Department of Clinical Sciences, Malmö, Lund University, Skåne University Hospital, Sweden; Vascular Center, Department of Cardio-Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Sweden.
Department of Clinical Sciences, Malmö, Lund University, Skåne University Hospital, Sweden.
J Diabetes Complications. 2020 May;34(5):107551. doi: 10.1016/j.jdiacomp.2020.107551. Epub 2020 Feb 6.
The aim of the present study was to compare outcomes of endovascular surgery versus open vascular surgery in patients with diabetic foot ulcer (DFU) and peripheral arterial disease (PAD).
Between 1984 and 2006, 1151 patients with DFU were admitted to the diabetic foot care team. Three hundred seventy-six patients with 408 limbs were consecutively included at a multidisciplinary foot center, 289 limbs were treated with endovascular surgery and 119 limbs with open vascular surgery first strategy. A propensity score adjusted analysis was performed to compare outcomes for type of revascularization.
Major amputation rates at 3 years were 17.0% and 16.8% (p = 0.97) and mortality at 3 years were 43.1% and 46.5% (p = 0.55) after endovascular surgery and open vascular surgery, respectively. In the propensity score adjusted analysis, patients undergoing endovascular surgery first had similar outcomes in terms of major amputation, mortality, combined major amputation/mortality compared to those undergoing open vascular surgery. Longer time to intervention (p = 0.003) was associated with increased major amputation rate in the multivariable Cox regression analysis.
The endovascular surgery first and open vascular surgery first strategies were associated with similar long-term results in a large cohort of patients with DFU and PAD undergoing revascularization. Rapid revascularization reduces the risk of amputation.
本研究旨在比较糖尿病足溃疡（DFU）和外周动脉疾病（PAD）患者血管内手术与开放血管手术的结局。
1984 年至 2006 年期间，1151 例 DFU 患者被收入糖尿病足护理团队。376 例患者的 408 条肢体在多学科足部中心连续纳入研究，289 条肢体接受了血管内手术治疗，119 条肢体接受了开放血管手术治疗作为初始策略。进行倾向评分调整分析，以比较两种血运重建方式的结果。
血管内手术组和开放血管手术组 3 年时的主要截肢率分别为 17.0%和 16.8%（p=0.97），3 年死亡率分别为 43.1%和 46.5%（p=0.55）。在倾向评分调整分析中，与开放血管手术组相比，首先接受血管内手术的患者在主要截肢、死亡率和主要截肢/死亡率联合方面的结局相似。多变量 Cox 回归分析显示，介入时间延长（p=0.003）与主要截肢率增加相关。
在接受血运重建的 DFU 和 PAD 大患者队列中，血管内手术优先和开放血管手术优先策略与相似的长期结果相关。快速血运重建可降低截肢风险。
