Hardy David M, Lyden Sean P
Department of Vascular Surgery, Heart and Vascular Institute, Cleveland, OH.
Department of Vascular Surgery, Heart and Vascular Institute, Cleveland, OH.
Ann Vasc Surg. 2019 Jul;58:78-82. doi: 10.1016/j.avsg.2018.10.038. Epub 2019 Feb 4.
Critical limb ischemia (CLI) patients who do not undergo revascularization are at great risk for major lower extremity (LE) amputation. It has been reported that less than half (49%) of a reference Medicare amputation population had any diagnostic vascular evaluation prior to a major LE amputation. We were surprised by these data so we reviewed the preoperative evaluation in all patients who had a major LE amputation. We propose that significantly more patients will have a vascular evaluation prior to major LE amputation at a tertiary care referral center when a vascular surgeon does the amputation.
A retrospective analysis of major LE amputations was performed. Patient demographics, comorbidities, type of amputation, reason for amputation, Rutherford classification, and type of preoperative vascular examination were evaluated.
Over 4 years, 281 patients required major LE amputation. Above-knee amputation was performed in 39.1% of patients, whereas below-knee amputation was performed in 60.9%. Amputation was performed due to CLI in 92.9% of patients, whereas 7.1% of amputations were performed due to diabetes or other reasons. Preoperative vascular evaluation was performed in 100% of patients undergoing major LE amputation. Vascular surgeon pulse examination was most common (99.3%) followed by pulse volume recordings/ankle-brachial index (78.8%), angiography (54.8%), computed tomography angiography (29.3%), duplex ultrasonography (41.3%), and magnetic resonance angiography (0.4%). Amputations most commonly occurred due to Rutherford classification VI (63.3%) with 97.2% of patients having Rutherford IV-VI classification.
Preoperative vascular evaluation prior to major LE amputation is achievable in the majority of patients, reported here in 100% of patients undergoing a major LE amputation. This allows us to evaluate the patient for revascularization options prior to amputation for possible limb salvage.
未接受血运重建的严重肢体缺血（CLI）患者面临下肢大截肢的高风险。据报道，在医疗保险参考截肢人群中，不到一半（49%）的患者在接受下肢大截肢之前进行过任何诊断性血管评估。我们对这些数据感到惊讶，因此我们回顾了所有接受下肢大截肢患者的术前评估情况。我们认为，在三级医疗转诊中心，当由血管外科医生进行截肢手术时，会有显著更多的患者在下肢大截肢之前接受血管评估。
对下肢大截肢进行回顾性分析。评估了患者的人口统计学特征、合并症、截肢类型、截肢原因、卢瑟福分类以及术前血管检查类型。
在4年多的时间里，281例患者需要进行下肢大截肢。39.1%的患者进行了膝上截肢，而60.9%的患者进行了膝下截肢。92.9%的患者因CLI进行截肢，而7.1%的截肢是由于糖尿病或其他原因。100%接受下肢大截肢的患者进行了术前血管评估。血管外科医生的脉搏检查最为常见（99.3%），其次是脉搏容积记录/踝臂指数（78.8%）、血管造影（54.8%）、计算机断层血管造影（29.3%）、双功超声检查（41.3%）和磁共振血管造影（0.4%）。截肢最常见的原因是卢瑟福分类VI（63.3%），97.2%的患者为卢瑟福IV - VI分类。
大多数患者在下肢大截肢之前能够进行术前血管评估，本研究中100%接受下肢大截肢的患者均进行了评估。这使我们能够在截肢前评估患者的血运重建选择，以挽救可能的肢体。
