Furuyama Tadashi, Onohara Toshihiro, Yamashita Sho, Yoshiga Ryosuke, Yoshiya Keiji, Inoue Kentaro, Morisaki Koichi, Kyuragi Ryoichi, Matsumoto Takuya, Maehara Yoshihiko
1 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
2 Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan.
Vascular. 2018 Dec;26(6):626-633. doi: 10.1177/1708538118786864. Epub 2018 Jul 13.
A multidisciplinary approach is required to treat critical limb ischemia. We determined the poor prognostic factors of ischemic ulcer healing after optimal arterial revascularization, and assessed the efficacy of the medication therapy using cilostazol, which is a selective inhibitor of phosphodiesterase 3.
In this retrospective, single-center, cohort study, 129 limbs that underwent infrainguinal arterial revascularization for Rutherford class 5 critical limb ischemia were reviewed. The primary end point was the ulcer healing time after arterial revascularization. The secondary end point was the amputation-free survival rate.
Of the 129 limbs, endovascular therapy was performed in 69 limbs, and surgical reconstructive procedures were performed in 60 limbs for initial therapy. Complete ulcer healing was achieved in 95 limbs (74%). The median ulcer healing time was 90 days. In multivariate analysis, no cilostazol use significantly inhibited ulcer healing ( p = 0.0114). A white blood cell count >10,000 ( p = 0.0185), a major defect after debridement ( p = 0.0215), and endovascular therapy ( p = 0.0308) were significant poor prognostic factors for ulcer healing. Additionally, ischemic heart disease ( p < 0.0001), albumin levels <3 g/dl ( p = 0.0016), no cilostazol use ( p = 0.0078), and a major defect after debridement ( p = 0.0208) were significant poor prognostic factors for amputation-free survival rate.
Ulcer healing within 90 days after arterial revascularization is impaired by no cilostazol use, a white blood cell count >10,000, a major defect after debridement, and endovascular therapy. Furthermore, cilostazol improves amputation-free survival rate in patients with critical limb ischemia.
治疗严重肢体缺血需要多学科方法。我们确定了在最佳动脉血运重建后缺血性溃疡愈合的不良预后因素，并评估了使用西洛他唑（一种磷酸二酯酶3选择性抑制剂）进行药物治疗的疗效。
在这项回顾性、单中心队列研究中，对129条因卢瑟福5级严重肢体缺血而接受腹股沟下动脉血运重建的肢体进行了评估。主要终点是动脉血运重建后的溃疡愈合时间。次要终点是无截肢生存率。
129条肢体中，69条肢体接受了血管内治疗，60条肢体接受了手术重建程序作为初始治疗。95条肢体（74%）实现了溃疡完全愈合。溃疡愈合的中位时间为90天。在多变量分析中，未使用西洛他唑显著抑制溃疡愈合（p = 0.0114）。白细胞计数>10000（p = 0.0185）、清创后存在较大缺损（p = 0.0215）和血管内治疗（p = 0.0308）是溃疡愈合的显著不良预后因素。此外，缺血性心脏病（p < 0.0001）、白蛋白水平<3 g/dl（p = 0.0016）、未使用西洛他唑（p = 0.0078）和清创后存在较大缺损（p = 0.0208）是无截肢生存率的显著不良预后因素。
未使用西洛他唑、白细胞计数>10000、清创后存在较大缺损和血管内治疗会损害动脉血运重建后90天内的溃疡愈合。此外，西洛他唑可提高严重肢体缺血患者的无截肢生存率。
