血管体引导下的血管内治疗是否值得？
Is Angiosome-Guided Endovascular Therapy Worthwhile?
作者信息
Hata Yosuke, Iida Osamu, Mano Toshiaki
机构信息
Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
出版信息
Ann Vasc Dis. 2019 Sep 25;12(3):315-318. doi: 10.3400/avd.ra.19-00042.
Abstract
Endovascular therapy (EVT) plays a major role in the treatment of critical limb ischemia (CLI). The latest guidelines state that the angiosome concept should be considered when performing revascularization of infrapopliteal lesions in patients with CLI. There have been several reports both of favorable and unfavorable results of angiosome-guided EVT. Based on previous reports, angiosome-guided EVT tends to improve wound healing (WH) rather than amputation-free survival and overall survival. In addition, indirect revascularization based on the angiosome concept with a good collateral flow may achieve good WH comparable to that achieved by direct revascularization. In the future, rather than just debating the effectiveness/ineffectiveness of the angiosome concept, it will be desirable to investigate the patient and lesion characteristics that may have significant influences on WH after angiosome-guided EVT and to apply the results to clinical practice.
摘要
血管内治疗（EVT）在严重肢体缺血（CLI）的治疗中发挥着重要作用。最新指南指出，在对CLI患者进行腘下病变血管重建时应考虑血管体概念。关于血管体引导下的EVT，有一些报道显示了良好和不良的结果。根据以往的报道，血管体引导下的EVT倾向于改善伤口愈合（WH），而非无截肢生存率和总生存率。此外，基于血管体概念且侧支血流良好的间接血管重建可能实现与直接血管重建相当的良好WH。未来，与其仅仅争论血管体概念的有效性/无效性，不如研究可能对血管体引导下的EVT后的WH有重大影响的患者和病变特征，并将结果应用于临床实践。
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