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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.

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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