Fournet B, Falchetti A, Roques F, Gaillard G, Inamo J, Blanchet-Deverly A
Vascular surgery and medicine department, CHU, Pierre Zobda-Quitman hospital, CS 90632, 97261 Fort-de-France cedex, Martinique.
Service de chirurgie et médecine vasculaire, CHU, Hôpital Pierre Zobda-Quitman, CS 90632, 97261 Fort-de-France cedex, France.
J Med Vasc. 2020 May;45(3):114-124. doi: 10.1016/j.jdmv.2020.03.008. Epub 2020 Apr 9.
The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients.
We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique.
Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients.
A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.
截肢的精确流行病学评估颇具难度。它是一个严重的公共卫生和经济问题，死亡率很高。截肢前血管状况的截肢患者比例尚不清楚。我们研究的主要目的是评估接受下肢截肢的患者在术前进行血管评估的比例。次要目的是评估这些患者入院时的截肢风险，估计马提尼克岛的截肢发生率，并收集此类患者的流行病学数据。
我们在2018年1月1日至12月31日期间进行了一项流行病学、回顾性和观察性研究，纳入了所有在马提尼克大学医院中心接受下肢截肢的成年患者。
在170例纳入患者中，79例（46%）患者进行了下肢大截肢。2018年的截肢发生率估计为每10万居民48.9例。110例（65%）患者进行了血管评估。对于未进行血管评估的其他60例（35%）患者，53例（88%）患有严重感染。该评估与截肢水平显著相关：97例（70%）膝下截肢患者进行了血管评估，而膝上截肢患者为13例（41%）（P<0.01）。WIfI分类系统发现152例（89%）患者截肢风险高，但其中138例（81%）患者血管重建也有高获益。截肢原因是肢体缺血的患者有125例（68%）。
大量接受下肢截肢的患者术前未进行血管评估。因此，医疗保健方面有许多改进措施有待实施。马提尼克即将开展的M@diCICAT项目将有助于改善患者管理。与其他国家相比，马提尼克岛的截肢发生率较高（2003年法国全国发生率为每10万居民24.8例），且自2008年以来似乎一直保持稳定。根据SVS-WIfI分类，我们的人群被认为截肢风险高。该评分似乎适合预测这些患者的病情发展，在日常实践中可能有用。
