Kuoppala Monica, Franzén Sofia, Lindblad Bengt, Acosta Stefan
Vascular Center, Malmö University Hospital, Malmö, Sweden.
J Vasc Surg. 2008 Jun;47(6):1243-50. doi: 10.1016/j.jvs.2008.01.053.
This study assessed prognostic factors regarding long-term outcome for amputation and death among patients who underwent intra-arterial thrombolysis due to lower limb ischemia.
Consecutive patients with intra-arterial thrombolysis due to lower limb ischemia treated at the Department of Vascular Diseases, University Hospital of Malmö, between January 1, 2001, and December 31, 2005, were retrospectively reviewed. A multivariate Cox regression analysis was performed to determine independent predictors for amputation and death.
A total of 220 intra-arterial thrombolysis procedures were performed in 195 patients (46% women). Median age was 73 years. Complete and partial thrombolysis was obtained in 41% and 38%, respectively. Hemorrhagic complications were documented in 33%, but only 6% (13 of 220) were interrupted. The amputation rate was 26% and mortality was 35% during a median follow-up of 32 months. Degree of lysis (hazard ratio [HR], 4.8; 95% confidence interval [CI], 2.4-9.7; P < .001), motor deficit at admission (HR, 4.0; 95% CI, 1.8-8.7; P = .001), foot ulcers (HR, 7.2; 95% CI, 2.2-23.4; P = .001), and ischemic heart disease (HR, 2.3; 95% CI, 1.1-4.8; P = .024) remained as independent factors associated with amputation. Renal insufficiency (HR, 2.4; 95% CI, 1.4-4.2; P = .003), ischemic heart disease (HR, 2.1; 95% CI, 1.2-3.7; P = .007), cerebrovascular disease (HR, 2.2; 95% CI, 1.2-4.0; P = .009), foot ulcers (HR, 3.2; 95% CI, 1.2-8.6; P = .019), and acute lower limb ischemia (HR, 3.4; 95% CI, 1.1-10.1; P = .028) remained as independent factors associated with mortality.
Thrombolysis is successful, with few major complications in most patients with lower limb ischemia. Patients with ischemic heart disease and foot ulcers are at higher long-term risk for both amputation and death. A lesser degree of lysis and motor deficit were associated with higher amputation rates. The presence of such negative prognostic factors may help clinicians to deny further invasive vascular treatment. Renal insufficiency, cerebrovascular disease, and acute lower limb ischemia were associated with increased mortality.
本研究评估了因下肢缺血接受动脉内溶栓治疗的患者截肢和死亡的长期预后因素。
对2001年1月1日至2005年12月31日在马尔默大学医院血管疾病科接受动脉内溶栓治疗的下肢缺血连续患者进行回顾性分析。进行多因素Cox回归分析以确定截肢和死亡的独立预测因素。
195例患者共进行了220次动脉内溶栓治疗（46%为女性）。中位年龄为73岁。完全溶栓和部分溶栓分别为41%和38%。有33%记录到出血并发症，但仅6%（220例中的13例）治疗中断。中位随访32个月期间，截肢率为26%，死亡率为35%。溶栓程度（风险比[HR]，4.8；95%置信区间[CI]，2.4 - 9.7；P < 0.001）、入院时运动功能障碍（HR，4.0；95% CI，1.8 - 8.7；P = 0.001）、足部溃疡（HR，7.2；95% CI，2.2 - 23.4；P = 0.001）和缺血性心脏病（HR，2.3；95% CI，1.1 - 4.8；P = 0.024）仍然是与截肢相关的独立因素。肾功能不全（HR，2.4；95% CI，1.4 - 4.2；P = 0.003）、缺血性心脏病（HR，2.1；95% CI，1.2 - 3.7；P = 0.007）、脑血管疾病（HR，2.2；95% CI，1.2 - 4.0；P = 0.009）、足部溃疡（HR，3.2；95% CI，1.2 - 8.6；P = 0.019）和急性下肢缺血（HR，3.4；95% CI，1.1 - 10.1；P = 0.028）仍然是与死亡相关的独立因素。
溶栓治疗是成功的，大多数下肢缺血患者的主要并发症较少。患有缺血性心脏病和足部溃疡的患者截肢和死亡的长期风险较高。溶栓程度较低和运动功能障碍与较高的截肢率相关。这些不良预后因素的存在可能有助于临床医生拒绝进一步的侵入性血管治疗。肾功能不全、脑血管疾病和急性下肢缺血与死亡率增加相关。
