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肾移植受者慢性肢体威胁性缺血的血管内治疗临床结局

Clinical outcomes of endovascular therapy for chronic limb-threatening ischemia in renal transplant recipients.

作者信息

Muangsillapasart Viroj, Morioka Yuta, Nakao Masashi, Arashi Hiroyuki, Yamaguchi Junichi

机构信息

Department of Cardiology, Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.

出版信息

Cardiovasc Interv Ther. 2025 Jan;40(1):95-101. doi: 10.1007/s12928-024-01042-0. Epub 2024 Sep 3.

DOI:10.1007/s12928-024-01042-0
PMID:39225897
Abstract

Endovascular treatment (EVT) for peripheral artery disease in patients with chronic limb-threatening ischemia (CLTI) is a common practice in contemporary medicine and its effectiveness is widely acknowledged. However, refractory ulcers can occasionally be encountered, particularly in patients who underwent renal transplantation (RT), even after successful EVT. To date, there have been no data on prognosis reported following EVT for CLTI in RT recipients. We included all RT recipients who underwent EVT in our hospital between 2010 and 2022. We analyzed data from 43 limbs with ischemic ulcerations classified as Rutherford class 5 or 6, which were managed solely with EVT (i.e., no bypass surgery was performed). The primary and secondary outcomes of our study were the incidence of complete wound healing and major adverse limb events (MALE), including clinically driven target vessel revascularization, major amputation, and all-cause death. The median follow-up was 31 months. The mean age of the study population was 64.7 ± 8.7 years, with predominantly male participants (79.1%). The overall wound healing rate was 34.9%. Kaplan-Meier curve revealed that wound healing rates at 1 and 3 years were 33.6% and 40.9%, respectively. The wound healing rates of RT recipients who underwent EVT for CLTI were found to be less than satisfactory.

摘要

对于慢性肢体威胁性缺血(CLTI)患者,血管内治疗(EVT)是当代医学中的常见做法,其有效性已得到广泛认可。然而,即使在成功进行EVT后,仍可能偶尔遇到难治性溃疡,尤其是在接受肾移植(RT)的患者中。迄今为止,尚无关于RT受者CLTI接受EVT后预后的报道。我们纳入了2010年至2022年期间在我院接受EVT的所有RT受者。我们分析了43条患有缺血性溃疡的肢体的数据,这些溃疡被分类为卢瑟福5级或6级,仅通过EVT进行治疗(即未进行旁路手术)。我们研究的主要和次要结局是完全伤口愈合的发生率和主要不良肢体事件(MALE),包括临床驱动的靶血管再血管化、大截肢和全因死亡。中位随访时间为31个月。研究人群的平均年龄为64.7±8.7岁,主要为男性参与者(79.1%)。总体伤口愈合率为34.9%。Kaplan-Meier曲线显示,1年和3年时的伤口愈合率分别为33.6%和40.9%。结果发现,接受CLTI的RT受者接受EVT后的伤口愈合率不尽人意。

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本文引用的文献

1
Outcomes of Infrapopliteal Bypass for Chronic Limb-Threatening Ischemia are Worse in Renal Transplant Patients than in Hemodialysis-Dependent Patients.对于慢性肢体威胁性缺血,肾移植患者行腘下旁路移植术的结果比依赖血液透析的患者更差。
Ann Vasc Surg. 2023 Mar;90:181-187. doi: 10.1016/j.avsg.2022.10.014. Epub 2022 Nov 26.
2
Roles of Angioplasty With Drug-Coated Balloon for Chronic Ischemia in Wound Healing.药物涂层球囊血管成形术在慢性缺血性创面愈合中的作用。
J Endovasc Ther. 2021 Oct;28(5):778-787. doi: 10.1177/15266028211025023. Epub 2021 Jun 21.
3
Wound healing adverse events in kidney transplant recipients receiving everolimus with reduced calcineurin inhibitor exposure or current standard-of-care: insights from the 24-month TRANSFORM study.
在接受依维莫司治疗且减少钙调磷酸酶抑制剂暴露或接受当前标准治疗的肾移植受者中,伤口愈合不良事件:来自 24 个月 TRANSFORM 研究的见解。
Expert Opin Drug Saf. 2020 Oct;19(10):1339-1348. doi: 10.1080/14740338.2020.1792441. Epub 2020 Jul 20.
4
Outcomes for peripheral vascular intervention and lower extremity bypass in kidney transplant recipients are superior to outcomes of patients remaining on dialysis.外周血管介入治疗和下肢旁路移植术在肾移植受者中的疗效优于继续透析患者的疗效。
J Vasc Surg. 2019 Jun;69(6):1849-1862.e6. doi: 10.1016/j.jvs.2018.10.060. Epub 2018 Dec 21.
5
Clinical Effects of Planned Endovascular Therapy for Critical Limb Ischemia Patients with Tissue Loss.计划性血管内治疗对伴有组织损失的肢体缺血危重症患者的临床疗效。
J Atheroscler Thromb. 2019 Mar 1;26(3):294-301. doi: 10.5551/jat.45344. Epub 2018 Aug 21.
6
Clinical outcome and its predictors in hemodialysis patients with critical limb ischemia undergoing endovascular therapy.接受血管内治疗的严重肢体缺血血液透析患者的临床结局及其预测因素
J Interv Cardiol. 2017 Aug;30(4):374-381. doi: 10.1111/joic.12393. Epub 2017 Jun 8.
7
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JACC Cardiovasc Interv. 2017 Jan 23;10(2):188-194. doi: 10.1016/j.jcin.2016.10.026.
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Vascular. 2017 Jun;25(3):272-282. doi: 10.1177/1708538116673015. Epub 2016 Oct 6.
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3-Year Outcomes of the OLIVE Registry, a Prospective Multicenter Study of Patients With Critical Limb Ischemia: A Prospective, Multi-Center, Three-Year Follow-Up Study on Endovascular Treatment for Infra-Inguinal Vessel in Patients With Critical Limb Ischemia.OLIVE 注册研究的 3 年结果:一项对严重肢体缺血患者的前瞻性多中心研究:严重肢体缺血患者股浅动脉腔内治疗的前瞻性、多中心、3 年随访研究。
JACC Cardiovasc Interv. 2015 Sep;8(11):1493-1502. doi: 10.1016/j.jcin.2015.07.005.