Miwa Hiromi, Hayakawa Naoki, Tsuchida Yasuyuki, Ichihara Shinya, Hirano Satoshi, Maruta Shunsuke, Miyaji Kotaro, Kushida Shunichi
Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
Heart Vessels. 2024 Dec 5. doi: 10.1007/s00380-024-02500-8.
Urgent revascularization should be performed to patients with acute limb ischemia (ALI) unless the ischemia is irreversible. In patients with severe ALI and multiple morbidities, surgical revascularization is not feasible; however, endovascular revascularization (EVR) may be an option. This study aimed to examine 1-year clinical outcomes of EVR in patients with ALI and determine prognostic factors. We retrospectively examined 90 EVR procedures performed in 81 patients with ALI between January 2018 and February 2024. The primary endpoint was 1-year amputation-free survival (AFS). Multivariable logistic regression was performed to identify predictors of 1-year AFS. Fifty-one procedures were performed for severe ALI (56.7%). Fifty-six patient were ambulatory at the time of procedures (62.2%). The 1-year AFS rate was 59.7%. Multivariable analysis revealed that hypertension (adjusted hazard ratio [aHR] 0.14; 95% confidence interval [CI], 0.05-0.47; P = 0.0007), presence of blood flow of both tibial arteries after EVR (aHR 0.19; 95% CI, 0.03-0.93; P = 0.04), and presence of arterial flow below the ankle after EVR (aHR 0.29; 95% CI, 0.09-0.84; P = 0.022) were independently associated with a higher AFS rate. Aortic plaque was independently associated with a lower AFS rate (aHR 3.98; 95% CI, 1.55-9.90; P = 0.048). EVR may be an acceptable treatment of ALI even in non-ambulatory patients and those with severe ALI. Achieving adequate blood flow of both tibial arteries and below the ankle by performing EVR may be important for improving patient outcomes.
除非肢体缺血不可逆，否则应对急性肢体缺血（ALI）患者进行紧急血运重建。对于患有严重ALI和多种合并症的患者，手术血运重建不可行；然而，血管腔内血运重建（EVR）可能是一种选择。本研究旨在探讨EVR治疗ALI患者的1年临床结局并确定预后因素。我们回顾性分析了2018年1月至2024年2月期间在81例ALI患者中进行的90例EVR手术。主要终点是1年无截肢生存率（AFS）。进行多变量逻辑回归以确定1年AFS的预测因素。51例手术用于治疗严重ALI（56.7%）。56例患者在手术时可步行（62.2%）。1年AFS率为59.7%。多变量分析显示，高血压（调整后风险比[aHR]0.14；95%置信区间[CI]，0.05 - 0.47；P = 0.0007）、EVR后胫动脉双支血流存在（aHR 0.19；95%CI，0.03 - 0.93；P = 0.04）以及EVR后踝关节以下动脉血流存在（aHR 0.29；95%CI，0.09 - 0.84；P = 0.022）与较高的AFS率独立相关。主动脉斑块与较低的AFS率独立相关（aHR 3.98；95%CI，1.55 - 9.90；P = 0.048）。即使对于非步行患者和严重ALI患者，EVR也可能是ALI的一种可接受的治疗方法。通过进行EVR实现胫动脉双支和踝关节以下充足的血流可能对改善患者结局很重要。
