Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan.
J Vasc Surg. 2023 Jul;78(1):193-200.e2. doi: 10.1016/j.jvs.2023.03.024. Epub 2023 Mar 16.
This study aimed to evaluate the influence of change in ambulatory status on the prognosis of patients with chronic limb-threatening ischemia (CLTI) undergoing infrainguinal bypass surgery or endovascular therapy (EVT).
We retrospectively analyzed data from two vascular centers for patients who underwent revascularization for CLTI between 2015 and 2020. The primary endpoint was overall survival (OS), and the secondary endpoints were changes in ambulatory status and postoperative complications.
Throughout the study, 377 patients and 508 limbs were analyzed. In the preoperative nonambulation cohort, the average body mass index (BMI) was lower in the postoperative nonambulatory group than in the postoperative ambulatory group (P < .01). The percentage of cerebrovascular disease (CVD) was higher in the postoperative nonambulatory group than in the postoperative ambulatory group (P = .01). In the preoperative ambulation cohort, the average controlling nutritional status (CONUT) score was higher in the postoperative nonambulatory group than in the postoperative ambulatory group (P < .01). There was no difference in the bypass percentage and the EVT in the preoperative nonambulation (P = .32) and ambulation (P = .70) cohorts. According to the change in ambulatory status before and after revascularization, the 1-year OS rates were 86.8% in the ambulatory → ambulatory group, 81.1% in the nonambulatory → ambulatory group, 54.7% in the nonambulatory → nonambulatory group, and 23.9% in the ambulatory → nonambulatory group (P < .01). On multivariate analysis, increased age (P = .04), higher Wound, Ischemia, and foot Infection stage (P = .02), and increased CONUT score (P < .01) were independent risk factors for the decline in ambulatory status in patients with preoperative ambulation. In patients with preoperative nonambulation, increased BMI (P < .01) and absence of CVD (P = .04) were independent factors related to the improved ambulatory status. The percentages of postoperative complications were 31.0% and 17.0% in the preoperative nonambulation and the preoperative ambulation in the overall cohort (P < .01). Preoperative nonambulatory status (P < .01), CONUT score (P < .01), and bypass surgery (P < .01) were risk factors for postoperative complications.
Improved ambulatory status is associated with better OS in patients with preoperative nonambulatory status after infrainguinal revascularization for CLTI. Although patients with preoperative nonambulatory status have a risk of postoperative complication, some may benefit from revascularization if they have no factors such as low BMI and CVD, improving their ambulatory status.
本研究旨在评估活动能力变化对接受下肢缺血旁路手术或血管内治疗（EVT）的慢性肢体威胁性缺血（CLTI）患者预后的影响。
我们回顾性分析了 2015 年至 2020 年在两个血管中心接受 CLTI 血运重建的患者数据。主要终点是总生存（OS），次要终点是活动能力变化和术后并发症。
在整个研究过程中，分析了 377 名患者和 508 条肢体。在术前非活动组中，术后非活动组的平均体重指数（BMI）低于术后活动组（P<.01）。术后非活动组的脑血管疾病（CVD）比例高于术后活动组（P=.01）。在术前活动组中，术后非活动组的平均控制营养状况（CONUT）评分高于术后活动组（P<.01）。在术前非活动（P=.32）和活动（P=.70）组中，旁路百分比和 EVT 无差异。根据血管重建前后活动能力的变化，1 年 OS 率在活动→活动组为 86.8%，非活动→活动组为 81.1%，非活动→非活动组为 54.7%，活动→非活动组为 23.9%（P<.01）。多因素分析显示，年龄增加（P=.04）、伤口、缺血和足部感染分期升高（P=.02）和 CONUT 评分增加（P<.01）是术前活动患者活动能力下降的独立危险因素。对于术前非活动的患者，较高的 BMI（P<.01）和无 CVD（P=.04）是与活动能力改善相关的独立因素。在整个队列中，术前非活动和术前活动的术后并发症百分比分别为 31.0%和 17.0%（P<.01）。术前非活动状态（P<.01）、CONUT 评分（P<.01）和旁路手术（P<.01）是术后并发症的危险因素。
对于接受下肢缺血血管重建的术前非活动状态患者，活动能力的改善与更好的 OS 相关。尽管术前非活动状态的患者有术后并发症的风险，但如果没有 BMI 和 CVD 等因素，一些患者可能会从血管重建中受益，改善他们的活动能力。
