Bisdas Theodosios, Patelis Nikolaos, Argyrakopoulou Georgia, Tsiachris Dimitrios, Kurtis Aristotelis, Gargalianos-Kakoliris Panagiotis, Stefanadis Christodoulos
Athens Medical Center, Athens, Greece.
Int J Low Extrem Wounds. 2022 Jun;21(2):174-181. doi: 10.1177/1534734620933069. Epub 2020 Jun 28.
The complexity of critical limb ischemia (CLI) requires dedicated multidisciplinary teams of different care providers, who will supervise the full cycle of CLI care. Until CLI treatment is fully centralized, such dedicated teams may work as second-opinion tools before major amputation is undertaken in CLI patients. The aim of the study is to assess the effectiveness of a well-timed referral to a dedicated CLI-center of patients scheduled to major amputation elsewhere. A retrospective analysis of all CLI-patients treated in our department between January 2019 and March 2020 was conducted. Only patients scheduled for a major amputation elsewhere and referred to our clinic were included. Primary endpoint was amputation-free survival, whereas technical success, limb salvage, minor amputation rate, re-admission at 30 days, and frequency of medication change from other disciplines were the secondary endpoints. Sixteen patients with 19 treated limbs were identified and included in this analysis. The WIfI (wound, infection and foot ischemia) clinical stage on admission was 2 in 4 limbs (21%), 3 in 5 limbs (26%), and 4 in 10 limbs (53%). All patients underwent advanced endovascular revascularization. Minor amputation was performed in 8 patients (42%). Amputation-free survival at 6 months was 93% with limb salvage rate of 100%. Technical success and re-admission rates at 30 days was 95% and 6%, respectively. There was a medication adjustment from other specialties in 13 (81%) patients. Patients in severe stages of CLI scheduled to major amputation reached high limb salvage and survival rate, since they are referred for a second opinion to a dedicated multidisciplinary CLI team.
严重肢体缺血（CLI）的复杂性需要由不同护理人员组成的专门多学科团队，他们将监督CLI护理的整个周期。在CLI治疗完全集中化之前，这样的专门团队可以在CLI患者进行大截肢之前作为二次诊断工具。本研究的目的是评估及时转诊至专门的CLI中心对计划在其他地方进行大截肢的患者的有效性。对2019年1月至2020年3月期间在我们科室接受治疗的所有CLI患者进行了回顾性分析。仅纳入计划在其他地方进行大截肢并转诊至我们诊所的患者。主要终点是无截肢生存率，而技术成功率、肢体挽救率、小截肢率、30天再入院率以及其他学科的用药变化频率为次要终点。确定了16例患者的19条治疗肢体并纳入本分析。入院时的WIfI（伤口、感染和足部缺血）临床分期为：4条肢体为2期（21%），5条肢体为3期（26%），10条肢体为4期（53%）。所有患者均接受了先进的血管内血运重建术。8例患者（42%）进行了小截肢。6个月时的无截肢生存率为93%，肢体挽救率为100%。30天时的技术成功率和再入院率分别为95%和6%。13例（81%）患者有来自其他专科的用药调整。计划进行大截肢的CLI严重阶段患者达到了较高的肢体挽救率和生存率，因为他们被转诊至专门的多学科CLI团队进行二次诊断。
