Kobayashi Taira, Hamamoto Masaki, Okazaki Takanobu, Okusako Ryo, Hasegawa Misa, Honma Tomoaki, Iba Kazutoshi, Nishitani Yoshiko, Takahashi Shinya
Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Japan.
Department of Reconstructive and Plastic Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Japan.
Vascular. 2025 Apr;33(2):432-438. doi: 10.1177/17085381241245603. Epub 2024 Apr 3.
ObjectivesMany factors affect long-term outcomes after open bypass in patients with chronic limb-threatening ischemia (CLTI). Ambulatory status has been suggested to be associated with clinical outcomes, but there is limited knowledge on the effect of gait speed on outcomes. The purpose of this study is to evaluate the effect of gait speed assessed in a 6-min walk test (6MWT) on outcomes after crural and pedal bypass in patients with CLTI.MethodsA retrospective analysis was performed in patients with CLTI who underwent a 6MWT at 1 month after crural and pedal bypass at a single center from 2014 to 2021. Comparisons were made between those with high gait speed (HG group, 6-min walk distance (6MWD) > 288 m) and those with low gait speed (LG group, 6MWD ≤288 m). The primary endpoint was survival, and the secondary endpoints were graft patency, limb salvage, wound healing, major adverse cardiovascular events (MACEs), and hospital outcomes.ResultsOf 104 patients with CLTI who underwent a 6MWT after crural and pedal bypass, 46 (44%) and 58 (56%) were placed in the HG and LG groups, respectively. The LG group was older ( < .001), had more female subjects ( = .006), and had a higher prevalence of cerebrovascular disease ( = .042) and tissue loss ( = .007). The median follow-up was 36 (22-57) months. The HG group had significantly higher 3-year primary patency (65% vs 42%, = .013), 3-year secondary patency (87% vs 66%, = .018), 3-year overall survival (89% vs 58%, < .001), and 3-year freedom from MACE (79% vs 67%, = .039). The 3-year limb salvage and 12-month wound healing rates did not differ between the groups.ConclusionsGait speed in patients with CLTI after crural and pedal bypass was associated with survival, freedom from MACE, and graft patency but not with limb salvage and wound healing. A detailed study of walking ability in these patients may be needed in the future.
目的
许多因素影响慢性肢体威胁性缺血（CLTI）患者开放旁路术后的长期预后。已有研究表明门诊状态与临床预后相关，但关于步速对预后的影响知之甚少。本研究旨在评估6分钟步行试验（6MWT）中评估的步速对CLTI患者小腿和足部旁路术后预后的影响。
方法
对2014年至2021年在单一中心接受小腿和足部旁路术后1个月进行6MWT的CLTI患者进行回顾性分析。比较高步速组（HG组，6分钟步行距离（6MWD）>288米）和低步速组（LG组，6MWD≤288米）。主要终点是生存率，次要终点是移植物通畅率、肢体挽救率、伤口愈合情况、主要不良心血管事件（MACE）和住院结局。
结果
104例小腿和足部旁路术后进行6MWT的CLTI患者中，46例（44%）和58例（56%）分别被纳入HG组和LG组。LG组患者年龄更大（P<0.001），女性患者更多（P = 0.006），脑血管疾病（P = 0.042）和组织缺损（P = 0.007）的患病率更高。中位随访时间为36（22 - 57）个月。HG组3年的初级通畅率（65%对42%，P = 0.013）、3年的次级通畅率（87%对66%，P = 0.018）、3年总生存率（89%对58%，P<0.001）和3年无MACE生存率（79%对67%，P = 0.039）显著更高。两组间3年肢体挽救率和12个月伤口愈合率无差异。
结论
CLTI患者小腿和足部旁路术后的步速与生存率、无MACE生存率和移植物通畅率相关，但与肢体挽救率和伤口愈合无关。未来可能需要对这些患者的步行能力进行详细研究。
