Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia.
Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia.
Ann Vasc Surg. 2021 Oct;76:389-398. doi: 10.1016/j.avsg.2021.03.050. Epub 2021 Apr 24.
Vascular patients with tissue loss requiring minor amputations could be an early sign of a terminal event. The long-term outcomes and timing of revascularisation for these patients are not well-studied. The aim of this study was to determine the clinical outcomes following minor amputations. Primary outcomes were functional status, limb loss, and mortality. Secondary outcomes compared immediate and delayed revascularisation.
A retrospective analysis of 200 vascular patients who required minor amputations at Austin Hospital, Melbourne was performed over 5 years. Demographics, details of revascularisation, functional status, and clinical outcomes such as recurrent tissue loss, limb loss and death were recorded.
Of the entire cohort requiring minor amputations, 118 (59%) patients underwent revascularisation. 111 (94%) revascularisation procedures were performed within 90 days of minor amputation. Over all 5-year limb preservation was 89.9%. Patients who required revascularisation were not statistically significantly more at risk for limb loss at 5 years [13.6% vs. 6.6%; P=0.08]. Limb salvage at 1 year was not different between groups revascularized before and after amputation [89.5% vs. 90.9%; P=0.70]. Over all 5-year mortality rate was 50%. In the diabetic subset, those who had revascularisation after minor amputation had a greater 5-year mortality [67.9% vs. 50%; P=0.03]. A scoring system based on risk factors was developed but was not reliable based on the study data.
The data from this study suggest that patients with diabetes who undergo revascularisation after minor amputation have worse outcomes than those revascularised prior to minor amputation. A predictive model applied at presentation could help detect high-risk patients but requires further work.
有组织损失需要进行小截肢的血管患者可能是终末期事件的早期迹象。这些患者的长期结果和再血管化时间尚未得到充分研究。本研究旨在确定小截肢后的临床结果。主要结果是功能状态、肢体丧失和死亡率。次要结果比较了即刻和延迟再血管化。
对在墨尔本奥斯汀医院接受小截肢的 200 名血管患者进行了为期 5 年的回顾性分析。记录了人口统计学、再血管化细节、功能状态以及复发性组织损失、肢体丧失和死亡等临床结果。
在需要小截肢的整个队列中，有 118 名（59%）患者接受了再血管化。111 例（94%）再血管化手术在小截肢后 90 天内进行。所有 5 年的肢体保存率为 89.9%。需要再血管化的患者在 5 年内肢体丧失的风险没有统计学意义[13.6%比 6.6%；P=0.08]。在截肢前和截肢后进行再血管化的患者，1 年时的肢体存活率无差异[89.5%比 90.9%；P=0.70]。所有 5 年的死亡率为 50%。在糖尿病亚组中，小截肢后接受再血管化的患者 5 年死亡率更高[67.9%比 50%；P=0.03]。基于风险因素开发了一种评分系统，但根据研究数据该系统不可靠。
本研究数据表明，小截肢后接受再血管化的糖尿病患者比小截肢前接受再血管化的患者预后更差。在出现时应用预测模型可以帮助发现高危患者，但需要进一步研究。
