编辑推荐——美国频繁进行用于治疗间歇性跛行的腘下周围血管介入治疗，且其长期预后不佳。
Editor's Choice - Infrapopliteal Peripheral Vascular Interventions for Claudication are Performed Frequently in the USA and Are Associated with Poor Long Term Outcomes.
作者信息
Bose Sanuja, Dun Chen, Solomon Alex J, Black James H, Conte Michael S, Kalbaugh Corey A, Woo Karen, Makary Martin A, Hicks Caitlin W
机构信息
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Eur J Vasc Endovasc Surg. 2025 Jan;69(1):89-101. doi: 10.1016/j.ejvs.2024.06.017. Epub 2024 Jun 19.
OBJECTIVE
Infrapopliteal peripheral vascular interventions (PVIs) for claudication are still performed in the USA. This study aimed to evaluate whether infrapopliteal PVI is associated with worse long term outcomes than isolated femoropopliteal PVI for treatment of claudication.
METHODS
A retrospective analysis of fee for service claims in a national administrative database was conducted using 100% of the Medicare fee for service claims between 2017 and 2019 to capture all Medicare beneficiaries who underwent an index infra-inguinal PVI for claudication. Hierarchical Cox proportional hazards models were performed to assess the association of infrapopliteal PVI with conversion to chronic limb threatening ischaemia (CLTI), repeat PVI, and major amputation.
RESULTS
In total, 36 147 patients (41.1% female; 89.7% age ≥ 65 years; 79.0% non-Hispanic White ethnicity) underwent an index PVI for claudication, of whom 32.6% (n = 11 790) received an infrapopliteal PVI. Of these, 61.4% (n = 7 245) received a concomitant femoropopliteal PVI and 38.6% (n = 4 545) received an isolated infrapopliteal PVI. The median follow up time was 3.5 years (interquartile range 2.7, 4.3). Patients receiving infrapopliteal PVI had a higher three year cumulative incidence of conversion to CLTI (26.0%; 95% confidence interval [CI] 24.9 - 27.2% vs. 19.9%; 95% CI 19.1 - 20.7%), repeat PVI (56.0%; 95% CI 54.8 - 57.3% vs. 45.7%; 95% CI 44.9 - 46.6%), and major amputation (2.2%; 95% CI 1.8 - 2.6% vs. 1.3%; 95% CI 1.1 - 1.5%) compared with patients receiving isolated femoropopliteal PVI. After adjusting for patient and physician level characteristics, the risk of conversion to CLTI (adjusted hazard ratio [aHR] 1.31, 95% CI 1.23 - 1.39), repeat PVI (aHR 1.12, 95% CI 1.05 - 1.20), and major amputation (aHR 1.72, 95% CI 1.42 - 2.07) remained significantly higher for patients receiving infrapopliteal PVI. An increasing number of infrapopliteal vessels treated during the index intervention was associated with increasingly poor outcomes (p < .001 for trend).
CONCLUSION
Infrapopliteal PVI for claudication is associated with worse long term outcomes relative to isolated femoropopliteal PVI.
目的
在美国，仍会对跛行患者进行腘下周围血管介入治疗（PVI）。本研究旨在评估与单纯股腘PVI治疗跛行相比，腘下PVI是否会导致更差的长期预后。
方法
对一个国家行政数据库中的服务收费索赔进行回顾性分析，使用了2017年至2019年间100%的医疗保险服务收费索赔，以纳入所有接受初次腹股沟下PVI治疗跛行的医疗保险受益人。采用分层Cox比例风险模型评估腘下PVI与转为慢性肢体威胁性缺血（CLTI）、重复PVI和大截肢之间的关联。
结果
共有36147例患者（41.1%为女性；89.7%年龄≥65岁；79.0%为非西班牙裔白人）接受了初次PVI治疗跛行其中32.6%（n = 11790）接受了腘下PVI。在这些患者中，61.4%（n = 7245）同时接受了股腘PVI，38.6%（n = 4545）接受了单纯腘下PVI。中位随访时间为3.5年（四分位间距2.7，4.3）。与接受单纯股腘PVI的患者相比，接受腘下PVI的患者转为CLTI的三年累积发生率更高（26.0%；95%置信区间[CI]24.9 - 27.2% vs. 19.9%；95%CI 19.1 - 20.7%），重复PVI的发生率更高（56.0%；95%CI 54.8 - 57.3% vs. 45.7%；95%CI 44.9 - 46.6%），大截肢的发生率更高（2.2%；95%CI 1.8 - 2.6% vs. 1.3%；95%CI 1.1 - 1.5%）。在对患者和医生层面的特征进行调整后，接受腘下PVI的患者转为CLTI（调整后风险比[aHR]1.31，95%CI 1.23 - 1.39）、重复PVI（aHR 1.12，95%CI 1.05 - 1.20）和大截肢（aHR 1.72，95%CI 1.42 - 2.07）的风险仍然显著更高。在初次干预期间治疗的腘下血管数量增加与预后越来越差相关（趋势p <.001）。
结论
与单纯股腘PVI相比，腘下PVI治疗跛行的长期预后更差。
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