Kechagias Aristotelis, Ylönen Kari, Kechagias Georgios, Juvonen Tatu, Biancari Fausto
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Ann Vasc Surg. 2012 Feb;26(2):213-8. doi: 10.1016/j.avsg.2011.03.018. Epub 2011 Nov 1.
The aim of the present study was to compare the early- and midterm outcomes after infrainguinal bypass surgery in the treatment of low- and high-risk patients with critical limb ischemia (CLI) (Finnvasc score 0-2 and 3-4, respectively), and to evaluate limits of infrainguinal bypass surgery in treatment of the latter group.
Two hundred seventy-four infrainguinal bypass procedures performed in 218 patients were retrospectively reviewed. The Finnvasc score (range: 0-4) was calculated by assigning one point to each of four preoperative risk factors, that is, coronary artery disease, diabetes, urgency of the procedure, and gangrene. Major outcome end points were survival, limb salvage, and amputation-free survival.
Among 274 infrainguinal bypass procedures performed for CLI, 92 procedures (33.6%) were performed in patients with Finnvasc score 3-4. They had significantly lower leg salvage (at 3-year follow-up, 53.7 vs. 70.6%; log-rank: p = 0.004), survival (at 3-year follow-up, 49.7 vs. 69.7%; log-rank: p < 0.0001), and amputation-free survival (at 3-year follow-up, 27.7 vs. 53.1%; log-rank: p < 0.0001) compared with patients with Finnvasc score 0-2. Patients with Finnvasc score 3-4 and a preoperative serum creatinine level of >150 μmol/L had 1-year amputation-free survival of 12.5%, whereas patients with lower level of creatinine had 1-year amputation-free survival of 53.1% (p = 0.028).
Infrainguinal bypass revascularization in CLI patients who present with Finnvasc score 3-4 can be considered at higher risk of poor intermediate outcome in terms of survival, leg salvage, and amputation-free survival. Poor outcome is particularly expected in patients with Finnvasc score 3-4 and renal failure. In this subgroup of patients, primary amputation should be considered.
本研究旨在比较股腘以下旁路手术治疗低风险和高风险严重肢体缺血（CLI）患者（芬兰血管评分分别为0 - 2分和3 - 4分）的早期和中期结果，并评估股腘以下旁路手术治疗后一组患者的局限性。
回顾性分析218例患者进行的274例股腘以下旁路手术。芬兰血管评分（范围：0 - 4分）通过对四个术前风险因素（即冠状动脉疾病、糖尿病、手术紧迫性和坏疽）各赋予1分来计算。主要结局终点为生存率、肢体挽救率和无截肢生存率。
在为CLI患者进行的274例股腘以下旁路手术中，92例（33.6%）手术是在芬兰血管评分为3 - 4分的患者中进行的。与芬兰血管评分为0 - 2分的患者相比，他们的下肢挽救率（3年随访时，53.7%对70.6%；对数秩检验：p = 0.004）、生存率（3年随访时，49.7%对69.7%；对数秩检验：p < 0.0001）和无截肢生存率（3年随访时，27.7%对53.1%；对数秩检验：p < 0.0001）显著更低。芬兰血管评分为3 - 4分且术前血清肌酐水平>150 μmol/L的患者1年无截肢生存率为12.5%，而肌酐水平较低的患者1年无截肢生存率为53.1%（p = 0.028）。
对于芬兰血管评分为3 - 4分的CLI患者，股腘以下旁路血管重建术在生存、下肢挽救和无截肢生存方面中期预后不良的风险可能更高。对于芬兰血管评分为3 - 4分且伴有肾衰竭的患者，尤其预期预后不良。在这一亚组患者中，应考虑一期截肢。
