足弓通畅而非直接血管体再血管化可预测严重肢体缺血糖尿病患者血管内介入治疗的预后。
Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia.
作者信息
Troisi Nicola, Turini Filippo, Chisci Emiliano, Ercolini Leonardo, Frosini Pierfrancesco, Lombardi Renzo, Falciani Francesca, Baggiore Cristiana, Anichini Roberto, Michelagnoli Stefano
机构信息
Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy -
Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy -
出版信息
Int Angiol. 2017 Oct;36(5):438-444. doi: 10.23736/S0392-9590.17.03809-3. Epub 2017 May 24.
BACKGROUND
The aim of this study was to evaluate the impact of pedal arch status and direct-angiosome revascularization (DAR) on clinical outcomes in diabetic patients with foot wounds undergoing endovascular revascularization.
METHODS
Between January 2014 and June 2015, 93 diabetic patients with foot wounds underwent endovascular revascularization of at least one below-the-knee vessel. Patients were divided into three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA) and absent pedal arch (APA). Healing within 3 months and 1-year outcomes in terms of freedom from minor amputation, limb salvage, and survival were evaluated on the basis of DAR and pedal arch status.
RESULTS
DAR did not affect healing within 3 months from the procedure (DAR, 13/55 cases, 23.6% vs. n-DAR, 9/38 cases, 23.7%; P=1), estimated 1-year freedom from minor amputation (DAR 74.4% vs. n-DAR 76.8%, P=0.80), limb salvage (DAR 88.2% vs. n-DAR 89.5%, P=0.44), and survival (DAR 83.3% vs. n-DAR 66.6%, P=0.15). Pedal arch had positive impact on wound healing within 3 months from the procedure (CPA 45.8% vs. IPA 12.5% vs. APA 20.7%, P=0.009), estimated 1-year limb salvage (CPA 100% vs. IPA 90.9% vs. APA 76.1%, P=0.02), and 1-year survival (CPA 100% vs. IPA 87.2% vs. APA 60.3%, P=0.02).
CONCLUSIONS
DAR is not a predictor of good outcomes in diabetic patients undergoing endovascular procedure. Pedal arch patency seems to be a key factor to obtain good outcomes in terms of wound healing, and limb salvage.
背景
本研究旨在评估足弓状态和直接血管分支血运重建术（DAR）对接受血管内血运重建术的糖尿病足伤口患者临床结局的影响。
方法
2014年1月至2015年6月期间，93例患有足部伤口的糖尿病患者接受了至少一条膝下血管的血管内血运重建术。根据足弓状态将患者分为三组：完整足弓（CPA）、不完整足弓（IPA）和无足弓（APA）。根据DAR和足弓状态评估3个月内愈合情况以及1年时免于小截肢、保肢和生存的结局。
结果
DAR不影响术后3个月内的愈合情况（DAR组，13/55例，23.6%；非DAR组，9/38例，23.7%；P = 1）、预计1年免于小截肢情况（DAR组74.4%，非DAR组76.8%，P = 0.80）、保肢情况（DAR组88.2%，非DAR组89.5%，P = 0.44）和生存情况（DAR组83.3%，非DAR组66.6%，P = 0.15）。足弓对术后3个月内的伤口愈合有积极影响（CPA组45.8%，IPA组12.5%，APA组20.7%，P = 0.009）、预计1年保肢情况（CPA组100%，IPA组90.9%，APA组76.1%，P = 0.02）和1年生存情况（CPA组100%，IPA组87.2%，APA组60.3%，P = 0.
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