Zettervall Sara L, Buck Dominique B, Darling Jeremy D, Lee Vanessa, Schermerhorn Marc L, Guzman Raul J
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
J Vasc Surg. 2016 Mar;63(3):673-677. doi: 10.1016/j.jvs.2015.09.033. Epub 2015 Nov 11.
Pulse pressure is a noninvasive measure of arterial stiffness. Increased pulse pressure is associated with an increased risk of cardiovascular events and death. The effects of pulse pressure on outcomes after endovascular interventions for critical limb ischemia (CLI), however, are unknown. We thus evaluated whether increased preoperative pulse pressure was associated with adverse outcomes and mortality in patients who underwent endovascular tibial artery intervention.
All patients who underwent endovascular tibial intervention for CLI at a single institution from 2004 to 2014 were included in this study. Preoperative pulse pressure was derived from measurements obtained in the holding area before the procedure. Patients were divided into two groups on the basis of pulse pressure, <80 or ≥80 mm Hg. Patient demographic characteristics and comorbidities were documented, and outcomes including procedural complications, repeat intervention, amputation, and mortality were recorded. Multivariable logistic regression was used to account for patient demographic characteristics and comorbidities.
Of 371 patients, 186 patients had a preoperative pulse pressure <80 mm Hg and 185 had a preoperative pulse pressure ≥80 mm Hg. No significant differences in patient demographic characteristics or comorbidities were identified; however, there was a trend toward older age in patients with increased pulse pressure (70 vs 72; P = .07). In univariate analysis, procedural complications (21% vs 13%; P = .02), reinterventions (26% vs 17%; P < .01), and restenosis (32% vs 23%; P = .03) were more common among patients with pulse pressure ≥80. Procedural complications remained significant in multivariate analysis (odds ratio, 1.8; 95% confidence interval, 1.0-3.1; P = .04). There was no difference in 30-day mortality; however, increased mortality was seen at 5 years of follow-up (odds ratio, 1.6; 95% confidence interval, 1.0-2.5; P = .04) in multivariable analysis.
Increased preoperative pulse pressure is associated with procedural complications and increased mortality in patients who undergo endovascular tibial intervention for CLI. It is a marker of increased risk, and might be a suitable target for interventions aimed at improving outcomes in this high-risk population.
脉压是动脉僵硬度的一种非侵入性测量指标。脉压升高与心血管事件和死亡风险增加相关。然而，脉压对严重肢体缺血（CLI）血管内介入治疗后结局的影响尚不清楚。因此，我们评估了术前脉压升高是否与接受胫动脉血管内介入治疗的患者的不良结局和死亡率相关。
本研究纳入了2004年至2014年在单一机构接受CLI胫动脉血管内介入治疗的所有患者。术前脉压来自手术前在等候区测得的数据。根据脉压将患者分为两组，<80或≥80 mmHg。记录患者的人口统计学特征和合并症，并记录包括手术并发症、再次干预、截肢和死亡率在内的结局。采用多变量逻辑回归分析来考虑患者的人口统计学特征和合并症。
在371例患者中，186例患者术前脉压<80 mmHg，185例患者术前脉压≥80 mmHg。未发现患者人口统计学特征或合并症有显著差异；然而，脉压升高的患者有年龄较大的趋势（70岁对72岁；P = 0.07）。在单变量分析中，脉压≥80的患者手术并发症（21%对13%；P = 0.02）、再次干预（26%对17%；P < 0.01）和再狭窄（32%对23%；P = 0.03）更为常见。在多变量分析中，手术并发症仍然显著（比值比，1.8；95%置信区间，1.0 - 3.1；P = 0.04）。30天死亡率没有差异；然而，在多变量分析中，随访5年时死亡率升高（比值比，1.6；95%置信区间，1.0 - 2.5；P = 0.04）。
术前脉压升高与接受CLI胫动脉血管内介入治疗的患者的手术并发症和死亡率增加相关。它是风险增加的一个标志，可能是旨在改善这一高危人群结局的干预措施的合适靶点。
