Dua Anahita, Rothenberg Kara A, Lee Jisun J, Gologorsky Rebecca, Desai Sapan S
1 Division of Vascular Surgery, Department of Surgery, Stanford Hospital and Clinics, Palo Alto, CA, USA.
2 Department of Surgery, University of California San Francisco-East Bay, Oakland, CA, USA.
Vasc Endovascular Surg. 2019 Apr;53(3):212-215. doi: 10.1177/1538574418823378. Epub 2019 Jan 8.
: Patients with critical limb ischemia (CLI) and gangrene have a 10% to 38% rate of major amputation at 6 months. The purpose of this study is to report short- and mid-term major and minor amputation rates for patients who underwent tibial and pedal revascularization in addition to quality-of-life (QoL) scores.
: All patients who presented to a single institution with CLI (defined as rest pain or nonhealing wounds) and underwent antegrade or retrograde tibial access, atherectomy and angioplasty of the tibial circulation, and angioplasty of pedal circulation (antegrade or retrograde) from June 2016 to September 2017 were included. The Stark QoL questionnaire was used at each visit. Patients were scored at 1, 3, and 6 months postprocedure. Amputation rates were recorded.
: Forty-two patients with CLI and gangrene underwent 57 peripheral interventions for limb salvage between June 2016 and September 2017. Thirty-two limbs had dry gangrene along the dorsalis pedis angiosome, 14 limbs had dry gangrene along the posterior tibial angiogram, and 11 limbs had a combined disease pattern. Twelve limbs underwent angioplasty of the superficial femoral artery (SFA), 18 limbs underwent angioplasty and stenting of the SFA, and 14 limbs underwent atherectomy, angioplasty, and stenting of the SFA. All patients had 1 or 2 tibial vessel runoff and high-grade stenosis of the pedal circulation. Immediate technical success defined as 3-vessel outflow to the foot occurred in 49 limbs (86%) with zero 30-day complications (30-day readmission, major amputation, or sepsis). Major amputation rate at 1, 3, and 6 months was 0%, 2%, and 4%, respectively. Patient satisfaction in terms of QoL increased over the 6-month follow-up period.
: Aggressive tibial and pedal revascularization may improve freedom from minor and major amputation at 6 months and may be associated with a short- and mid-term higher QoL.
严重肢体缺血（CLI）和坏疽患者在6个月时的大截肢率为10%至38%。本研究的目的是报告接受胫部和足部血管重建术患者的短期和中期大截肢率及小截肢率，以及生活质量（QoL）评分。
纳入2016年6月至2017年9月期间就诊于单一机构、患有CLI（定义为静息痛或伤口不愈合）并接受顺行或逆行胫部通路、胫部循环斑块旋切术和血管成形术以及足部循环血管成形术（顺行或逆行）的所有患者。每次就诊时使用斯塔克生活质量问卷。在术后1、3和6个月对患者进行评分。记录截肢率。
2016年6月至2017年9月期间，42例CLI和坏疽患者接受了57次肢体挽救的外周介入治疗。32条肢体在足背血管区出现干性坏疽，14条肢体在胫后血管造影显示干性坏疽，11条肢体有合并病变模式。12条肢体接受了股浅动脉（SFA）血管成形术，18条肢体接受了SFA血管成形术和支架置入术，14条肢体接受了SFA斑块旋切术、血管成形术和支架置入术。所有患者均有1或2条胫部血管流出道以及足部循环的重度狭窄。定义为足部有3条血管流出道的即刻技术成功率在49条肢体（86%）中实现，30天并发症（30天再入院、大截肢或败血症）为零。1、3和6个月时的大截肢率分别为0%、2%和4%。在6个月的随访期内，患者在生活质量方面的满意度有所提高。
积极的胫部和足部血管重建术可能提高6个月时避免小截肢和大截肢的几率，并且可能与短期和中期较高的生活质量相关。
