Kishida Toshihiko, Mori Shinsuke, Yamaguchi Kohei, Tsutsumi Masakazu, Kobayashi Norihiro, Ito Yoshiaki
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
CVIR Endovasc. 2024 Dec 7;7(1):86. doi: 10.1186/s42155-024-00500-3.
Lower limb peripheral artery disease classified as Rutherford category IV, is characterized by lower limb ischemic pain both during exertion and at rest. This disease has an unclear course. We aimed to evaluate outcome predictors in this patient group after endovascular therapy. This single-center, retrospective, observational study included 234 consecutive patients (264 limbs), between April 2007 and December 2020. We investigated the disease clinical course after endovascular therapy. The primary endpoint was the wound formation rate 3 years after endovascular therapy.
The mean observation period was 48.2 ± 8.9 months. The patients (61.9% male; mean age, 76 ± 10 years) presented with diabetes (64.1%), and received hemodialysis with chronic kidney disease (35.0%) and ambulatory treatment (85.0%). The average ankle-brachial index before endovascular therapy was 0.69 ± 0.23. Skin perfusion pressure on the dorsal and plantar sides was 38 ± 13 mmHg and 36 ± 12 mmHg, respectively. The wound incidence rates at 1, 2, and 3 years after endovascular therapy were 8.3%, 11.4%, and 14.4%, respectively. Multivariate analysis revealed the following factors associated with wound formation: P2 in inframalleolar/pedal disease category in the Global Limb Anatomical Staging System (hazard ratio: 1.73, 95% confidence interval: 1.22-2.83, P = 0.01), non-ambulatory status (hazard ratio: 1.09, 95% confidence interval: 1.11-1.36, P = 0.02), intervention up to infrapopliteal lesion (hazard ratio: 1.55, 95% confidence interval: 1.17-2.46, P = 0.03), and patient with chronic kidney disease on hemodialysis (hazard ratio: 1.61, 95% confidence interval: 1.32-2.18, P = 0.03).
The 3-year incidence of wound onset in this study was 14.4%. Factors associated with this outcome included P2 in the Global Limb Anatomical Staging System, non-ambulatory status, intervention up to infrapopliteal lesion, and patient with chronic kidney disease on hemodialysis.
下肢外周动脉疾病被归类为卢瑟福分类IV级，其特征是在运动和休息时均出现下肢缺血性疼痛。这种疾病的病程尚不清楚。我们旨在评估该患者群体接受血管内治疗后的预后预测因素。这项单中心、回顾性、观察性研究纳入了2007年4月至2020年12月期间连续的234例患者（264条肢体）。我们调查了血管内治疗后的疾病临床病程。主要终点是血管内治疗后3年的伤口形成率。
平均观察期为48.2±8.9个月。患者中男性占61.9%；平均年龄为76±10岁，患有糖尿病的患者占64.1%，接受慢性肾病血液透析的患者占35.0%，接受门诊治疗的患者占85.0%。血管内治疗前的平均踝肱指数为0.69±0.23。足背和足底的皮肤灌注压分别为38±13mmHg和36±12mmHg。血管内治疗后1年、2年和3年的伤口发生率分别为8.3%、11.4%和14.4%。多因素分析显示与伤口形成相关的因素如下：全球肢体解剖分期系统中踝下/足部疾病分类为P2（风险比：1.73，95%置信区间：1.22 - 2.83，P = 0.01）、非门诊状态（风险比：1.09，95%置信区间：1.11 - 1.36，P = 0.02）、干预至腘下病变（风险比：1.55，95%置信区间：1.17 - 2.46，P = 0.03）以及接受血液透析的慢性肾病患者（风险比：1.61，95%置信区间：1.32 - 2.18，P = 0.03）。
本研究中伤口发生的3年发生率为14.4%。与该结果相关的因素包括全球肢体解剖分期系统中的P2、非门诊状态、干预至腘下病变以及接受血液透析的慢性肾病患者。
