Bischoff Moritz S, Meisenbacher K, Peters A S, Weber D, Bisdas T, Torsello G, Böckler D
Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Langenbecks Arch Surg. 2018 Sep;403(6):741-748. doi: 10.1007/s00423-018-1689-7. Epub 2018 Jun 17.
To evaluate the significance of perioperative changes in ankle-brachial index (ABI) with regard to extremity-related outcome in non-diabetic patients with critical limb ischemia (CLI) following revascularization.
The study represents a subanalysis of the multicentric Registry of First-line Treatment in Patients with CLI (CRITISCH). After exclusion of diabetic patients, conservative cases, and primary major amputation, 563 of 1200 CRITISCH patients (mean age 74 ± 10.7 years) were analyzed. This population was divided into two groups regarding perioperative ABI changes ∆ + 0.15 (Group 1) or ∆ - 0.15 (Group 2). Study endpoints were reintervention and major amputation during a mean follow-up of 14.6 ± 9 months. Logistic regression was performed in order to identify factors for ABI group affiliation.
There were 279 patients in Group 1 (49.5%) and 284 in Group 2 (51.5%). ABI sensitivity and specificity regarding vessel patency were calculated to be 54 and 87%. A preoperative ABI ≤ 0.4 [odds ratio (OR) 7.7], patent vessels at discharge (OR 12.2), and secondary interventions (OR 2.4) were identified as factors for Group 1 affiliation. Contrariwise, previous revascularization (OR 0.6), a glomerular filtration rate ≤ 15 ml/min/1.73 m (OR 0.3), and TASC A lesions (OR 0.2) were associated with Group 2 affiliation. No statistical difference was found with regard to the need of reintervention. However, time to reintervention was significantly shorter in Group 2 compared to that in Group 1 (10.0 ± 9.5 months vs 12.1 ± 9.1 months; p = 0.005). Amputation rate in Group 2 was 14.4%, significantly higher compared to that in Group 1 (6.0%; p < 0.0001).
Failure of perioperative ABI improvement is associated with a higher probability for amputation and should be valued as prognostic factor in non-diabetic patients with CLI. Patients with no/marginal improvement in ABI after revascularization require close follow-up monitoring and may benefit from early reintervention.
评估非糖尿病严重肢体缺血（CLI）患者血管重建术后踝肱指数（ABI）围手术期变化对肢体相关预后的意义。
本研究是CLI患者一线治疗多中心注册研究（CRITISCH）的一项亚分析。排除糖尿病患者、保守治疗病例和一期大截肢病例后，对1200例CRITISCH患者中的563例（平均年龄74±10.7岁）进行分析。根据围手术期ABI变化Δ≥0.15（第1组）或Δ＜ -0.15（第2组）将该人群分为两组。研究终点为平均随访14.6±9个月期间的再次干预和大截肢。进行逻辑回归以确定ABI分组的相关因素。
第1组有279例患者（49.5%），第2组有284例患者（51.5%）。计算得出ABI对血管通畅性的敏感性和特异性分别为54%和87%。术前ABI≤0.4（比值比[OR]7.7）、出院时血管通畅（OR 12.2）和二次干预（OR 2.4）被确定为第1组分组的相关因素。相反，既往血管重建（OR 0.6）、肾小球滤过率≤15 ml/min/1.73 m²（OR 0.3）和TASC A病变（OR 0.2）与第2组分组相关。在再次干预需求方面未发现统计学差异。然而，第2组再次干预的时间明显短于第1组（10.0±9.5个月对12.1±9.1个月；p = 0.005）。第2组的截肢率为14.4%，明显高于第1组（6.0%；p＜0.0001）。
围手术期ABI改善失败与截肢概率较高相关，应作为非糖尿病CLI患者的预后因素。血管重建术后ABI无改善/改善甚微的患者需要密切随访监测，可能从早期再次干预中获益。
