Okamoto Shin, Iida Osamu, Takahara Mitsuyoshi, Hata Yosuke, Asai Mitsutoshi, Masuda Masaharu, Ishihara Takayuki, Nanto Kiyonori, Kanda Takashi, Tsujimura Takuya, Okuno Syota, Matsuda Yasuhiro, Mano Toshiaki
Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
J Endovasc Ther. 2020 Aug;27(4):608-613. doi: 10.1177/1526602820924338. Epub 2020 May 18.
To determine in a chronic limb-threatening ischemia (CLTI) population who underwent endovascular therapy (EVT) how many patients would have been categorized as preferred for bypass surgery according to the Global Vascular Guidelines (GVG) and ascertain their surgical risk.
The current study analyzed 1043 CLTI patients who presented WIfI (wound, ischemia, and foot infection) stage ≥2 and underwent EVT between April 2010 and December 2017. Of these, 176 were excluded for lack of angiographic or other data, leaving 867 CLTI patients (mean age 74±10 years; 523 men) for stratification according to the GVG into bypass-preferred, indeterminate, or EVT-preferred groups. The GVG recommend bypass as the first-line treatment when the wound is severe (WIfI stage ≥3) and lesions are complex (GLASS stage III). Surgical risk was estimated using the modified PREVENT III risk score. To further stratify the bypass-preferred population according to mortality risk, a survival decision tree was constructed using recursive partitioning.
The bypass-preferred group accounted for 55% [95% confidence interval (CI) 51% to 58%] of the overall population. The decision tree analysis extracted a low-mortality risk subgroup with a survival rate of 99% (95% CI 98% to 100%) at 1 month and 80% (95% CI 73% to 87%) at 2 years. According to the PREVENT III score, 34% (95% CI 27% to 42%) of the low mortality risk subgroup were classified as high surgical risk.
A high proportion of patients undergoing EVT were considered bypass preferred based on the GVG, and the survival of these patients was not significantly different whether they were high or low surgical risk.
在接受血管内治疗（EVT）的慢性肢体威胁性缺血（CLTI）患者群体中，确定根据全球血管指南（GVG）有多少患者会被归类为适合旁路手术，并确定其手术风险。
本研究分析了1043例呈现WIfI（伤口、缺血和足部感染）分期≥2且在2010年4月至2017年12月期间接受EVT的CLTI患者。其中，176例因缺乏血管造影或其他数据而被排除，留下867例CLTI患者（平均年龄74±10岁；523例男性）根据GVG分层为旁路首选、不确定或EVT首选组。当伤口严重（WIfI分期≥3）且病变复杂（GLASS分期III）时，GVG推荐旁路手术作为一线治疗。使用改良的PREVENT III风险评分估计手术风险。为了根据死亡风险进一步对旁路首选人群进行分层，使用递归划分构建了生存决策树。
旁路首选组占总人群的55%[95%置信区间（CI）51%至58%]。决策树分析提取出一个低死亡风险亚组，其1个月生存率为99%（95%CI 98%至100%），2年生存率为80%（95%CI 73%至87%）。根据PREVENT III评分，低死亡风险亚组中34%（95%CI 27%至42%）被归类为高手术风险。
根据GVG，接受EVT的患者中有很大比例被认为适合旁路手术，无论手术风险高低，这些患者的生存率无显著差异。
