Kansai Rosai Hospital Cardiovascular Center, Inabaso, Amagasaki, Hyogo, Japan.
Eur J Vasc Endovasc Surg. 2013 Nov;46(5):575-82. doi: 10.1016/j.ejvs.2013.08.002. Epub 2013 Sep 11.
To investigate factors in patients with critical limb ischemia (CLI) and isolated infrapopliteal lesions that adversely affect outcomes of endovascular therapy (EVT) with or without angiosome-oriented revascularization.
This was a retrospective multicenter study. We used a database of 718 consecutive CLI patients (70 ± 11 years, 75% diabetics, 68% on hemodialysis, 24% Rutherford class 6) with ischemic tissue loss due to isolated infrapopliteal lesions undergoing primary EVT. Primary outcome was MALE (major adverse limb event). Association between indirect EVT (recanalization of a non-angiosome-based artery) and outcome was assessed by Cox proportional hazard regression model.
C-reactive protein (CRP) level was >3 mg/dL in 32% of cases. Indirect EVT (in 307 CLI patients, 43%), was associated with MALE (p = .04, hazard ratio [95% confidence interval] 1.25 [1.01, 1.55]), and interacted with CRP >3 mg/dL (p < .004) but not with other baseline characteristics. Indirect EVT with CRP >3 mg/dL had higher MALE risk (HR 2.08), and interacted with diabetes mellitus (DM) presence. Indirect EVT with CRP >3 mg/dL and DM had higher MALE risk (HR 2.17).
Limb prognosis was equivalent for direct and indirect endovascular revascularization except in the presence of both diabetes and wound infection, when indirect revascularization has a poorer outcome.
探讨影响伴有孤立性腘下病变的严重肢体缺血(CLI)患者血管内治疗(EVT)及其联合血管生成靶向再通治疗结局的不利因素。
这是一项回顾性多中心研究。我们使用了 718 例连续 CLI 患者(70±11 岁,75%为糖尿病患者,68%在进行血液透析,24% Rutherford 分级为 6 级)数据库,这些患者因孤立性腘下病变导致缺血性组织丧失,接受了初次 EVT。主要结局为 MALE(主要不良肢体事件)。通过 Cox 比例风险回归模型评估间接 EVT(非血管生成靶向动脉再通)与结局之间的关系。
32%的病例 C-反应蛋白(CRP)水平>3mg/dL。间接 EVT(在 307 例 CLI 患者中,占 43%)与 MALE 相关(p=0.04,风险比[95%置信区间]1.25[1.01,1.55]),并且与 CRP>3mg/dL 存在交互作用(p<0.004),但与其他基线特征无关。CRP>3mg/dL 合并间接 EVT 的患者 MALE 风险更高(HR 2.08),且与糖尿病的存在存在交互作用。CRP>3mg/dL 合并糖尿病且行间接 EVT 的患者 MALE 风险更高(HR 2.17)。
直接和间接血管内血运重建的肢体预后相当,除非同时存在糖尿病和伤口感染,此时间接血运重建的预后较差。