Ohtake Takayasu, Mochida Yasuhiro, Matsumi Junya, Tobita Kazuki, Ishioka Kunihiro, Oka Machiko, Maesato Kyoko, Moriya Hidekazu, Hidaka Sumi, Saito Shigeru, Kobayashi Shuzo
Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
Department of Cardiology and Catheterization, Shonan Kamakura General Hospital, Kamakura, Japan.
Ther Apher Dial. 2016 Dec;20(6):661-667. doi: 10.1111/1744-9987.12450. Epub 2016 Jul 14.
To assess the clinical benefit of combined treatment of below-knee endovascular therapy (BK-EVT) plus low-density lipoprotein apheresis (LDLA) compared with BK-EVT monotherapy, we retrospectively evaluated the clinical outcome of hemodialysis (HD) patients with critical limb ischemia (CLI) due to isolated BK arterial lesions who underwent BK-EVT or BK-EVT plus short-term LDLA. Between October 2011 and September 2014, 62 HD patients underwent isolated BK-EVT monotherapy (BK-EVT group), and 25 HD patients underwent BK-EVT plus LDLA (BK-EVT + LDLA group). LDLA was started within 1 week after BK-EVT and performed four times in total within next 2 weeks. Major adverse limb events (MALE) including major amputation and re-intervention, and all-cause mortality were examined by Kaplan-Meier method and the log-rank test. Baseline characteristics were not different other than low ABI and low dorsal SPP in BK-EVT + LDLA group. Cumulative MALE-free rate was significantly improved in BK-EVT + LDLA group over the BK-EVT group (72.0% and 45.1% respectively at 30 months after treatment, P = 0.04). All-cause mortality did not differ between the two groups. Major causes of death were heart failure and sepsis in both groups. Short-term LDLA hybrid treatment immediately after BK-EVT might improve the outcome of ischemic limbs after re-vascularization therapy.
为评估膝下血管内治疗（BK-EVT）联合低密度脂蛋白单采术（LDLA）与BK-EVT单一疗法相比的临床获益，我们回顾性评估了因孤立性BK动脉病变而接受BK-EVT或BK-EVT联合短期LDLA治疗的严重肢体缺血（CLI）血液透析（HD）患者的临床结局。在2011年10月至2014年9月期间，62例HD患者接受了孤立性BK-EVT单一疗法（BK-EVT组），25例HD患者接受了BK-EVT联合LDLA治疗（BK-EVT + LDLA组）。LDLA在BK-EVT后1周内开始，并在接下来的2周内总共进行4次。采用Kaplan-Meier法和对数秩检验对包括大截肢和再次干预在内的主要不良肢体事件（MALE）以及全因死亡率进行了检查。除BK-EVT + LDLA组的踝臂指数（ABI）较低和足背收缩期峰值压（SPP）较低外，两组的基线特征无差异。BK-EVT + LDLA组的累积无MALE发生率显著高于BK-EVT组（治疗后30个月时分别为72.0%和45.1%，P = 0.04）。两组的全因死亡率无差异。两组的主要死亡原因均为心力衰竭和脓毒症。BK-EVT后立即进行短期LDLA联合治疗可能会改善血管再通治疗后缺血肢体的结局。
