Soon Joel Jia Yi, Patel Ankur, Tay Hsien Ts'ung Luke, Tan Seck Guan, Chandramohan Sivanathan, Yap Charyl Jia Qi, Chen Stephanie Hui Min, Tay Kiang Hiong, Chong Tze Tec
Department of Vascular Surgery, Singapore General Hospital, Singapore.
Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore.
J Vasc Surg. 2025 Feb;81(2):425-431. doi: 10.1016/j.jvs.2024.09.034. Epub 2024 Oct 2.
This study compares chronic limb-threatening ischemia disease characteristics and endovascular revascularization outcomes in a multi-ethnic Asian cohort vs their North American counterparts.
The Society for Vascular Surgery Vascular Quality Initiative (VQI) registry database from the first and currently the only VQI center in Asia was reviewed to identify patients with chronic limb-threatening ischemia who underwent endovascular revascularization between July 2019 and April 2024. Standardized VQI reporting variables were compared against benchmarks derived from all participating centers in North America.
A total of 2862 endovascular revascularization procedures from our center were benchmarked against 129,347 procedures from 406 North American centers. Our cohort had a higher burden of comorbidities (diabetes mellitus, end-stage renal disease, cardiac disease) and presented with more advanced Wound, Ischemia, and foot Infection stages. Our patients had more heavily calcified and longer (14.8 cm vs 6.0 cm) diseased vessels with higher prevalence of multi-level (87% vs 54.6%), infrapopliteal (52.6% vs 38.9%), and inframalleolar (9.6% vs 2.4%) disease. Rates of technical success (92.7% vs 93%) and symptom improvement (39.1% vs 40.4%) were comparable between cohorts. However, 1-year mortality rates (28.9% vs 25.1%) and major amputation rates (13.3% vs 7.8%) were significantly higher.
Short-term outcomes of technical success and symptom relief in our center were comparable to benchmarked North American outcomes despite having a cohort with more diseased vessels, higher Wound, Ischemia, and foot Infection stages, and more comorbidities. However, this cohort fared worse in longer term outcomes of 1-year mortality and major amputation rates. Further studies are required to elucidate the causes to improve these outcomes.
本研究比较了多民族亚洲队列与北美队列中慢性肢体威胁性缺血疾病的特征及血管内血运重建的结果。
回顾了亚洲首个也是目前唯一的血管外科质量改进计划（VQI）登记数据库，以确定2019年7月至2024年4月期间接受血管内血运重建的慢性肢体威胁性缺血患者。将标准化的VQI报告变量与来自北美的所有参与中心得出的基准进行比较。
我们中心的2862例血管内血运重建手术与北美406个中心的129347例手术进行了基准对比。我们的队列有更高的合并症负担（糖尿病、终末期肾病、心脏病），且伤口、缺血和足部感染阶段更严重。我们的患者血管钙化更严重且病变血管更长（14.8厘米对6.0厘米），多节段病变（87%对54.6%）、腘动脉以下病变（52.6%对38.9%）和踝关节以下病变（9.6%对2.4%）的患病率更高。队列间技术成功率（92.7%对93%）和症状改善率（39.1%对40.4%）相当。然而，1年死亡率（28.9%对25.1%）和大截肢率（13.3%对7.8%）显著更高。
尽管我们的队列血管病变更多、伤口、缺血和足部感染阶段更高且合并症更多，但我们中心技术成功和症状缓解的短期结果与北美基准结果相当。然而，该队列在1年死亡率和大截肢率的长期结果方面表现更差。需要进一步研究以阐明原因，改善这些结果。
