Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.
Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland.
Ann Vasc Surg. 2022 Aug;84:305-313. doi: 10.1016/j.avsg.2022.01.008. Epub 2022 Jan 31.
To determine predisposing factors that may lead to the development of compartment syndrome (CS) in patients with acute lower limb ischemia (ALLI) managed with intra-arterial catheter-directed thrombolysis (CDT).
This is a retrospective study of patients admitted between 01/2002 and 12/2015 to three university hospitals in Tampere, Turku, and Oulu, Finland, with acute or acute-on-chronic lower limb ischemia (Rutherford I-IIb). Patients managed with CDT and aspiration thrombectomies (AT) as an adjunct to CDT were included in the study. Multivariable binary logistic regression models were used to detect possible risk factors for the development of CS and its impact on the limb salvage and survival. Amputation-free survival (AFS) rates of CS and non-CS patients were compared using Kaplan-Meier survival analysis. The length of hospitalization was calculated and compared between the CS and non-CS groups.
A total of 292 CDTs with or without ATs were performed on patients with a mean age of 71 years (standard deviation 13 years), 151 (51.7%) being male. Altogether, 12/292 (4.1%) treatment-related CS cases were registered. Renal insufficiency (odds ratio [OR] 4.27, P = 0.07) was associated with an increased risk of CS. All CS cases were managed with fasciotomies. Treatment with fasciotomy was associated with a prolonged hospitalization of a median of 7 days versus the 4 days for non-CS patients, P < 0.001. During the median follow-up of 51 months (interquartile range 72 months), 152/292 (52.1%) patients died and 51/292 (17.5%) underwent major amputations. CS was not associated with an increased risk of mortality, but it was associated with a higher risk of major amputation (OR 3.87, P = 0.027). The AFS rates of patients with or without CS did not significantly differ from each other in the long term.
CS after CDT for the treatment of ALLI is uncommon. Renal insufficiency is associated with an increased risk of CS. Fasciotomy prolongs the hospitalization. Patients with CS are exposed to an increased risk of major amputation.
为了确定可能导致接受动脉内导管定向溶栓 (CDT) 治疗的急性下肢缺血 (ALLI) 患者发生间隔综合征 (CS) 的诱发因素。
这是一项回顾性研究，纳入了 2002 年 1 月至 2015 年 12 月期间在芬兰坦佩雷、图尔库和奥卢的三所大学医院就诊的急性或慢性下肢缺血加重的患者 (Rutherford I-IIb)。纳入了接受 CDT 联合抽吸血栓切除术 (AT) 治疗的患者。采用多变量二项逻辑回归模型来检测 CS 发展的可能危险因素及其对肢体存活率的影响。采用 Kaplan-Meier 生存分析比较 CS 患者和非 CS 患者的无截肢生存率 (AFS)。计算 CS 患者和非 CS 患者的住院时间，并进行比较。
共对 292 例接受 CDT 联合或不联合 AT 的患者进行了治疗，患者平均年龄为 71 岁 (标准差 13 岁)，其中 151 例 (51.7%) 为男性。共记录到 12/292 (4.1%) 与治疗相关的 CS 病例。肾功能不全 (比值比 [OR] 4.27，P = 0.07) 与 CS 风险增加相关。所有 CS 病例均行筋膜切开术治疗。与非 CS 患者的 4 天相比，行筋膜切开术治疗的 CS 患者的中位住院时间延长至 7 天，P < 0.001。在中位随访 51 个月 (四分位距 72 个月) 期间，292 例患者中有 152 例 (52.1%) 死亡，51 例 (17.5%) 接受了大截肢。CS 与死亡率增加无关，但与大截肢风险增加相关 (OR 3.87，P = 0.027)。在长期随访中，有 CS 的患者和无 CS 的患者的 AFS 率没有显著差异。
CDT 治疗 ALLI 后发生 CS 并不常见。肾功能不全与 CS 风险增加相关。筋膜切开术延长了住院时间。发生 CS 的患者面临更高的大截肢风险。
