Kobayashi Taira, Hamamoto Masaki, Okazaki Takanobu, Okusako Ryo, Shimoda Hironori, Hasegawa Misa, Takahashi Shinya
Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan.
Department of Nephrology, JA Hiroshima General Hospital, Hatsukaichi, Japan.
Vasc Endovascular Surg. 2025 Apr;59(3):243-249. doi: 10.1177/15385744241290012. Epub 2024 Oct 4.
Chronic limb-threatening ischemia (CLTI) is mostly caused by arteriosclerosis, but is sometimes due to connective tissue disease. However, there is a limited knowledge of clinical outcomes of patients with CLTI with connective tissue disease. The objective of the study was to assess outcomes after distal bypass in these patients using global vascular guidelines.
Data from distal bypasses performed for CLTI at a single center from 2014 to 2023 were evaluated retrospectively. Clinical outcomes after distal bypass were compared for patients with CLTI with arteriosclerosis (AS group) and those with connective tissue disease (CD group). The primary endpoints were limb salvage and wound healing.
Of the 282 distal bypasses performed for 222 patients with CLTI, 22 were conducted for 21 patients with connective tissue disease (CD group). The connective tissue disease was progressive systemic scleroderma (n = 11 patients), pemphigoid diseases (n = 2), polyarteritis nodosa (n = 2), rheumatoid arthritis (n = 2), and others (n = 4). Compared with the AS group, the CD group included more females ( = .007) and had greater oral steroid use ( < .001) and a higher Global Limb Anatomical Staging System (GLASS) inframalleolar (IM) modifier P2 ( < .001). The mean follow-up period of the whole cohort was 27 ± 22 months with no significant difference between the groups ( = .25), and 22 limbs required major amputation during this period. The 2-year limb salvage rate was significantly lower in the CD group compared to the AS group (75% vs 94%, = .020). Wound healing was achieved in 220 (78%) limbs, and the 12-month wound healing rate was significantly lower in the CD group (52% vs 86%, = .006).
The low 2-year limb salvage and 12-month wound healing rates in patients with CLTI with connective tissue disease indicate that distal bypass may be challenging in these patients.
慢性肢体威胁性缺血（CLTI）大多由动脉硬化引起，但有时也归因于结缔组织病。然而，对于患有结缔组织病的CLTI患者的临床结局了解有限。本研究的目的是使用全球血管指南评估这些患者行远端旁路术后的结局。
回顾性评估2014年至2023年在单一中心因CLTI行远端旁路术的数据。比较患有动脉硬化的CLTI患者（AS组）和患有结缔组织病的患者（CD组）远端旁路术后的临床结局。主要终点是肢体挽救和伤口愈合。
在为222例CLTI患者进行的282次远端旁路术中，有21例患有结缔组织病的患者进行了22次手术（CD组）。结缔组织病包括进行性系统性硬化症（11例患者）、类天疱疮疾病（2例）、结节性多动脉炎（2例）、类风湿关节炎（2例）和其他（4例）。与AS组相比，CD组女性更多（P = 0.007），口服类固醇使用更多（P < 0.001），全球肢体解剖分期系统（GLASS）踝下（IM）修饰符P2更高（P < 0.001）。整个队列的平均随访期为27±22个月，两组之间无显著差异（P = 0.25），在此期间有22条肢体需要进行大截肢。CD组的2年肢体挽救率明显低于AS组（75%对94%，P = 0.020）。220条（78%）肢体实现了伤口愈合，CD组的12个月伤口愈合率明显较低（52%对86%，P = 0.006）。
患有结缔组织病的CLTI患者较低的2年肢体挽救率和12个月伤口愈合率表明，远端旁路术在这些患者中可能具有挑战性。
