Utsunomiya Makoto, Iida Osamu, Yamauchi Yasutaka, Nakano Masatsugu, Soga Yoshimitsu, Kawasaki Daizo, Takahara Mitsuyoshi, Nakamura Masato
Division of Cardiovascular Medicine, Tokyo Rosai Hospital, Tokyo, Japan
Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan.
J Endovasc Ther. 2016 Oct;23(5):710-6. doi: 10.1177/1526602816656831. Epub 2016 Jul 1.
To assess the influence of repeat intervention on the risk of major amputation after infrapopliteal angioplasty for patients with critical limb ischemia (CLI).
A multicenter database of Japanese CLI patients was interrogated to identify patients who underwent balloon angioplasty for isolated infrapopliteal lesions from April 2004 to December 2012. In that time frame, 1298 limbs of 1065 patients (mean age 72±10 years; 739 men) were eligible for this analysis. The prevalence of tissue loss was 76%, with 33% accompanied by infection. The association between repeat intervention and future risk for major amputation was evaluated using a mixed effects logistic regression model. A stratification analysis was also performed with baseline variables. A supplementary analysis compared baseline characteristics between the cases with and without repeat intervention. Hazard ratios (HR) and their 95% confidence intervals (CI) are reported.
Median follow-up was 1.2 years (interquartile range 0.4-2.5), during which time 143 (11.0%) limbs had major amputations and 499 (38.4%) underwent repeat intervention. The mixed effects modeling revealed that repeat intervention was significantly associated with future risk for major amputation (unadjusted HR 3.01, 95% CI 2.05 to 4.41, p=0.001). From the stratification analysis, repeat intervention significantly increased future risk of major amputation in cases with regular dialysis (HR 3.35, 95% CI 2.14 to 5.26, p<0.001), whereas it did not in those without dialysis. The supplemental analysis showed that patients with repeat intervention within 1 year had a higher prevalence of nonambulatory status, regular dialysis, tissue loss, and infection at baseline compared to those without repeat intervention for 1 year.
In the patients with CLI due to infrapopliteal lesions, the need for repeat intervention increased the risk of future major amputation. However, this correlation was not applicable to nondialysis patients.
评估重复干预对严重肢体缺血（CLI）患者腘下血管成形术后大截肢风险的影响。
查询日本CLI患者的多中心数据库，以确定2004年4月至2012年12月期间因孤立性腘下病变接受球囊血管成形术的患者。在此时间段内，1065例患者（平均年龄72±10岁；739例男性）的1298条肢体符合本分析标准。组织缺失的患病率为76%，其中33%伴有感染。使用混合效应逻辑回归模型评估重复干预与未来大截肢风险之间的关联。还对基线变量进行了分层分析。进行了一项补充分析，比较了有和没有重复干预的病例之间的基线特征。报告了风险比（HR）及其95%置信区间（CI）。
中位随访时间为1.2年（四分位间距0.4 - 2.5年），在此期间，143条肢体（11.0%）进行了大截肢，499条肢体（38.4%）接受了重复干预。混合效应模型显示，重复干预与未来大截肢风险显著相关（未调整的HR为3.01，95%CI为2.05至4.41，p = 0.001）。分层分析表明，在接受定期透析的病例中，重复干预显著增加了未来大截肢的风险（HR为3.35，95%CI为2.14至5.26，p < 0.001），而在未接受透析的病例中则不然。补充分析表明，与1年内未进行重复干预的患者相比，1年内进行重复干预的患者在基线时非行走状态、定期透析、组织缺失和感染的患病率更高。
在因腘下病变导致CLI的患者中，重复干预的需求增加了未来大截肢的风险。然而，这种相关性不适用于未接受透析的患者。
