Takayama Toshio, Matsumura Jon S
1 Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Vasc Endovascular Surg. 2018 May;52(4):255-261. doi: 10.1177/1538574418761723. Epub 2018 Feb 27.
Complete revascularization, achieving inline flow to the foot through at least 1 patent tibioperoneal artery, is considered to be desirable for treating critical limb ischemia (CLI). Hybrid procedure, combined femoral endarterectomy and endovascular treatment, is commonly performed on patients with CLI because they often present with complicated lower extremity lesions involving the common femoral artery. This study aimed to investigate the efficacy of complete revascularization (CR) achieved by hybrid procedure on limb salvage in patients with CLI.
Between February 2010 and January 2016, 95 limbs (82 patients) were treated by lower extremity hybrid procedure; of these 95 procedures, 61 were for patients with CLI. We defined CR as achieving inline flow to the foot through at least 1 patent tibioperoneal artery. Complete revascularization was performed on 37 limbs, and incomplete revascularization (IR) was performed on 24 limbs. Specific variables, including patient age, male-female ratio, Rutherford classification, preoperative and postoperative ankle-brachial pressure indices (ABIs), follow-up duration (months), primary patency rate, assisted primary patency rate, secondary patency rate, and major amputation rate, were analyzed.
The mean age was similar between the groups 67.2 years in the CR group and 70.7 years in the IR group ( P = .11). Limb ischemia severity was significantly higher in the CR group: 63% of the patients scored Rutherford 5 in the CR group, compared to 30% in the IR group ( P = .027). Mean postoperative ABI was significantly higher in the CR group (CR: 0.87, IR: 0.53; P = .0001). Major amputation rate was higher in the IR group (CR: 2.7%, IR: 13%; P = .29), and major amputation-free survival rate at 3 years after the index procedure was higher in the CR group (CR: 97%, IR: 81%; P = .054).
Complete lower extremity revascularization was beneficial for patients with CLI, avoiding major amputation.
完全血运重建，即通过至少1条通畅的胫腓动脉实现足部直线血流，被认为是治疗严重肢体缺血（CLI）的理想方法。杂交手术，即股动脉内膜切除术与血管腔内治疗相结合，常用于CLI患者，因为这些患者常伴有累及股总动脉的复杂下肢病变。本研究旨在探讨杂交手术实现的完全血运重建（CR）对CLI患者肢体挽救的疗效。
2010年2月至2016年1月期间，95条肢体（82例患者）接受了下肢杂交手术；在这95例手术中，61例是针对CLI患者。我们将CR定义为通过至少1条通畅的胫腓动脉实现足部直线血流。37条肢体进行了完全血运重建，24条肢体进行了不完全血运重建（IR）。分析了特定变量，包括患者年龄、男女比例、卢瑟福分级、术前和术后踝肱压力指数（ABI）、随访时间（月）、一期通畅率、辅助一期通畅率、二期通畅率和大截肢率。
两组的平均年龄相似，CR组为67.2岁，IR组为70.7岁（P = 0.11）。CR组肢体缺血严重程度明显更高：CR组63%的患者卢瑟福分级为5级，而IR组为30%（P = 0.027）。CR组术后平均ABI明显更高（CR：0.87，IR：0.53；P = 0.0001）。IR组的大截肢率更高（CR：2.7%，IR：13%；P = 0.29），首次手术后3年的无大截肢生存率在CR组更高（CR：97%，IR：81%；P = 0.054）。
下肢完全血运重建对CLI患者有益，可避免大截肢。
