Piffaretti Gabriele, Angrisano Alessandro, Franchin Marco, Ferrario Massimo, Rivolta Nicola, Bacuzzi Alessandro, Castelli Patrizio, Tozzi Matteo
Division of Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy -
Division of Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy.
J Cardiovasc Surg (Torino). 2018 Dec;59(6):810-816. doi: 10.23736/S0021-9509.16.09673-7. Epub 2016 Nov 30.
Aim of this study is to report the results of thromboembolectomy (ThEmb) for acute thromboembolic lower limb ischemia (ATLI) in native arteries and to create a predictive score for amputation-free survival (AFS) at 30 days.
It is a single center, retrospective analysis of a four years period. All patients had ThEmb: adjunctive procedures included femoral and/or popliteal endarterectomy in 30 (18.3%) cases, PTA-stent in 24 (14.6%), and femoral endarterectomy plus PTA-stent in 12 (7.3%). Fasciotomies were performed in 6 (3.6%) patients. Predictors of AFS identified on univariate screen (inclusion threshold, P<.20) were included in a multivariable model. The resulting significant predictors were assigned an integer score to stratify patients into risk groups.
Authors analyzed 164 limbs in 164 patients. Mean age was 80±10 years (range, 40-99). In-hospital mortality was 9.8% (N.=16); AFS at 30 days was 84.7% (N.=139). The anatomic level (iliac vs. femoropopliteal vs. infrapopliteal) of the occlusion did not affect AFS (P=.326). Multivariable analysis identified six significant predictors of AFS at 30 days: age >85 (P=0.050), chronic obstructive pulmonary disease (P=0.008), chronic renal insufficiency (P=0.019), late (>6 hours) onset (P=0.004), the presence of major neurologic deficit (P=0.023), and an increased (>800IU/L) level of creatine phosphokinase (P=0.001). An integer score generated two risk groups (low-risk 0-2 [70.1% of cohort], and high-risk ≥3 [29.9% of cohort]): stratification of the patients according to risk category yielded significantly different AFS at 30 days (low-risk 5.2% vs. high-risk 38.8%, P<0.0001).
Among patients selected to undergo ThEmb for ATLI in native arteries, this risk score identified a group of patients with a 40% chance of death or major amputation at 30 days. The score can help to optimize the operative strategy, but further prospective validation is needed.
本研究旨在报告对原发性动脉急性血栓栓塞性下肢缺血（ATLI）进行血栓切除术（ThEmb）的结果，并创建一个30天无截肢生存率（AFS）的预测评分。
这是一项对四年期间的单中心回顾性分析。所有患者均接受了ThEmb：辅助手术包括30例（18.3%）的股动脉和/或腘动脉内膜切除术、24例（14.6%）的经皮腔内血管成形术-支架置入术以及12例（7.3%）的股动脉内膜切除术加经皮腔内血管成形术-支架置入术。6例（3.6%）患者进行了筋膜切开术。在单变量筛查中确定的AFS预测因素（纳入阈值，P<0.20）被纳入多变量模型。将得到的显著预测因素赋予一个整数评分，以将患者分层为风险组。
作者分析了164例患者的164条肢体。平均年龄为80±10岁（范围40-99岁）。住院死亡率为9.8%（N=16）；30天的AFS为84.7%（N=139）。闭塞的解剖水平（髂动脉、股腘动脉、腘动脉以下）不影响AFS（P=0.326）。多变量分析确定了30天AFS的六个显著预测因素：年龄>85岁（P=0.050）、慢性阻塞性肺疾病（P=0.008）、慢性肾功能不全（P=0.019）、发病较晚（>6小时）（P=0.004）、存在严重神经功能缺损（P=0.023）以及肌酸磷酸激酶水平升高（>800IU/L）（P=0.001）。一个整数评分产生了两个风险组（低风险0-2分[队列的70.1%]和高风险≥3分[队列的29.9%]）：根据风险类别对患者进行分层，30天时的AFS有显著差异（低风险5.2%对高风险38.8%，P<0.0001）。
在选择接受原发性动脉ATLI的ThEmb治疗的患者中，该风险评分确定了一组在30天时死亡或进行大截肢几率为40%的患者。该评分有助于优化手术策略，但需要进一步的前瞻性验证。
