Akagi Daisuke, Hoshina Katsuyuki, Akai Atsushi, Yamamoto Kota
Division of Vascular Surgery, Department of Surgery, The University of Tokyo Hospital.
Int Heart J. 2018 Sep 26;59(5):1041-1046. doi: 10.1536/ihj.17-592. Epub 2018 Aug 11.
The prevalence of arteriosclerosis obliterans (ASO) and critical limb ischemia (CLI) is currently increasing, and arterial reconstruction is often attempted to salvage the limb. Some patients cannot undergo attempted revascularization because of contraindications, and they only receive conservative treatment. In this study, we investigate the comorbidities and survival rates of patients with CLI who receive conservative treatment. Thirty-five patients with CLI due to ASO, who had not undergone revascularization surgery (C group), were enrolled. As controls, 136 patients with CLI due to ASO who did undergo revascularization (R group), mainly via bypass surgery, were enrolled. Coronary artery disease, heart failure, and respiratory dysfunction were factors indicating conservative treatment. Limb salvage rates and survival rates were not significantly different between the two groups. Patients who had survived for less than two years after surgery had a higher prevalence of chronic heart failure, cardiovascular disease, and end-stage renal disease compared to patients who had survived for more than two years. The use of statins, dual antiplatelets, aspirin, or warfarin did not influence whether a patient survived for longer than two years. 77% of patients survived for more than two years after receiving only conservative therapies. Surgical revascularization did not improve the prognosis of patients with CLI as compared with the conservative therapy. Clinicians might start with conservative treatment while considering other treatment options for patients with CLI.
目前，闭塞性动脉硬化症（ASO）和严重肢体缺血（CLI）的患病率正在上升，人们常常尝试进行动脉重建以挽救肢体。一些患者由于存在禁忌证而无法进行血管重建尝试，只能接受保守治疗。在本研究中，我们调查了接受保守治疗的CLI患者的合并症和生存率。纳入了35例因ASO导致CLI且未接受血管重建手术的患者（C组）。作为对照，纳入了136例因ASO导致CLI且接受了血管重建（R组）的患者，主要是通过搭桥手术。冠状动脉疾病、心力衰竭和呼吸功能障碍是表明需进行保守治疗的因素。两组之间的肢体挽救率和生存率没有显著差异。与存活超过两年的患者相比，术后存活不到两年的患者慢性心力衰竭、心血管疾病和终末期肾病的患病率更高。使用他汀类药物、双联抗血小板药物、阿司匹林或华法林并不影响患者是否能存活超过两年。77%的患者仅接受保守治疗后存活超过两年。与保守治疗相比，手术血管重建并未改善CLI患者的预后。临床医生在考虑CLI患者的其他治疗选择时，可能应首先采用保守治疗。
