Schreuder Sanne M, Hendrix Yvette M G A, Reekers Jim A, Bipat Shandra
Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Cardiovasc Intervent Radiol. 2018 Jan;41(1):1-20. doi: 10.1007/s00270-017-1796-9. Epub 2017 Sep 18.
To identify possible risk factors in predicting clinical outcome in critical limb ischemia (CLI) patients undergoing percutaneous transluminal angioplasty (PTA).
PubMed and EMBASE were searched for studies analyzing CLI and clinical outcome after PTA from January 2006 to April 2017. Outcome measures were ulcer healing, amputation free survival (AFS)/limb salvage and overall survival. Data on predictive factors for ulcer healing, AFS/limb salvage and survival were extracted.
Ten articles with a total of 2448 patients were included, all cohorts and based on prospective-designed databases. For ulcers, it seems that complete healing can be achieved in most of the patients within 1 year. No significant predictive factors were found. AFS/limb salvage: AFS rates for 1, 2 and 3 years ranged from 49.5 to 75.2%, 37 to 58% and 22 to 59%, respectively. Limb salvage rates for 1, 2 and 3 years ranged from 71 to 95%, 54 to 93.3% and 32 to 92.7%, respectively. All studies had different univariate and multivariate outcomes for predictive factors; however, age and diabetes were significant predictors in at least three studies. Survival: Survival rates for 1, 2 and 3 years ranged from 65.4 to 91.5%, 45.7 to 76% and 37.3 to 83.1%, respectively. Different predictive factors were found; however, age was found in 2 out of 5 studies reporting on predictive factors.
In several studies two factors, age and diabetes, were found as predictive factors for AFS/limb salvage and survival in patients with CLI undergoing PTA. Therefore, we believe that these factors should be taken into account in future research.
Level 2a.
确定预测接受经皮腔内血管成形术（PTA）的严重肢体缺血（CLI）患者临床结局的可能风险因素。
检索PubMed和EMBASE，查找2006年1月至2017年4月期间分析CLI及PTA术后临床结局的研究。结局指标为溃疡愈合、无截肢生存（AFS）/肢体挽救及总生存。提取溃疡愈合、AFS/肢体挽救及生存的预测因素数据。
纳入10篇文章，共2448例患者，均为队列研究且基于前瞻性设计数据库。对于溃疡，似乎大多数患者在1年内可实现完全愈合。未发现显著预测因素。AFS/肢体挽救：1年、2年和3年的AFS率分别为49.5%至75.2%、37%至58%和22%至59%。1年、2年和3年的肢体挽救率分别为71%至95%、54%至93.3%和32%至92.7%。所有研究对于预测因素的单变量和多变量结局各不相同；然而，年龄和糖尿病在至少三项研究中是显著预测因素。生存：1年、2年和3年的生存率分别为65.4%至91.5%、45.7%至76%和37.3%至83.1%。发现了不同的预测因素；然而，在报告预测因素的5项研究中有2项发现了年龄因素。
在多项研究中，年龄和糖尿病这两个因素被发现是接受PTA的CLI患者AFS/肢体挽救及生存的预测因素。因此，我们认为在未来研究中应考虑这些因素。
2a级。
