Nakano Masatsugu, Hirano Keisuke, Yamauchi Yasutaka, Iida Osamu, Soga Yoshimitsu, Kawasaki Daizo, Yamaoka Terutosh, Suematsu Nobuhiro, Suzuki Kenji
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
Department of Cardiology, Kikuna Memorial Hospital, Yokohama, Japan.
Catheter Cardiovasc Interv. 2015 Aug;86(2):289-98. doi: 10.1002/ccd.25676. Epub 2015 Mar 16.
Among hemodialysis (HD)-dependent patients with critical limb ischemia (CLI), Endovascular therapy (EVT) of isolated infrapopliteal lesions improves limb salvage. Accordingly, we sought to determine the outcomes of this group of patients based on the extent of tissue loss at baseline.
From 2004 to 2011, 449 consecutive HD patients with CLI had ischemic wounds and underwent EVT for isolated infrapopliteal lesions. The "minor tissue loss" (MI) group was confirmed by 340 HD patients with wounds located distal to the metatarsophalangeal joints, and the "major tissue loss" (MA) group included 109 HD patients with wounds that extended beyond this point. The two groups were compared for limb salvage and amputation free survival (AFS) rates by Kaplan-Meier analysis.
There was no significant difference in the percentage of diabetic patients (MI: 76.5 vs. MA: 75.2%). The percentage with direct flow to the wound site was lower in the MA group than in the MI group (MI: 63.5 vs. MA: 45.9%, P < 0.01). After EVT the MI group had a significantly better limb salvage rate (MI: 83.7 vs. MA: 71.2% at 3 years, P < 0.01), and AFS rate (MI: 44.1 vs. MA: 29.1% at 3 years, P < 0.01) compared to the MA group.
EVT is an efficient treatment for HD patients with minor tissue loss, achieving >80% limb salvage rates at 3 years. However, AFS rates in all HD patients with tissue loss are <50% at 3 years, making their prognosis poor.
在依赖血液透析（HD）的严重肢体缺血（CLI）患者中，孤立性腘下病变的血管内治疗（EVT）可提高肢体挽救率。因此，我们试图根据基线时组织损失的程度来确定这组患者的治疗结果。
2004年至2011年，449例连续性HD合并CLI患者有缺血性伤口，并接受了孤立性腘下病变的EVT治疗。“轻度组织损失”（MI）组由340例伤口位于跖趾关节远端的HD患者组成，“重度组织损失”（MA）组包括109例伤口超出此范围的HD患者。通过Kaplan-Meier分析比较两组的肢体挽救率和无截肢生存率（AFS）。
糖尿病患者的比例在两组间无显著差异（MI组：76.5% vs. MA组：75.2%）。MA组中伤口部位直接血流的比例低于MI组（MI组：63.5% vs. MA组：45.9%，P<0.01）。与MA组相比，EVT后MI组的肢体挽救率显著更高（3年时MI组：83.7% vs. MA组：71.2%，P<0.01），AFS率也更高（3年时MI组：44.1% vs. MA组：29.1%，P<0.01）。
EVT是治疗轻度组织损失的HD患者的有效方法，3年时肢体挽救率超过80%。然而，所有有组织损失的HD患者3年时的AFS率均<50%，其预后较差。
