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. 2024 Feb;79(2):316-322.e2. doi: 10.1016/j.jvs.2023.09.035. Epub 2023 Oct 5.
To examine limb salvage (LS) and wound healing in dialysis-dependent and -independent patients with chronic limb-threatening ischemia (CLTI) after infrainguinal bypass surgery or endovascular therapy (EVT).
We retrospectively analyzed the multi-center data of patients who underwent infrainguinal revascularization for CLTI with Wound, Ischemia, and foot Infection (WIfI) stage 2 to 4 between 2015 and 2020. The primary endpoint was LS. The secondary endpoint included wound healing, amputation-free survival (AFS), periprocedural complications, and 2-year survival. Comparison of these outcomes were made after propensity score matching.
We analyzed 252 dialysis-dependent (318 limbs) and 305 dialysis-independent (354 limbs) patients. Propensity score matching extracted 202 pairs with no significant differences in characteristics. The LS rate in bypass surgery was better than that in EVT in dialysis-dependent patients (P < .001). There was no significant difference in the LS rates between bypass surgery and EVT in dialysis-independent patients (P = .168). The wound healing rate of bypass surgery was better than that of EVT both dialysis-dependent and -independent patients with CLTI. The AFS rate of bypass surgery was better than that of EVT in dialysis-dependent patients (P < .001). There was no significant difference in the AFS rates between bypass surgery and EVT in dialysis-independent patients (P = .099). There was no significant difference in the occurrence of Clavien-Dindo ≥ IV and V between bypass surgery and EVT in dialysis-dependent and -independent patients. Age ≥75 years, serum albumin levels <3.5 g/dL, and non-ambulatory status were risk factors for 2-year mortality in dialysis-dependent patients. The 2-year survival rates in dialysis-dependent patients with risk factors of 0, 1, 2, and 3 were 82.5%, 67.1%, 49.5%, and 10.2%, respectively (P < .001).
For LS and wound healing, bypass surgery was preferred for revascularization in dialysis-dependent patients with WIfI stage 2 to 4. Although dialysis dependency was one of the risk factors for 2-year mortality, dialysis-dependent patients, who have 0 to 1 risk factors, may benefit from bypass surgery, as 2-year survival of >50% is expected.
探讨血透依赖和非依赖患者慢性肢体严重缺血（CLTI）下肢旁路手术或血管腔内治疗（EVT）后保肢（LS）和伤口愈合情况。
我们回顾性分析了 2015 年至 2020 年间接受下肢血运重建治疗 WIfI 2 至 4 期 CLTI 的患者的多中心数据。主要终点为 LS。次要终点包括伤口愈合、无截肢生存率（AFS）、围手术期并发症和 2 年生存率。在倾向评分匹配后比较这些结果。
我们分析了 252 例血透依赖（318 条肢体）和 305 例非血透依赖（354 条肢体）患者。倾向评分匹配提取了 202 对特征无显著差异的患者。血透依赖患者旁路手术的 LS 率优于 EVT（P<0.001）。非血透依赖患者旁路手术和 EVT 的 LS 率无显著差异（P=0.168）。旁路手术的伤口愈合率优于 EVT 在血透依赖和非血透依赖的 CLTI 患者中。旁路手术的 AFS 率优于 EVT 在血透依赖患者（P<0.001）。非血透依赖患者旁路手术和 EVT 的 AFS 率无显著差异（P=0.099）。血透依赖和非血透依赖患者旁路手术和 EVT 的 Clavien-Dindo≥IV 和 V 并发症发生率无显著差异。年龄≥75 岁、血清白蛋白水平<3.5g/dL 和非活动状态是血透依赖患者 2 年死亡率的危险因素。有 0、1、2 和 3 个危险因素的血透依赖患者 2 年生存率分别为 82.5%、67.1%、49.5%和 10.2%（P<0.001）。
对于 WIfI 2 至 4 期的血透依赖患者，LS 和伤口愈合，旁路手术是血运重建的首选。尽管透析依赖是 2 年死亡率的危险因素之一，但有 0 至 1 个危险因素的透析依赖患者可能从旁路手术中获益，因为预计 2 年生存率>50%。
