Departments of Cardiovascular Surgery, Medical Faculty of Uludağ University, 16310 Bursa, Turkey.
Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey.
Tomography. 2023 Jan 30;9(1):255-263. doi: 10.3390/tomography9010020.
Acute lower extremity ischemia (ALI) is a cardiovascular emergency resulting from embolic and thrombotic causes. Although endovascular techniques have advanced, surgical thromboembolectomy is still the gold standard. Emergency thromboembolectomy surgery involves an ischemia-reperfusion injury, which also poses a risk for acute renal injury (AKI). The stress hyperglycemia rate (SHR) has recently emerged as an important prognostic value in emergency cardiovascular events. In the present study, we aimed to analyze the impact of preoperative contrast-enhanced tomographic angiography (CTA) and the SHR value on postoperative AKI in emergency thromboembolectomy procedures in patients with insulin-dependent diabetes mellitus (DM). In this retrospective analysis, patients with DM who received emergency surgical thromboembolectomy after being hospitalized at our hospital with ALI between 20 October 2015, and 10 September 2022, were included. Patients were classified into two groups: Group 1 ( = 159), who did not develop AKI, and Group 2 ( = 45), who did. The 45 patients in Group 2 and the 159 patients in Group 1 had median ages of 59 (39-90) and 66 (37-93), respectively ( = 0.008). The percentage of patients in Group 2 with Rutherford class IIB and admission times longer than 6 h was higher ( = 0.003, = 0.027, respectively). To determine the variables affecting AKI after surgical embolectomy procedures, multivariate logistic regression analysis was used. In multivariate analysis Model 1, age > 65 years (odds ratio [OR]: 1.425, 95% confidence interval [CI]: 1.230-1.980, < 0.001), preoperative high creatinine (OR: 4.194, 95% CI: 2.890-6.156, = 0.003), and Rutherford class (OR: 0.874, 95% CI: 0.692-0.990, = 0.036) were determined as independent predictors for AKI. In Model 2, age > 65 years (OR: 1.224 CI: 1.090-1.679, = 0.014), preoperative high creatinine (OR: 3.975, 95% CI: 2.660-5.486, = 0.007), and SHR (OR: 2.142, CI: 1.134-3.968, = 0.003), were determined as independent predictors for amputation. In conclusion, when an emergency thromboembolectomy operation is planned in insulin-dependent DM patients, renal risky groups can be identified, and renal protective measures can be taken. In addition, to reduce the renal risk, according to the suitability of the clinical conditions of the patients, the decision to perform a CTA with contrast can be taken by looking at the SHR value.
急性下肢缺血（ALI）是一种心血管急症，由栓子和血栓形成引起。尽管血管内技术已经取得了进展，但手术血栓切除术仍然是金标准。急诊血栓切除术涉及缺血再灌注损伤，这也会增加急性肾损伤（AKI）的风险。应激性高血糖发生率（SHR）最近已成为急诊心血管事件的一个重要预后指标。在本研究中，我们旨在分析术前对比增强 CT 血管造影（CTA）和 SHR 值对胰岛素依赖型糖尿病（DM）患者急诊血栓切除术术后 AKI 的影响。在这项回顾性分析中，纳入了 2015 年 10 月 20 日至 2022 年 9 月 10 日期间因 ALI 住院并接受急诊手术血栓切除术的 DM 患者。患者分为两组：第 1 组（n = 159），未发生 AKI；第 2 组（n = 45），发生 AKI。第 2 组的 45 例患者和第 1 组的 159 例患者的中位年龄分别为 59（39-90）和 66（37-93）（= 0.008）。第 2 组中 Rutherford 分级为 IIB 级和入院时间超过 6 小时的患者比例更高（= 0.003，= 0.027）。为了确定手术血栓切除术术后影响 AKI 的变量，我们使用了多变量逻辑回归分析。在多变量分析模型 1 中，年龄＞65 岁（比值比 [OR]：1.425，95%置信区间 [CI]：1.230-1.980，＜0.001）、术前高肌酐（OR：4.194，95%CI：2.890-6.156，= 0.003）和 Rutherford 分级（OR：0.874，95%CI：0.692-0.990，= 0.036）被确定为 AKI 的独立预测因子。在模型 2 中，年龄＞65 岁（OR：1.224 CI：1.090-1.679，= 0.014）、术前高肌酐（OR：3.975，95%CI：2.660-5.486，= 0.007）和 SHR（OR：2.142，CI：1.134-3.968，= 0.003）被确定为截肢的独立预测因子。总之，当计划对胰岛素依赖型 DM 患者进行急诊血栓切除术时，可以识别出肾脏风险组，并采取肾脏保护措施。此外，为了降低肾脏风险，可以根据患者的临床状况，通过观察 SHR 值，决定是否进行带对比剂的 CTA。
