Utsunomiya Makoto, Takahara Mitsuyoshi, Iida Osamu, Soga Yoshimitsu, Hata Yosuke, Shiraki Tatsuya, Nagae Ayumu, Kato Tamon, Kobayashi Norihiro, Suematsu Nobuhiro, Tasaki Junichi, Horie Kazunori, Uchida Daiki, Kodama Akio, Azuma Nobuyoshi, Nakamura Masato
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
Department of Metabolic Medicine and Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
J Endovasc Ther. 2020 Aug;27(4):584-594. doi: 10.1177/1526602820923388. Epub 2020 May 20.
To determine whether limb-based patency (LBP) after infrainguinal revascularization for chronic limb-threatening ischemia (CLTI) is similar between bypass surgery and endovascular therapy (EVT).
The database for the urgical Reconstruction vs eripheral tervention in Ptients With Critical Limb Isemia (SPINACH) study was interrogated to identify 130 patients (mean age 73±8 years; 94 men) who underwent bypass surgery and 271 patients (mean age 74±10 years; 178 men) who underwent EVT alone. Skin perfusion pressure (SPP) and the ankle-brachial index (ABI) were measured before the procedure and at 0, 1, and 3 months after revascularization. The outcome measure was hemodynamically evaluated LBP (SPP ≥10 mm Hg or ABI ≥0.1) maintained over the first 3 months after treatment. Any reintervention or major amputation was regarded as loss of LBP. The associations between the revascularization strategy (bypass vs EVT) and between the preoperative characteristics and the study outcome (ie, SPP- or ABI-based LBP), were determined using generalized linear mixed models with a logit link function. Patency rates are presented with the 95% confidence interval (CI).
The bypass surgery group had a higher stage of limb severity (WIfI) and anatomic complexity (GLASS) than the EVT group, whereas the EVT group had a higher prevalence of heart failure. Both SPP- and ABI-based LBP rates were higher in the bypass group than in the EVT group. SPP-based LBP rates at 3 months were 73.8% (95% CI 63.4% to 84.2%) in the bypass group and 46.2% (95% CI 38.5% to 53.8%) in the EVT group; the corresponding ABI-based LBP rates were 71.5% (95% CI 61.8% to 81.2%) and 44.0% (95% CI 37.3% to 50.7%).
LBP is an important concept in the new global vascular guidelines for assessing the anatomic and hemodynamic status of CLTI patients. The present study found that LBP was significantly lower in the EVT group vs the bypass surgery group.
确定慢性肢体威胁性缺血（CLTI）患者行股动脉以下血管重建术后基于肢体的通畅率（LBP）在旁路手术和血管内治疗（EVT）之间是否相似。
查询严重肢体缺血患者手术重建与外周干预（SPINACH）研究的数据库，以确定130例行旁路手术的患者（平均年龄73±8岁；94例男性）和271例仅接受EVT的患者（平均年龄74±10岁；178例男性）。在手术前以及血管重建术后0、1和3个月测量皮肤灌注压（SPP）和踝臂指数（ABI）。结局指标是在治疗后的前3个月内通过血流动力学评估维持的LBP（SPP≥10 mmHg或ABI≥0.1）。任何再次干预或大截肢均视为LBP丧失。使用具有logit链接函数的广义线性混合模型确定血管重建策略（旁路手术与EVT）之间以及术前特征与研究结局（即基于SPP或ABI的LBP）之间的关联。通畅率以95%置信区间（CI）表示。
旁路手术组的肢体严重程度（WIfI）和解剖复杂性（GLASS）阶段高于EVT组，而EVT组心力衰竭的患病率更高。基于SPP和ABI的LBP率在旁路手术组均高于EVT组。旁路手术组3个月时基于SPP的LBP率为73.8%（95%CI 63.4%至84.2%），EVT组为46.2%（95%CI 38.5%至53.8%）；相应的基于ABI的LBP率分别为71.5%（95%CI 61.8%至81.2%）和44.0%（95%CI 37.3%至50.7%）。
LBP是新的全球血管指南中评估CLTI患者解剖和血流动力学状态的重要概念。本研究发现，EVT组的LBP明显低于旁路手术组。
