Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA.
Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA.
Ann Vasc Surg. 2022 Feb;79:65-71. doi: 10.1016/j.avsg.2021.08.015. Epub 2021 Oct 14.
Patients with lower extremity wounds from diabetes mellitus or peripheral artery disease (PAD) have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine if the early assessment of arterial perfusion correlates with the risk of amputation.
We retrospectively reviewed patients referred to the vascular clinic over 18 months with Rutherford Grade 5 and 6 chronic limb-threatening ischemia to determine if patients had a pulse exam done at the time the wound was identified and when ankle brachial index (ABI) testing to evaluate perfusion was performed. Kaplan Meier analysis was used to determine if the timing of ABI testing affected the time to revascularization, wound healing, and risk of amputation.
Ninety-three patients with lower extremity wounds were identified. Of these, 59 patients (63%) did not have a pulse exam performed by their primary care provider when the wound was identified. Patients were classified by when they underwent ankle brachial index testing to assess arterial perfusion. Twenty-four had early ABI (<30 days) testing, with the remaining 69 patients having late ABI testing. Patients in the early ABI group were more likely to have a pulse exam done by their PCP than those in the late group, 12 (50%) vs. 22 (32%), P = 0.03. Early ABI patients had a quicker time to vascular referral (13 days vs. 91 days, P < 0.001). Early ABI patients also had quicker times to wound healing than those in the late group (117 days vs. 287 days, P < 0.001). Finally, patients that underwent early ABI were less likely to require amputation (Fig. 1), although this did not reach statistical significance (P = 0.07).
Early ABI testing expedites specialty referral and time to revascularization. It can decrease the time to wound healing. Larger cohort studies are needed to determine the overall effect of early ABI testing to decrease amputation rates.
患有糖尿病或外周动脉疾病（PAD）下肢伤口的患者，其截肢风险高达 25%。在动脉疾病患者中，血运重建可降低截肢风险。我们旨在确定动脉灌注的早期评估是否与截肢风险相关。
我们回顾性分析了 18 个月内在血管科就诊的 Rutherford 5 级和 6 级慢性肢体威胁性缺血患者，以确定在确定伤口时是否对患者进行了脉搏检查，以及何时进行踝肱指数（ABI）检查以评估灌注。Kaplan-Meier 分析用于确定 ABI 测试的时间是否影响血运重建、伤口愈合和截肢风险。
确定了 93 例下肢伤口患者。其中，59 例（63%）患者在确定伤口时其初级保健提供者未进行脉搏检查。根据他们进行踝肱指数检查以评估动脉灌注的时间对患者进行分类。24 例患者早期（<30 天）进行 ABI 测试，其余 69 例患者进行晚期 ABI 测试。早期 ABI 组患者更有可能由其 PCP 进行脉搏检查，12 例（50%）比 22 例（32%），P=0.03。早期 ABI 患者的血管转介时间更快（13 天 vs. 91 天，P<0.001）。早期 ABI 患者的伤口愈合时间也比晚期组更快（117 天 vs. 287 天，P<0.001）。最后，尽管这没有达到统计学意义（P=0.07），但接受早期 ABI 的患者截肢的可能性较小。
早期 ABI 测试可加快专科转诊和血运重建时间。它可以缩短伤口愈合时间。需要更大的队列研究来确定早期 ABI 测试降低截肢率的总体效果。
