Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine.
Department of Diabetes Care Medicine, and Department of Metabolic Medicine, Osaka University Graduate School of Medicine.
J Atheroscler Thromb. 2022 Jun 1;29(6):866-880. doi: 10.5551/jat.62892. Epub 2021 May 27.
Maintaining functional status through revascularization is a major goal in patients with chronic limb-threatening ischemia (CLTI). Nevertheless, there is a lack of clarity on the impact of revascularization on mobility over time. This study examined ambulatory status over time after revascularization and predictors of ambulation loss in CLTI patients.
We used a clinical database established by the Surgical reconstruction versus Peripheral INtervention in pAtients with critical limb isCHemia study, a prospective, multicentre, observational study including patients with CLTI. The primary endpoint was mobility over time.
Of the 381 patients, the ambulatory proportion at baseline was 71%. The proportion gradually decreased, finally reaching 40% at 36 months. In non-ambulatory patients at revasacularisation, approximately 20-40% of patients achieved ambulation. Multivariate analysis confirmed that age, impaired mobility before CLTI onset and at revascularization, renal failure on dialysis, and WIfI clinical stage 4 were positively associated with ambulation loss at either specific or all time points, whereas male sex and surgical reconstruction were inversely associated with the outcomes at specific time points.
Mobility in the overall population gradually decreased, whereas the number of deceased patients increased. Advanced age, impaired mobility before CLTI onset and at revascularization, renal failure on dialysis, and WIfI stage 4 were associated with ambulation loss at almost all points after revascularization.
通过血运重建维持功能状态是慢性肢体严重缺血（CLTI）患者的主要目标。然而，关于血运重建对随时间推移的移动能力的影响尚不清楚。本研究检查了 CLTI 患者血运重建后随时间推移的活动状态以及丧失活动能力的预测因素。
我们使用了由外科重建与外周干预治疗严重肢体缺血患者研究（SURGICAL REVASCULARIZATION VERSUS PERIPHERAL INTERVENTION IN pAtients with CRITICAL LIMB ISCHEmia study）建立的临床数据库，这是一项前瞻性、多中心、观察性研究，包括 CLTI 患者。主要终点是随时间推移的移动能力。
在 381 名患者中，基线时的活动比例为 71%。该比例逐渐下降，最终在 36 个月时达到 40%。在血运重建时无法行走的非活动患者中，大约 20-40%的患者能够行走。多变量分析证实，年龄、CLTI 发病前和血运重建时活动能力受损、透析时肾功能衰竭以及 WIfI 临床 4 期与在特定或所有时间点丧失活动能力呈正相关，而男性和手术重建与特定时间点的结果呈负相关。
总体人群的活动能力逐渐下降，而死亡患者的数量增加。年龄较大、CLTI 发病前和血运重建时活动能力受损、透析时肾功能衰竭以及 WIfI 4 期与血运重建后几乎所有时间点的活动能力丧失相关。
