Elitary Research Centre of Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark; Department of Cardiovascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark.
Departments of Vascular Surgery and Vascular Research Unit, Viborg Hospital, Viborg, Denmark.
Eur J Vasc Endovasc Surg. 2019 Jan;57(1):111-120. doi: 10.1016/j.ejvs.2018.08.047. Epub 2018 Oct 5.
Contemporary information on major amputations after revascularisation in Denmark is sparse. This population based national study aimed to determine outcomes following revascularisation for PAD and to identify predictors of major amputation after revascularisation, including geographical variation.
Data on patients with PAD undergoing revascularisation (endovascular, open, and hybrid procedures) from 2002 to 2014 were obtained from the Danish Vascular Registry and linked with information from population based healthcare and administrative databases. Cox proportional hazards regression was used to assess the relationship between major amputation and the various associated factors.
In all 25,982 first time vascular reconstructions for PAD were performed between 2002 and 2014 and major amputations were performed in 2883 (11.1%) of the patients. The total number of revascularisations increased up to 2010 and thereafter numbers decreased slightly. A trend towards endovascular revascularisation as first time revascularisation was seen (36.6% in 2002 vs. 59.0% in 2014, p < .001). Median time from first revascularisation to major amputation was 4.66 months (range 0.03-146.88 months), and 63.1% of major amputations were performed within one year following revascularisation. No change in the number of amputations performed within one year after revascularisation was found during the study (p = .251). The strongest predictor for major amputations was ulcers/gangrene (HR 8.06, CI 7.11-9.13, p < .001) at the time of revascularisation. Geographic variation for intensity of revascularisation was observed and geographic differences in amputation free survival for patients with intermittent claudication and ulcers/gangrene were found.
Although more patients with PAD undergo revascularisation, one in 10 still ends up with a major amputation of the lower limb. The risk of amputation was highly associated with the severity of the vascular disease at the time of revascularisation, with ulcers/gangrene as the strongest predictor. Geographic differences in vascular treatment intensity were found, but these failed to explain the differences in risk of major amputation after revascularisation across catchment areas.
丹麦有关血运重建后主要截肢的当代信息较为匮乏。本项基于人群的全国性研究旨在确定 PAD 血运重建后的结局，并确定血运重建后发生主要截肢的预测因素，包括地理差异。
从丹麦血管登记处获取了 2002 年至 2014 年期间接受血运重建（腔内、开放和杂交手术）的 PAD 患者的数据，并与基于人群的医疗保健和行政数据库中的信息相链接。采用 Cox 比例风险回归来评估主要截肢与各种相关因素之间的关系。
在 2002 年至 2014 年期间，共进行了 25982 例首次血管重建术以治疗 PAD，其中 2883 例（11.1%）患者进行了主要截肢。首次血运重建的总数一直增加到 2010 年，此后略有下降。首次血运重建时倾向于采用腔内血管重建术（2002 年为 36.6%，2014 年为 59.0%，p<0.001）。从首次血运重建到主要截肢的中位时间为 4.66 个月（范围 0.03-146.88 个月），63.1%的主要截肢发生在血运重建后一年内。在研究期间，未发现血运重建后一年内进行的截肢数量发生变化（p=0.251）。血运重建时存在溃疡/坏疽（HR 8.06，95%CI 7.11-9.13，p<0.001）是发生主要截肢的最强预测因素。观察到血管重建强度的地理差异，并发现间歇性跛行和溃疡/坏疽患者的截肢无病生存率存在地理差异。
尽管越来越多的 PAD 患者接受了血运重建，但仍有十分之一的患者最终会发生下肢主要截肢。截肢风险与血运重建时血管疾病的严重程度高度相关，其中溃疡/坏疽是最强的预测因素。发现血管治疗强度存在地理差异，但这些差异无法解释流域范围内血运重建后发生主要截肢的风险差异。
