Lee Rui En, Patel Ankur, Soon Shereen Xue Yun, Chan Sze Ling, Yap Charyl Jia Qi, Chandramohan Sivanathan, Tay Luke Hsien Ts'ung, Chong Tze Tec, Tang Tjun Yip
Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
Department of Vascular Interventional Radiology, Singapore General Hospital, Singapore, Singapore.
CVIR Endovasc. 2022 Jul 6;5(1):32. doi: 10.1186/s42155-022-00306-1.
Percutaneous transluminal angioplasty (PTA) is widely used as a first-line revascularisation option in patients with chronic limb threatening ischemia (CLTI). This study aimed to evaluate the short-term endovascular revascularisation treatment outcomes of a cohort of Rutherford 6 (R6) CLTI patients, from a multi-ethnic Asian population in Singapore. Patients with R6 CLTI who underwent endovascular revascularisation from June 2019 to February 2020 at Singapore General Hospital, a tertiary vascular centre in Singapore, were included and followed up for one year. Primary outcome measures included number and type of reinterventions required, 3-, 6- and 12-month mortality, 6- and 12-month amputation free survival (AFS), wound healing success and changes in Rutherford staging after 3, 6 and 12 months.
Two hundred fifty-five procedures were performed on 86 patients, of whom 78 (90.7%) were diabetics, 54 (62.8%) had coronary artery disease (CAD) and 54 (62.8%) had chronic kidney disease (CKD). 42 patients (48.8%) required reintervention within 6 months. Multivariate analysis revealed that the presence of CAD was a significant independent predictor for reintervention. Mortality was 15.1%, 20.9% and 33.7% at 3, 6 and 12 months respectively. AFS was 64.0% and 49.4% at 6 and 12 months. Inability to ambulate, congestive heart failure (CHF), dysrhythmia and CKD were significant independent predictors of lower 12-month AFS.
PTA for R6 CLTI patients was associated with relatively high mortality and reintervention rates at one year. CAD was an independent predictor of reintervention. More research is required to help risk stratify which CLTI patients would benefit from an endovascular-first approach versus conservative treatment or an immediate major lower extremity amputation policy.
经皮腔内血管成形术（PTA）被广泛用作慢性肢体威胁性缺血（CLTI）患者的一线血管重建选择。本研究旨在评估来自新加坡多民族亚洲人群的一组卢瑟福6级（R6）CLTI患者的短期血管内血管重建治疗结果。纳入了2019年6月至2020年2月在新加坡一家三级血管中心新加坡总医院接受血管内血管重建的R6 CLTI患者，并进行了一年的随访。主要结局指标包括所需再次干预的次数和类型、3个月、6个月和12个月的死亡率、6个月和12个月的无截肢生存率（AFS）、伤口愈合成功率以及3个月、6个月和12个月后卢瑟福分期的变化。
对86例患者进行了255次手术，其中78例（90.7%）为糖尿病患者，54例（62.8%）患有冠状动脉疾病（CAD），54例（62.8%）患有慢性肾脏病（CKD）。42例患者（48.8%）在6个月内需要再次干预。多变量分析显示，CAD的存在是再次干预的显著独立预测因素。3个月、6个月和12个月时的死亡率分别为15.1%、20.9%和33.7%。6个月和12个月时的AFS分别为64.0%和49.4%。无法行走、充血性心力衰竭（CHF）、心律失常和CKD是12个月时较低AFS的显著独立预测因素。
R6 CLTI患者的PTA在一年时与相对较高的死亡率和再次干预率相关。CAD是再次干预的独立预测因素。需要更多的研究来帮助进行风险分层，以确定哪些CLTI患者将从血管内优先方法与保守治疗或立即进行主要下肢截肢策略中获益。
