Division of Vascular and Endovascular Surgery.
Division of Biomedical Statistics, Mayo Clinic, Rochester, MN. J.J.N. is currently at the Charles George VA Medical Center, Asheville, NC. M.C. is currently at Instituto Vascular, Passo Fundo, Brazil. P.G.R. is currently in the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2022 May;97(5):919-930. doi: 10.1016/j.mayocp.2021.10.021. Epub 2022 Feb 15.
To determine trends in amputations and revascularizations for peripheral artery disease (PAD) in a well-defined population.
A population-based cohort study of Olmsted County, Minnesota, residents with PAD undergoing amputation or revascularization was conducted between January 1, 1990, and December 31, 2009. Population-level 5-year incidence trends for endovascular, open surgical, and hybrid revascularizations and major and minor amputations were determined. Limb-specific outcomes after revascularization, including major adverse limb events and amputation-free survival, were compared between initial surgical and endovascular or hybrid revascularization groups using Kaplan-Meier analysis.
We identified 773 residents who underwent 1906 limb-procedures, including 689 open revascularizations, 685 endovascular or hybrid revascularizations, and 220 major amputations. During the 20-year study period, the incidence of endovascular and hybrid revascularizations increased, whereas the incidence of open surgical revascularizations and major amputations decreased. Incidence of revascularizations for chronic limb-threatening ischemia (CLTI) did not change. Among residents with CLTI undergoing their first revascularization on a limb, endovascular revascularization was associated with more major adverse limb events and major amputations compared with surgical revascularization during the ensuing 15 years.
The rising incidence of endovascular and hybrid revascularizations and the decreasing incidence of open surgical revascularizations for PAD were associated with a decreasing incidence of major amputations in this population between 1990 and 2009, despite a stable incidence of revascularizations for CLTI. With more major adverse limb events and major amputations after endovascular revascularization, these trends suggest that additional emphasis should be placed on improving limb salvage efforts beyond just mode of revascularization.
在一个明确界定的人群中，确定外周动脉疾病（PAD）患者截肢和血运重建的趋势。
对明尼苏达州奥姆斯特德县接受截肢或血运重建的 PAD 患者进行了一项基于人群的队列研究。研究时间为 1990 年 1 月 1 日至 2009 年 12 月 31 日。确定了腔内、开放手术和杂交血运重建以及大截肢和小截肢的 5 年人群发生率趋势。使用 Kaplan-Meier 分析比较了初始手术与腔内或杂交血运重建组之间血运重建后肢体特异性结局，包括主要肢体不良事件和无截肢生存率。
我们确定了 773 名接受了 1906 次肢体手术的居民，包括 689 次开放血运重建、685 次腔内或杂交血运重建和 220 次大截肢。在 20 年的研究期间，腔内和杂交血运重建的发生率增加，而开放手术血运重建和大截肢的发生率下降。慢性肢体威胁性缺血（CLTI）的血运重建发生率没有变化。在首次接受肢体血运重建的 CLTI 居民中，与手术血运重建相比，腔内血运重建在随后的 15 年内更易发生主要肢体不良事件和大截肢。
在 1990 年至 2009 年期间，PAD 患者腔内和杂交血运重建的发生率上升，而开放手术血运重建的发生率下降，这与该人群大截肢的发生率下降有关，尽管 CLTI 的血运重建发生率保持稳定。腔内血运重建后主要肢体不良事件和大截肢的发生率更高，这些趋势表明，除了血运重建方式之外，还应更加重视提高肢体保存效果。
