编辑精选——慢性肢体威胁性缺血的腔内血管重建和旁路手术：回顾性欧洲多中心队列研究与倾向评分匹配。
Editor's Choice - Infra-inguinal Endovascular Revascularisation and Bypass Surgery for Chronic Limb Threatening Ischaemia: a Retrospective European Multicentre Cohort Study with Propensity Score Matching.
机构信息
Department of Clinical Research and Vascular Surgery Service, Poitiers University Hospital, Poitiers, France.
Department of Computer Information Science, Minnesota State University, Mankato, MN, USA.
出版信息
Eur J Vasc Endovasc Surg. 2023 Oct;66(4):531-540. doi: 10.1016/j.ejvs.2023.06.031. Epub 2023 Jun 27.
OBJECTIVE
The aim of this study was to compare the long term efficacy of lower limb bypass with that of endovascular treatment (EVT) in patients with chronic limb threatening ischaemia (CLTI).
METHODS
This retrospective, multicentre study evaluated the outcomes of patients with CLTI who underwent first time infra-inguinal bypass or EVT. The primary outcome was to compare amputation free survival (AFS) rates between the two propensity score matched groups. The secondary outcome was to compare wound healing within the first six months. Major adverse events were compared according to the type of revascularisation.
RESULTS
Overall, 793 patients fulfilled the eligibility criteria, from whom 236 propensity score matched pairs were analysed. The mean follow up was 52 months. The 236 bypass procedures included 190 autogenous bypass grafts (80.5%), 151 (64.0%) of which were infrapopliteal. Among the 236 EVT procedures, the target lesion was the femoropopliteal segment in 81 patients (34.3%), the femoropopliteal and infrapopliteal segments in 101 patients (42.8%), and the infrapopliteal segment in 54 patients (22.9%). AFS was significantly better in the bypass group at five years (60.5 ± 3.6%) compared with the EVT group (35.3 ± 3.6%) (p < .001). Major amputation occurred in 61 patients (25.8%) in the bypass group and 85 patients (36.0%) in the EVT group (HR 0.66, 95% CI 0.47 - 0.92; p = .014). The probability of healing was significantly better in the bypass group at six months compared with the EVT group (p = .003). The median length of stay was shorter for the EVT group (4 days) than for the bypass group (8 days) (p = .001). Urgent re-intervention and re-admission rates were high and did not differ significantly between the groups.
CONCLUSION
This study has shown that lower limb bypass surgery offered a significantly higher probability of AFS and wound healing compared with EVT in patients with CLTI.
目的
本研究旨在比较下肢旁路手术与血管内治疗（EVT）在慢性肢体威胁性缺血（CLTI）患者中的长期疗效。
方法
本回顾性多中心研究评估了首次接受下肢旁路或 EVT 治疗的 CLTI 患者的结局。主要结局是比较两组倾向评分匹配后患者的截肢无生存（AFS）率。次要结局是比较前 6 个月内的伤口愈合情况。根据血运重建的类型比较主要不良事件。
结果
总体而言，793 名患者符合入选标准，其中 236 对进行了倾向评分匹配分析。平均随访时间为 52 个月。236 例旁路手术包括 190 例自体旁路移植（80.5%），其中 151 例（64.0%）为膝下旁路。236 例 EVT 手术中，81 例（34.3%）靶病变为股腘段，101 例（42.8%）股腘段和膝下段，54 例（22.9%）膝下段。5 年时旁路组 AFS 明显优于 EVT 组（60.5 ± 3.6%比 35.3 ± 3.6%）（p<.001）。旁路组有 61 例（25.8%）患者发生大截肢，EVT 组有 85 例（36.0%）患者发生大截肢（HR 0.66，95%CI 0.47-0.92；p=0.014）。旁路组 6 个月时愈合的可能性明显高于 EVT 组（p=0.003）。EVT 组的中位住院时间（4 天）短于旁路组（8 天）（p=0.001）。紧急再次干预和再入院率较高，两组间无显著差异。
结论
本研究表明，在 CLTI 患者中，与 EVT 相比，下肢旁路手术在 AFS 和伤口愈合方面具有更高的可能性。
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