Meloni Marco, Izzo Valentina, Da Ros Valerio, Morosetti Daniele, Stefanini Matteo, Brocco Enrico, Giurato Laura, Gandini Roberto, Uccioli Luigi
Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Department of Biomedicine and Prevention, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
J Clin Med. 2020 Nov 21;9(11):3745. doi: 10.3390/jcm9113745.
The study aimed to evaluate clinical and vascular characteristics, as well as outcomes, for diabetic persons with foot ulceration and no-option critical limb ischemia (CLI). The study group included a sample of patients admitted to our diabetic foot unit because of a new diabetic foot ulcer and CLI. All subjects were managed using a limb salvage protocol which includes lower-limb revascularization. According to whether or not the revascularization procedure was a success, patients were respectively divided into two groups: successfully treated CLI patients (ST-CLI) and no-option CLI patients (NO-CLI). Failed revascularization was considered in the case of technical recanalization failure of occluded vessels (inability to overcome the obstruction) and/or absence of arterial flow to the foot. Limb salvage, major amputation, and death after 1 year of follow-up were evaluated and compared between the two groups. Overall, 239 patients were included, 74.9% belonging to ST-CLI and 25.1% to NO-CLI. NO-CLI patients reported more cases of ischemic heart disease (80 vs. 62.1, = 0.008), heart failure (63.3 vs. 32.4%, < 0.0001), and end-stage renal disease (ESRD) (60 vs. 25.7%) than ST-CLI patients. In addition, more vessels were affected in the NO-CLI group (5.2 ± 1.6 vs. 4 ± 1.5, < 0.0001), and there was more involvement of tibio-peroneal trunk (50 vs. 30.2%, = 0.006), anterior tibial (93.3 vs. 82.7, = 0.03), posterior tibial (93.3 vs. 73.7%, = 0.0005), peroneal (70 vs. 48%, = 0.002), and below-the-ankle arteries (73.3 vs. 39.1%, < 0.0001) than ST-CLI. The 1 year outcomes for the whole population were 69.9% limb salvage, 10.9% major amputation, and 19.2% death. The outcomes for NO-CLI and ST-CLI were, respectively, as follows: limb salvage (13.8 vs. 73.4%, < 0.0001), amputation (30 vs. 4.5%, = 0.0001), and mortality (50 vs. 8.9%, < 0.0001). NO-CLI patients showed a more severe pattern of peripheral arterial disease (PAD) with distal arterial lesions and worse outcomes than ST-CLI.
该研究旨在评估患有足部溃疡且无可选择的严重肢体缺血（CLI）的糖尿病患者的临床和血管特征以及预后情况。研究组包括因新发糖尿病足溃疡和CLI而入住我们糖尿病足治疗单元的患者样本。所有受试者均采用包括下肢血管重建术的保肢方案进行治疗。根据血管重建手术是否成功，患者被分别分为两组：成功治疗的CLI患者（ST-CLI）和无可选择的CLI患者（NO-CLI）。血管重建失败被定义为闭塞血管的技术再通失败（无法克服阻塞）和/或足部无动脉血流。对两组患者随访1年后的保肢情况、大截肢情况和死亡情况进行了评估和比较。总体而言，共纳入239例患者，其中74.9%属于ST-CLI组，25.1%属于NO-CLI组。与ST-CLI患者相比，NO-CLI患者报告的缺血性心脏病病例更多（80例对62.1例，P = 0.008）、心力衰竭更多（63.3%对32.4%，P < 0.0001）以及终末期肾病（ESRD）更多（60%对25.7%）。此外，NO-CLI组受影响的血管更多（5.2±1.6对4±1.5，P < 0.0001），胫腓干受累更多（50%对30.2%，P = 0.006）、胫前动脉受累更多（93.3%对82.7%，P = 0.03）、胫后动脉受累更多（93.3%对73.7%，P = 0.0005）、腓动脉受累更多（70%对48%，P = 0.002）以及踝以下动脉受累更多（73.3%对39.1%，P < 0.0001）。整个人群1年的预后情况为保肢率69.9%、大截肢率10.9%和死亡率19.2%。NO-CLI组和ST-CLI组的预后情况分别如下：保肢（13.8%对73.4%，P < 0.0001）、截肢（30%对4.5%，P = 0.0001）和死亡率（50%对8.9%，P < 0.0001）。与ST-CLI患者相比，NO-CLI患者表现出更严重的外周动脉疾病（PAD）模式，伴有远端动脉病变且预后更差。
