Liistro Francesco, Grotti Simone, Venturuzzo Giorgio, Angioli Paolo, Turini Filippo, Ducci Kenneth, Falsini Giovanni, Bellandi Guido, Ricci Lucia, Anichini Roberto, Bolognese Leonardo
Dipartimento Cardiovascolare, Azienda Ospedaliera di Arezzo.
G Ital Cardiol (Rome). 2009 Nov-Dec;10(11-12):713-7.
The aim of this study was to assess the long-term clinical outcome of percutaneous peripheral interventions in diabetic patients with critical limb ischemia (CLI) in terms of occurrence of major amputation and mortality.
From January 2004 to December 2007, all diabetic patients undergoing peripheral angiography and percutaneous revascularization for the presence of CLI were enrolled in this registry and followed prospectively. Limb salvage, mortality, and repeat revascularization were reported at long term.
267 diabetic patients (mean age 72.2 +/- 9.6 years) with 290 ischemic limbs represent the study population. Hypertension was present in 227 patients (85%), hypercholesterolemia in 85 (32%), chronic renal failure in 61 (23%). Ischemic heart disease was present in 80 patients (30%), carotid disease in 75 (28%). According to the Texas Diabetic Ulcers Classification, 203 patients (70%) had type CIII lesion, 29 (10%) CII, 9 (3%) CI, 20 (7%) DIII, 23 (8%) DII, and 6 (2%) DI; 440 lesions (169 tibial arteries, 261 femoro-popliteal arteries, and 10 iliac arteries) were dilated with stent implantation in 290 of them (66%). The procedure was successful in 415 (94%) with restoration of direct flow in at least one tibial artery. The ankle-brachial index was 0.32 +/- 0.11 before procedure and increased to 0.77 +/- 0.23 (p<0.001). One patient died suddenly during hospital stay. Mean follow-up length was 17 +/- 11 months. Of the 290 limbs, major amputation was necessary in 17 (6%) of which 10 had an unsuccessful procedure. Amputation was fatal in 7 cases (41%). Complete foot lesion healing was obtained in 238 (82%) and partial healing in 35 (12%). Death occurred in 42 patients (16%) and it was related to cardiac events in 16 (6%), cerebrovascular events in 8 (3%), acute renal failure in 8 (3%), and cancer in 10 (4%). Repeat revascularization occurred in 67 patients (23%) in the target limb and in 29 (11%) in the contralateral limb.
Peripheral angioplasty with stent implantation is an effective procedure for limb salvage in diabetic patients with CLI. The high mortality is probably related to the systemic atherosclerosis process with involvement of coronary and cerebral circulation that leads to heart and cerebral fatal ischemic events.
本研究旨在评估糖尿病合并严重肢体缺血（CLI）患者经皮外周介入治疗在大截肢发生率和死亡率方面的长期临床结局。
2004年1月至2007年12月，所有因CLI接受外周血管造影和经皮血管重建术的糖尿病患者均纳入本登记研究并进行前瞻性随访。报告长期的肢体挽救情况、死亡率和再次血管重建情况。
267例糖尿病患者（平均年龄72.2±9.6岁），共290条缺血肢体构成研究人群。227例患者（85%）患有高血压，85例（32%）患有高胆固醇血症，61例（23%）患有慢性肾衰竭。80例患者（30%）患有缺血性心脏病，75例（28%）患有颈动脉疾病。根据德州糖尿病溃疡分类，203例患者（70%）为CIII型病变，29例（10%）为CII型，9例（3%）为CI型，20例（7%）为DIII型，23例（8%）为DII型，6例（2%）为DI型；440处病变（169条胫动脉、261条股腘动脉和10条髂动脉）进行了扩张，其中290处（66%）植入了支架。415例（94%）手术成功，至少一条胫动脉恢复了直接血流。术前踝肱指数为0.32±0.11，术后升至0.77±0.23（p<0.001）。1例患者在住院期间突然死亡。平均随访时间为17±11个月。在290条肢体中，17条（6%）需要进行大截肢，其中10条手术未成功。7例（41%）截肢导致死亡。238例（82%）足部病变完全愈合，35例（12%）部分愈合。42例患者（16%）死亡，其中16例（6%）与心脏事件有关，8例（3%）与脑血管事件有关，8例（3%）与急性肾衰竭有关，10例（4%）与癌症有关。67例患者（23%）目标肢体出现再次血管重建，29例（11%）对侧肢体出现再次血管重建。
外周血管成形术联合支架植入术是治疗糖尿病合并CLI患者肢体挽救的有效方法。高死亡率可能与全身动脉粥样硬化过程有关，累及冠状动脉和脑循环，导致心脏和脑部致命性缺血事件。
