血管生成体导向的腔内血管重建治疗伴外周动脉疾病的糖尿病足溃疡。
Angiosome-Guided Endovascular Revascularization for Treatment of Diabetic Foot Ulcers with Peripheral Artery Disease.
机构信息
Departments of Vascular and Endovascular Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Departments of Vascular and Endovascular Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
出版信息
Ann Vasc Surg. 2022 Oct;86:242-250. doi: 10.1016/j.avsg.2022.02.012. Epub 2022 Mar 4.
BACKGROUND
Because diabetic foot ulcers (DFUs) are difficult to heal and cause huge economic losses to the society, accelerating their healing has become extremely important. The purpose of this study was to evaluate the effect of revascularization based on the angiosome concept on DFU.
METHODS
Between January 2018 and July 2020, 112 consecutive legs with DFUs, in 111 patients who were discharged from the vascular surgery department of our hospital were retrospectively evaluated. The legs were assigned to two groups depending on whether direct arterial flow to the foot ulcer based on the angiosome concept was achieved. Comparisons of the ulcer healing rate, mean time to ulcer healing, major amputation rate, survival rate, and major amputation-free survival rate between the angiosome direct revascularization (DR) and angiosome indirect revascularization (IR) groups were performed.
RESULTS
DR was achieved in 71 legs (63%) compared with IR in 41 legs. The ulcer healing rate (70.4% in the DR group versus 34.1% in the IR group, P < 0.01), the mean time to ulcer healing (7.01 ± 4.26 months versus 10.09 ± 3.24 months, P < 0.01), the survival rate (90.1 vs. 53.7%, P < 0.01), and the major amputation-free survival rate (81.7 vs. 48.8%, P < 0.01) were significantly higher in the DR group than in the IR group. Undergoing DR did not significantly reduce the major amputations rate compared to IR (13.4 and 34.1%, respectively, P = 0.15), but there might be a trend. In multivariate models, DR remained a significant predictor for ulcer healing (HR, 7.07; 95% confidence interval (CI), 6.54-7.60, P < 0.01). Opening multiple infrapopliteal arteries in the DR group compared with restoring only one infrapopliteal artery did not significantly improve the ulcer healing rate (P = 0.59), the mean time to ulcer healing (P = 0.70), major amputation rate (P = 0.83), the survival rate (P = 0.31), and the major amputation-free survival rate (P = 0.40).
CONCLUSIONS
Attaining a direct arterial flow based on the angiosome concept may be important for ulcer healing, survival, and amputation-free survival in diabetic foot patients. Opening multiple infrapopliteal arteries in DR patients may not improve the ulcer healing, survival, major amputation or amputation-free survival compared with single DR vessel patency.
背景
由于糖尿病足溃疡（DFU）难以愈合，给社会造成巨大的经济损失，因此加速其愈合变得极其重要。本研究旨在评估基于血管生成单元概念的再血管化对 DFU 的治疗效果。
方法
回顾性分析 2018 年 1 月至 2020 年 7 月期间我院血管外科出院的 111 例患者 112 例连续下肢的 DFU。根据是否基于血管生成单元概念实现直接向足部溃疡的动脉血流，将下肢分为两组。比较血管生成单元直接血运重建（DR）和血管生成单元间接血运重建（IR）两组的溃疡愈合率、平均溃疡愈合时间、主要截肢率、生存率和无主要截肢生存率。
结果
与 IR 组 41 例相比，DR 组实现 71 例（63%）。溃疡愈合率（DR 组 70.4%，IR 组 34.1%，P<0.01）、平均溃疡愈合时间（DR 组 7.01±4.26 个月，IR 组 10.09±3.24 个月，P<0.01）、生存率（DR 组 90.1%，IR 组 53.7%，P<0.01）和无主要截肢生存率（DR 组 81.7%，IR 组 48.8%，P<0.01）DR 组明显高于 IR 组。与 IR 相比，DR 组的主要截肢率并没有显著降低（分别为 13.4%和 34.1%，P=0.15），但可能有一定趋势。在多变量模型中，DR 仍然是溃疡愈合的显著预测因子（HR，7.07；95%置信区间（CI），6.54-7.60，P<0.01）。与仅恢复一条胫后动脉相比，在 DR 组中开放多条胫后动脉并不能显著提高溃疡愈合率（P=0.59）、平均溃疡愈合时间（P=0.70）、主要截肢率（P=0.83）、生存率（P=0.31）和无主要截肢生存率（P=0.40）。
结论
基于血管生成单元概念实现直接动脉血流可能对糖尿病足患者的溃疡愈合、生存和免于截肢有重要意义。与单一 DR 血管通畅性相比，在 DR 患者中开放多条胫后动脉并不能改善溃疡愈合、生存、主要截肢或免于截肢。
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