Johner Fabian, Clemens Robert, Husmann Marc, Thalhammer Christoph, Seifert Burkhardt, Amann-Vesti Beatrice
1 Clinic for Angiology, University Hospital Zurich, Switzerland.
2 Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
Vasa. 2016;45(3):247-52. doi: 10.1024/0301-1526/a000532.
We evaluated the long-term outcome after endovascular revascularisation for acute limb ischaemia (ALI).
From a prospectively maintained database, 318 endovascular interventions for ALI were identified between 2004 and 2010. Event history and survival were analysed using the Kaplan-Meier method and Cox regression. Endpoints were target vessel revascularisation (TVR), non-target extremity revascularisation (NTER), amputation, major vascular events, coronary artery revascularisation and amputation-free survival.
Follow-up data of 303 patients (mean age 68.5 ± 12.7 years, 40% female) were available. The mean follow-up time was 38.7 ± 26.2 months. TVR was performed in 40.1 ± 2.9% at 1 year and 66.5 ± 3.8% at 5 years. NTER at 1 and 5 years were 7.1 ± 1.5% and 29.2 ± 4%, respectively. The proportion of patients who needed major or minor amputation was 4.3 ± 1.2% after 1 year and 9 ± 2.1% after 5 years. Amputation-free survival at 1 year was 90.3 ± 1.8% and 74.8 ± 3.2% at 5 years. Coronary artery disease (HR 2.22, 95% CI 1.33 to 3.7, p = 0.002) and atrial fibrillation (HR 2.56, % CI 1.3 to 5.04, p = 0.007) were independently associated with a worse amputation-free survival. The cumulative proportion surviving one year following acute limb ischemia was 95.4 ± 1.2% and 79.7 ± 3.1% after 5 years.
Long-term amputation-free survival after successful revascularisation for ALI is high; negative predictors are coronary artery disease and atrial fibrillation.
我们评估了急性肢体缺血（ALI）血管内血运重建后的长期疗效。
从一个前瞻性维护的数据库中，确定了2004年至2010年间318例针对ALI的血管内干预。使用Kaplan-Meier方法和Cox回归分析事件史和生存率。终点指标为靶血管血运重建（TVR）、非靶肢体血运重建（NTER）、截肢、主要血管事件、冠状动脉血运重建和无截肢生存率。
获得了303例患者（平均年龄68.5±12.7岁，40%为女性）的随访数据。平均随访时间为38.7±26.2个月。1年时TVR的发生率为40.1±2.9%，5年时为66.5±3.8%。1年和5年时NTER的发生率分别为7.1±1.5%和29.2±4%。1年后需要进行大截肢或小截肢的患者比例为4.3±1.2%，5年后为9±2.1%。1年时无截肢生存率为90.3±1.8%，5年时为74.8±3.2%。冠状动脉疾病（HR 2.22，95%CI 1.33至3.7，p = 0.002）和心房颤动（HR 2.56，95%CI 1.3至5.04，p = 0.007）与较差的无截肢生存率独立相关。急性肢体缺血后1年的累积生存率为95.4±1.2%，5年后为79.7±3.1%。
ALI成功血运重建后的长期无截肢生存率较高；负性预测因素为冠状动脉疾病和心房颤动。
