Department of Surgery, Boston Medical Center, Boston, MA.
Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA.
J Am Heart Assoc. 2018 Apr 12;7(8):e004782. doi: 10.1161/JAHA.116.004782.
Contemporary data on patients presenting with acute limb ischemia (ALI), who are selected for treatment with endovascular peripheral vascular interventions (PVI), are limited. Our study examined outcomes following endovascular PVI in patients with ALI by comparing with patients treated for chronic critical limb ischemia using a regional quality improvement registry.
Of the 11 035 patients in the Vascular Study Group of New England PVI database (2010-2014), we identified 365 patients treated for lower extremity ALI who were 5:1 frequency matched (by procedure year and arterial segments treated) to 1808 patients treated for critical limb ischemia. ALI patients treated with PVI had high burden of atherosclerotic risk factors and were more likely to have had prior ipsilateral revascularizations. ALI patients were less likely to be treated with self-expanding stents and more likely to undergo thrombolysis than patients with critical limb ischemia. In multivariable analysis, ALI was associated with higher technical failure (odds ratio 1.7, 95% confidence interval, 1.1%-2.5%), increased rate of distal embolization (odds ratio 2.7, 95% confidence interval, 1.5%-4.9%), longer length of stay (means ratio 1.6, 95% confidence interval, 1.4%-1.8%), and higher in-hospital mortality (odds ratio 2.8, 95% confidence interval, 1.3%-5.9%). ALI was not associated with risk of major amputation or mortality at 1 year.
In a multicenter cohort of patients treated with PVI, we found that ALI patients selected for treatment with endovascular techniques experienced greater short-term adverse events but similar long-term outcomes as their critical limb ischemia counterparts. Further studies are needed to refine the selection of ALI patients who are best served by PVI.
目前关于急性肢体缺血（ALI）患者接受血管腔内外周血管介入治疗（PVI）的当代数据有限。我们通过比较使用区域性质量改进登记处治疗慢性肢体严重缺血的患者，研究了 ALI 患者接受 PVI 后的结果。
在血管研究组新英格兰 PVI 数据库（2010-2014 年）的 11035 例患者中，我们确定了 365 例接受下肢 ALI 治疗的患者，他们通过手术年份和治疗的动脉节段与 1808 例接受严重肢体缺血治疗的患者以 5:1 的频率进行匹配。接受 PVI 治疗的 ALI 患者有很高的动脉粥样硬化危险因素负担，并且更有可能进行过同侧再血管化。与严重肢体缺血患者相比，ALI 患者接受自膨式支架治疗的可能性较低，接受溶栓治疗的可能性较高。多变量分析显示，ALI 与更高的技术失败率（比值比 1.7，95%置信区间，1.1%-2.5%）、更高的远端栓塞发生率（比值比 2.7，95%置信区间，1.5%-4.9%）、更长的住院时间（平均比值 1.6，95%置信区间，1.4%-1.8%）和更高的住院死亡率（比值比 2.8，95%置信区间，1.3%-5.9%）相关。ALI 与 1 年时的主要截肢或死亡率风险无关。
在接受 PVI 治疗的多中心患者队列中，我们发现接受血管腔内技术治疗的 ALI 患者经历了更多的短期不良事件，但与严重肢体缺血患者的长期结果相似。需要进一步研究来完善最适合 PVI 治疗的 ALI 患者的选择。
