Thomas Adriaan R, Raats Jelle W, Lensvelt Mare M A, de Groot Hans G W, Veen Eelco J, van der Laan Lijckle
Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands,
World J Surg. 2015 Aug;39(8):2090-5. doi: 10.1007/s00268-015-3069-6.
To assess the outcome of conservative treatment of severe critical limb ischemia (CLI) classified as Rutherford 5/6.
The preferred therapy for CLI is either endovascular revascularization or bypass surgery. With a growing aged population with more serious comorbidities, these therapies are not always a viable option. Primary amputation leads to decreased mobility and a reduced quality of life. There is a lack of literature regarding the outcome of conservative therapy.
Hospital charts were reviewed of all patients who were diagnosed with Rutherford classification 5-6 and received conservative treatment and lacked interventional options. Outcome measures were mortality, complete wound closure, and limb salvage rate.
38 patients were included with a median age of 80 years (range 57-97). The amputation rate during follow-up was 16%. In 58% of patients, complete wound closure was achieved. All-cause mortality was 58% with a 2-year survivability rate of 55%.
Conservative management in our selected patients with CLI results in a moderate rate of wound closure and acceptable amputation rates albeit with a high mortality rate. For patients not eligible for endovascular revascularization or bypass surgery, conservative treatment could be a viable option besides primary limb amputation.
评估对分类为卢瑟福5/6级的严重下肢严重缺血（CLI）进行保守治疗的结果。
CLI的首选治疗方法是血管内血运重建或搭桥手术。随着老年人口增加且合并症更严重，这些治疗方法并非总是可行选择。一期截肢会导致活动能力下降和生活质量降低。关于保守治疗结果的文献较少。
回顾了所有被诊断为卢瑟福分类5 - 6级且接受保守治疗且没有介入治疗选择的患者的医院病历。结果指标为死亡率、伤口完全闭合率和肢体 salvage率。
纳入38例患者，中位年龄80岁（范围57 - 97岁）。随访期间截肢率为16%。58%的患者实现了伤口完全闭合。全因死亡率为58%，2年生存率为55%。
在我们选择的CLI患者中，保守治疗导致中等程度的伤口闭合率和可接受的截肢率，尽管死亡率较高。对于不符合血管内血运重建或搭桥手术条件的患者，除了一期肢体截肢外，保守治疗可能是一种可行的选择。
