Gargiulo Mauro, Maioli Filippo, Ceccacci Tanja, Morselli-Labate Antonio Maria, Faggioli Gianluca, Freyrie Antonio, Giovanetti Federica, Testi Gabriele, Muccini Natascia, Stella Andrea
Department of Vascular Surgery, Alma Mater Studiorum, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
J Endovasc Ther. 2008 Jun;15(3):363-9. doi: 10.1583/08-2423.1.
To evaluate arterial patency and factors influencing outcomes after successful tibial artery angioplasty in patients with critical limb ischemia (CLI).
From January 2005 to August 2007, a prospective single-center study was conducted involving 80 CLI patients (56 men; mean age 71.7+/-8.8 years) who underwent successful tibial artery angioplasty (<30% residual stenosis) in 87 limbs. Eighty (92%) limbs showed ischemic ulcers or gangrene at baseline. In two thirds, a more proximal lesion was treated, and a secondary stent was implanted in 14 (16%). Follow-up included clinical examination for wound healing (WH), limb salvage (LS), and duplex-documented target vessel patency or restenosis at discharge and at 1, 3, 6, 9, 12, 18, and then every 6 months. Patency rates, WH, and LS were assessed with the Kaplan-Meier method, and factors influencing these outcomes were analyzed using Cox proportional hazards models.
Mean follow-up was 10.9 months (range 2 days - 29 months). At 12 months, the primary and assisted primary patency rates were 37.9% and 71.2%, respectively. Restenosis was significantly correlated with smoking (HR 3.58, 95% CI 1.15 to 11.18; p = 0.02), infected ulcers (HR 2.04, 95% CI 1.02 to 4.09; p = 0.04), and posterior tibial artery angioplasty (HR 3.76, 95% CI 1.59 to 8.87; p = 0.003). Rates of LS and WH at 12 months were 92.7% and 74.9%, respectively. Peroneal angioplasty was significantly correlated with WH (HR 1.83, 95% CI 1.04 to 3.25; p = 0.03), and wound healing increased with classes of age (HR 1.60, 95% CI 1.07 to 2.39; p = 0.02).
One-year restenosis after optimal tibial artery angioplasty is significant and positively correlated with smoking, infection of trophic lesions, and posterior tibial artery angioplasty. Close ultrasound surveillance provides good limb salvage after optimal infrapopliteal angioplasty in patients with CLI.
评估严重肢体缺血（CLI）患者成功进行胫动脉血管成形术后的动脉通畅情况及影响预后的因素。
2005年1月至2007年8月，进行了一项前瞻性单中心研究，纳入80例CLI患者（56例男性；平均年龄71.7±8.8岁），其87条肢体成功进行了胫动脉血管成形术（残余狭窄<30%）。80条（92%）肢体在基线时出现缺血性溃疡或坏疽。三分之二的患者治疗了更近端的病变，14例（16%）植入了二级支架。随访包括临床检查伤口愈合情况（WH）、肢体挽救情况（LS），以及出院时、1、3、6、9、12、18个月时通过双功超声记录的靶血管通畅或再狭窄情况，之后每6个月记录一次。采用Kaplan-Meier法评估通畅率、WH和LS，并使用Cox比例风险模型分析影响这些预后的因素。
平均随访10.9个月（范围2天至29个月）。12个月时，初次通畅率和辅助初次通畅率分别为37.9%和71.2%。再狭窄与吸烟（风险比[HR]3.58，95%置信区间[CI]1.15至11.18；p = 0.02）、感染性溃疡（HR 2.04，95% CI 1.02至4.09；p = 0.04）以及胫后动脉血管成形术（HR 3.76，95% CI 1.59至8.87；p = 0.003）显著相关。12个月时的LS率和WH率分别为92.7%和74.9%。腓动脉血管成形术与WH显著相关（HR 1.83，95% CI 1.04至3.25；p = 0.03），伤口愈合随年龄组增加（HR 1.60，95% CI 1.07至2.39；p = 0.02）。
最佳胫动脉血管成形术后1年的再狭窄情况显著，且与吸烟、营养性病变感染及胫后动脉血管成形术呈正相关。在CLI患者中，最佳腘动脉以下血管成形术后密切的超声监测可实现良好的肢体挽救。
