Fellow, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA.
Attending Physician, Department of Interventional Radiology, Kaiser Permanente Oakland Medical Center, Oakland, CA.
J Foot Ankle Surg. 2020 Sep-Oct;59(5):964-968. doi: 10.1053/j.jfas.2020.03.018. Epub 2020 May 12.
There has been a growing trend toward endovascular intervention to improve peripheral flow in patients with peripheral arterial disease. To date, there is no clear consensus regarding timing of lower-extremity amputations after revascularization. The purpose of this study was to evaluate the effects of timing between endovascular intervention and minor lower-extremity amputations and its influence on wound healing and limb loss within 1 year. A secondary purpose was to evaluate the impact of restoring in-line flow on healing rates. A total of 310 patients who underwent endovascular intervention and a minor lower-extremity amputation within 90 days were included in the study. Healing rates were defined as optimal, delayed, or failure. There was a statistically significant difference between patients with optimal healing to delayed healing and amputation ≥30 days after endovascular intervention (p = .037). We found no difference in healing rates in regard to amputation timing when examining patients who ultimately healed versus patients who failed to heal (p = .6717). Absence of in-line flow (p = .0177), male sex (p = .0090) and diabetes mellitus (p = .0076) were statistically significant factors for failing to heal. Presence of infection (p ≤ .0001) and wound dehiscence (p ≤ .001) were also associated with a failure to heal. End-stage renal disease trended toward significance for failing to heal (p = .065). Amputation-free survival at 1 year after endovascular intervention and pedal amputation was 76.8% (n = 238). Our findings suggest that in the absence of infection, performing minor lower-extremity amputations 15 to 60 days after endovascular intervention may allow for improved healing. Absence of in-line flow, male sex, diabetes mellitus, postoperative infection, and wound dehiscence are significant factors for failure.
目前，外周动脉疾病患者的外周血流改善倾向于采用血管内介入治疗。迄今为止，对于血管重建后下肢截肢的时机尚没有明确的共识。本研究的目的是评估血管内干预与小下肢截肢之间的时间间隔及其对 1 年内伤口愈合和肢体丧失的影响。次要目的是评估恢复顺行血流对愈合率的影响。共纳入 310 例在 90 天内行血管内介入治疗和小下肢截肢的患者。愈合率定义为优、延迟和失败。血管内干预后 30 天以上行小下肢截肢的患者，其愈合率与延迟愈合和截肢之间存在统计学显著差异（p=0.037）。我们在检查最终愈合的患者和未愈合的患者时，未发现截肢时机与愈合率之间存在差异（p=0.6717）。无顺行血流（p=0.0177）、男性（p=0.0090）和糖尿病（p=0.0076）是愈合失败的统计学显著因素。感染（p≤0.0001）和伤口裂开（p≤0.001）也与愈合失败相关。终末期肾病对愈合失败的趋势有统计学意义（p=0.065）。血管内干预和足趾截肢后 1 年的无截肢生存率为 76.8%（n=238）。我们的研究结果表明，在无感染的情况下，血管内干预后 15 至 60 天进行小下肢截肢可能会改善愈合。顺行血流缺失、男性、糖尿病、术后感染和伤口裂开是失败的显著因素。
