Bolíbar Ignasi, Gich Ignasi, Anglès Albert, Romero Josep M, Escudero José R
Department of Clinical Epidemiology and Public Health, Institute of Biomedical Research (IIB de Sant Pau), Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Autonomous University of Barcelona, Barcelona, Spain -
Department of Clinical Epidemiology and Public Health, Institute of Biomedical Research (IIB de Sant Pau), Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Autonomous University of Barcelona, Barcelona, Spain.
Int Angiol. 2019 Feb;38(1):54-61. doi: 10.23736/S0392-9590.18.04041-5.
Indications for the revascularization treatment of peripheral arterial disease (PAD) generate much discussion, and practice varies significantly among hospitals. This study looked at patients with PAD admitted to all hospitals of the Catalan Health Service and analyzed patterns of revascularization techniques with subsequent amputation procedures.
We used the clinical-administrative registry of admissions of all patients in the hospitals of Catalonia, north-east Spain, between 2009 and 2014. We analyzed the clinical course of patients admitted with PAD throughout their successive hospital admissions. Variability between hospitals was described for the revascularization techniques and amputations performed. Endovascular outcomes were compared with those from open surgery.
Annually, there were 9,828 admissions with PAD and 631 major amputations. Eight hospitals accounted for 52% of all admissions, and endovascular techniques occurred predominantly in high-tech, high-resolution or reference hospitals. The ratio of admissions involving endovascular techniques/open surgery varied from 0.02 to 3.73 according to the hospital, and had a correlation of -0.175 (P=0.447) with the percentage of performed major amputations and of 0.122 (P=0.598) ratio of minor / major amputations. At the end of the 6 studied years, endovascular revascularization resulted in lower patency and more minor amputations than open surgery, but had the same percentage of major amputations (10.3% vs. 10.7%, P=0.526) and lower in-hospital mortality (7.1% vs. 9.5%, P<0.0001).
Interventions of PAD are centralized in complex hospitals and have an important variability depending on the treating hospital. Hospital variability in revascularization techniques seems to have no impact on leg salvage. Endovascular and surgical revascularization would result in similar percentages of major amputations.
外周动脉疾病（PAD）血运重建治疗的适应症引发了诸多讨论，各医院的治疗实践差异显著。本研究观察了加泰罗尼亚卫生服务体系所有医院收治的PAD患者，并分析了血运重建技术及后续截肢手术的模式。
我们使用了西班牙东北部加泰罗尼亚地区2009年至2014年期间所有医院患者的临床管理入院登记数据。我们分析了因PAD入院患者在其连续住院期间的临床病程。描述了各医院在血运重建技术和截肢手术方面的差异。将血管内治疗结果与开放手术结果进行了比较。
每年有9828例PAD患者入院，631例进行了大截肢手术。8家医院占所有入院病例的52%，血管内技术主要应用于高科技、高分辨率或参考医院。各医院血管内技术/开放手术的入院比例从0.02到3.73不等，与大截肢手术的百分比呈-0.175的相关性（P = 0.447），与小/大截肢手术比例呈0.122的相关性（P = 0.598）。在研究的6年结束时，血管内血运重建术的通畅率低于开放手术，小截肢手术更多，但大截肢手术的百分比相同（10.3%对10.7%，P = 0.526），住院死亡率更低（7.1%对9.5%，P < 0.0001）。
PAD的干预集中在综合医院，且因治疗医院不同而存在重要差异。血运重建技术的医院差异似乎对保肢无影响。血管内和手术血运重建术导致大截肢手术的百分比相似。
