Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2021 Jan;23(1):28-32.
Patients with critical limb ischemia (CLI) involving the below-the-knee (BTK) arteries are at increased risk of limb loss. Despite improvement in endovascular modalities, it is still unclear whether an aggressive approach results in improved limb salvage.
To assess whether an aggressive approach to BTK arterial disease results in improved limb salvage.
A comparative study of two groups was conducted. Group 1 included patients treated between 2012 and 2014, primarily with transfemoral angioplasty of the tibial arteries. Group 2 included patients treated between 2015-2019 with a wide array of endovascular modalities (stents, multiple tibial artery and pedal angioplasty, retrograde access). Primary endpoint was freedom from amputation at 4 years.
A total of 529 BTK interventions were performed. Mean age was 71 ± 10.6 years, 382 (79%) were male. Patients in group 1 were less likely to be taking clopidogrel (66% vs. 83%, P < 0.01) and statins (72 % vs. 87%, P < 0.01). Several therapeutic modalities were used more often in group 2 than in group 1, including pedal angioplasty (24 vs. 43 %, P = 0.01), tibial and pedal retrograde access (0 vs. 10%, P = 0.01), and tibial stenting (3% vs. 25%, P = 0.01). Revascularization of two or more tibial arteries was performed at a higher rate in group 2 (54% vs. 50%, P = 0.45). Estimated freedom from amputation at 40 months follow-up was higher in group 2 (53% vs. 63%, P = 0.05).
An aggressive, multimodality approach in treating BTK arteries results in improved limb salvage.
累及膝下动脉的严重肢体缺血（CLI）患者有更高的肢体丧失风险。尽管腔内治疗方法有所改善，但目前尚不清楚积极的治疗方法是否能提高肢体存活率。
评估积极治疗膝下动脉疾病是否能提高肢体存活率。
进行了两组比较研究。第 1 组包括 2012 年至 2014 年期间主要接受经股动脉胫动脉球囊扩张术治疗的患者。第 2 组包括 2015 年至 2019 年期间采用多种腔内治疗方法（支架、多支胫动脉和足背动脉球囊扩张术、逆行入路）治疗的患者。主要终点是 4 年内免于截肢。
共进行了 529 次膝下动脉介入治疗。平均年龄为 71±10.6 岁，382 例（79%）为男性。第 1 组患者更不可能服用氯吡格雷（66%比 83%，P<0.01）和他汀类药物（72%比 87%，P<0.01）。第 2 组比第 1 组更常使用多种治疗方法，包括足背动脉球囊扩张术（24%比 43%，P=0.01）、胫后和足背逆行入路（0%比 10%，P=0.01）和胫动脉支架置入术（3%比 25%，P=0.01）。第 2 组有更多的患者接受了两条或更多的胫动脉血运重建（54%比 50%，P=0.45）。第 2 组在 40 个月随访时免于截肢的估计率更高（53%比 63%，P=0.05）。
积极的、多模式的治疗膝下动脉的方法可以提高肢体存活率。
