Lukasiewicz Aleksander
Department of Surgery, Provincial Specialty Hospital in Wloclawek, 87-800 Wloclawek, Poland.
Department of Vascular Surgery, Regional Specialty Hospital in Grudziadz, 86-300 Grudziadz, Poland.
J Clin Med. 2020 May 16;9(5):1501. doi: 10.3390/jcm9051501.
The role of endovascular procedures in the treatment of acute lower limb ischemia (ALI) is expanding. For treatment, the choice between surgical or endovascular is still debated. The aim of this study was to identify factors that determine the selection of treatment. This study included 307 ALI patients (209 with thrombosis). Patient details, factors affecting the procedure choice, and outcomes were analyzed. The majority of patients were operated on (52.4%). Surgery was more frequent in embolic patients with embolus (odds ratio (OR) 33.85; 95% confidence interval (CI) 6.22-184.19, < 0.0001), severe ischemia (OR 1.79; 95% CI 1.2-2.66, = 0.0041), and active cancer (OR 4.99; 95% CI 1.26-19.72, = 0.02). Tibial arteries involvement was negatively related to surgery (OR 0.25; 95% CI 0.06-0.95, = 0.04). The complications and amputation rates were comparable. Reinterventions were more common in the endovascular group (19 (20.2%) vs. 17 (8.9%), = 0.007). The six-month mortality was higher in the operated patients (12.6% vs. 3.2%, respectively, = 0.001). The determinants of the treatment path are ischemia severity, concurrent cancer, embolus, and peripheral lesion location. Modification of the Rutherford acute lower limb ischemia classification is required to improve the decision-making in patients with profound ischemia.
血管内介入治疗在急性下肢缺血（ALI）治疗中的作用正在扩大。对于治疗方法，手术治疗还是血管内介入治疗的选择仍存在争议。本研究的目的是确定决定治疗选择的因素。本研究纳入了307例ALI患者（209例伴有血栓形成）。分析了患者的详细信息、影响治疗方法选择的因素以及治疗结果。大多数患者接受了手术治疗（52.4%）。在伴有栓子的栓塞患者中手术更为常见（优势比（OR）33.85；95%置信区间（CI）6.22 - 184.19，P < 0.0001），在严重缺血患者中（OR 1.79；95% CI 1.2 - 2.66，P = 0.0041）以及患有活动性癌症的患者中（OR 4.99；95% CI 1.26 - 19.72，P = 0.02）也是如此。胫动脉受累与手术呈负相关（OR 0.25；95% CI 0.06 - 0.95，P = 0.04）。两组的并发症和截肢率相当。血管内介入治疗组再次干预更为常见（19例（20.2%）对17例（8.9%），P = 0.007）。接受手术治疗的患者六个月死亡率更高（分别为12.6%对3.2%，P = 0.001）。治疗路径的决定因素包括缺血严重程度、并发癌症、栓子以及周围病变位置。需要对卢瑟福急性下肢缺血分类进行修订，以改善严重缺血患者的决策制定。
