Kansai Rosai Hospital, Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan.
Eur J Vasc Endovasc Surg. 2012 Sep;44(3):318-24. doi: 10.1016/j.ejvs.2012.05.011. Epub 2012 Jun 6.
To identify anatomical factors associated with major adverse limb events (MALE) after angioplasty as the basis for a novel morphology-driven classification of infrapopliteal lesions.
Retrospective-multicenter study.
Between March 2004 and October 2010, 1057 limbs from 884 patients with CLI due to isolated infrapopliteal lesions were studied. Freedom-from MALE, defined as major amputation or any reintervention, was assessed out to 2 years by the Kaplan-Meier methods. Anatomical predictors and risk stratification for MALE were analyzed by multivariate analysis.
Freedom-from MALE was 47 ± 1% at 2 years. Lesion calcification, target vessel diameter<3.0 mm, lesion length>300 mm and no below-the-ankle (BA) run-off were positively associated with MALE by multivariate-analysis. The total number of risk factors was used to calculate the risk score for each limbs for subsequent categorization into 3 groups with 0 or 1 (low-risk), 2 (moderate-risk) and 3 or 4 (high-risk) factors. Freedom-from MALE at 2 year-rates was 59% in low-risk, 46% in moderate-risk, and 29% in high-risk, respectively.
Target vessel diameter <3.0 mm, lesion calcification, lesion length > 300 mm and no-BA run-off were associated with MALE after infrapopliteal angioplasty. Risk stratification based on these predictors allows estimation of future incidence of MALE in CLI with isolated infrapopliteal lesions.
确定与经皮腔内血管成形术后主要肢体不良事件（MALE）相关的解剖学因素，为腘下病变的新型形态学驱动分类提供依据。
回顾性多中心研究。
2004 年 3 月至 2010 年 10 月，884 例因孤立性腘下病变导致 CLI 的患者的 1057 条肢体进行了研究。通过 Kaplan-Meier 方法评估至 2 年的无 MALE 生存率，MALE 定义为主要截肢或任何再干预。通过多变量分析分析 MALE 的解剖学预测因子和风险分层。
2 年时无 MALE 生存率为 47±1%。多变量分析显示，病变钙化、靶血管直径<3.0mm、病变长度>300mm 以及无踝下（BA）流出与 MALE 呈正相关。根据每个肢体的总危险因素数计算风险评分，随后将肢体分为 3 组，0 或 1 个（低危）、2 个（中危）和 3 个或 4 个（高危）危险因素。2 年时无 MALE 生存率分别为低危组 59%、中危组 46%和高危组 29%。
靶血管直径<3.0mm、病变钙化、病变长度>300mm 以及无 BA 流出与腘下血管成形术后 MALE 相关。基于这些预测因子的风险分层可估计孤立性腘下病变导致 CLI 患者未来 MALE 的发生率。
