展可能导致大截肢。我们试图了解，对于有肢体威胁性缺血的患者，更频繁地进行血管内血管成形术和支架置入术是否会影响大截肢的数量。我们回顾性分析了2003年至2006年期间在加利福尼亚州长滩退伍军人事务医疗中心实施更频繁血管内介入治疗的效果。在此期间，血管成形术成为治疗腹股沟下血管疾病的首选方法。对于有肢体威胁性缺血且病变广泛无法通过血管成形术治疗的患者，进行了开放旁路手术。患者平均年龄为68±1岁，96%为男性。患者中有45%为现吸烟者，43%患有糖尿病。在这4年中，两组的30天死亡率均为0%。2003年、2004年、2005年和2006财年的膝下、膝上和经跖骨截肢数量分别为42例、50例、62例和41例。同时，2003年、2004年、2005年和2006年开放股动脉至腘动脉或三叉血管旁路手术数量减少，分别为37例、43例、28例和14例。同期血管成形术和支架置入术从12例、12例、24例增加到59例。对于至少随访1年的患者，接受股动脉至远端旁路手术的患者比接受血管成形术的患者更有可能进行截肢（比值比=4.2，95%置信区间1.6 - 11.5），这可能是因为这些患者的病情更严重。在我们稳定的患者群体中，增加腹股沟下血管病变血管成形术的频率并未增加下肢大截肢的数量。
