Strøm M, Konge L, Lönn L, Schroeder T V, Rørdam P
Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark Centre for Clinical Education, The Capital Region of Denmark, Copenhagen, Denmark
Centre for Clinical Education, The Capital Region of Denmark, Copenhagen, Denmark University of Copenhagen, Copenhagen, Denmark.
Scand J Surg. 2016 Mar;105(1):42-8. doi: 10.1177/1457496915571403. Epub 2015 Feb 6.
To evaluate the amputation-free survival after below the knee percutaneous transluminal angioplasty in a consecutive group of patients with critical ischemia of the lower extremity.
A total of 70 consecutive patients with critical ischemia were treated with below the knee percutaneous transluminal angioplasty at the vascular center at Rigshospitalet with the purpose of limb salvage. All patients were deemed unfit for major surgery due to anatomical limitations or severe co-morbidity, and no prior attempts of revascularization were performed. Follow-up clinical examinations were performed within 6 weeks and after 1 year. All medical records were crosschecked with the national vascular registry ensuring a valid 1-year status in 97% of the patients.
A total of 15 major amputations were performed during follow-up, with 11 amputations performed within the first year. Complications after percutaneous transluminal angioplasty were rare. Cumulative mortality after 1 and 2 years was 22% and 34%, respectively. Amputation-free survival at 1 and 2 years of follow-up was 68% and 58%, respectively. There were no association between known risk factors such as diabetes, ischemic ulcers, cardiac disease, history of smoking, major amputation, or overall amputation.
Below the knee percutaneous transluminal angioplasty in patients with end-stage peripheral arterial disease and critical limb ischemia is a safe procedure in relieving critical ischemia, reducing the short-term rate of a major amputation as opposed to best medical treatment alone.
评估连续一组下肢严重缺血患者行膝下经皮腔内血管成形术后的保肢生存率。
在里格霍斯皮塔利特血管中心，对70例连续的严重缺血患者进行膝下经皮腔内血管成形术以挽救肢体。由于解剖学限制或严重的合并症，所有患者均被认为不适合进行大手术，且此前未进行过血管重建尝试。在6周内及1年后进行随访临床检查。所有病历均与国家血管登记处进行交叉核对，确保97%的患者有有效的1年状态。
随访期间共进行了15例大截肢手术，其中11例在第一年进行。经皮腔内血管成形术后并发症罕见。1年和2年后的累积死亡率分别为22%和34%。随访1年和2年时的保肢生存率分别为68%和58%。糖尿病、缺血性溃疡、心脏病、吸烟史、大截肢或总体截肢等已知危险因素之间无关联。
对于终末期外周动脉疾病和严重肢体缺血患者，膝下经皮腔内血管成形术是一种安全的手术，与单纯最佳药物治疗相比，可缓解严重缺血，降低大截肢的短期发生率。
