Welling Rutger H A, van Breugel Marjolein, van de Mortel Mats, de Borst Gert J, Schmidt Andrej, van den Heuvel Daniel A F, Bakker Olaf J
Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
J Vasc Surg. 2025 Apr;81(4):987-998. doi: 10.1016/j.jvs.2024.12.043. Epub 2024 Dec 25.
The 2019 Global Vascular Guidelines recommend risk assessment for evidence based revascularization based on the acronym PLAN: Patient risk, Limb severity and ANatomical complexity of disease. This meta-analysis compares a multitude of prognostic tests within these categories.
A systematic review and meta-analysis of tests that estimated 1-year major event (amputation-free survival and major adverse limb events) probability. Individual patient data were reconstructed from survival estimate curves. With presence or absence of major events, sensitivity, specificity, and area under receiver operating characteristics curves (AUC) were computed. Tests with an AUC ≥70%, or that correlated with revascularization feasibility were included. Practical application of tests was assessed to make a recommendation on PLAN implementation.
Ninety-six studies describing 77 unique predictive techniques were included, of which thirteen were sufficient. These 13 tests were divided in four Patient risk (5 studies), three Limb severity (3 studies), and six ANatomical complexity of disease (9 studies). Patient risk: Three tests were included: biochemical assessment of calprotectin and C-reactive protein, radiologic measurement of sarcopenia, and predictive score with the GermanVasc chronic limb-threatening ischemia (CLTI) score. These tests scored AUCs of 82.0%, 72.7%, and 71.8%, respectively, of which the GermanVasc CLTI score was deemed most applicable in clinical practice. Limb severity: The adjusted Wound Ischemia foot Infection score (WIfI) resulted as best predictive score (AUC, 78.8%), but due to the lack of external validation, the original WIfI score was deemed best applicable. ANatomical complexity of disease: No test surpassed 70% AUC for 1-year event estimation, and was correlated with feasibility of revascularization, the latter only being served by the Global Limb Anatomic Staging System.
In evidence-based revascularization in patients with CLTI according to the PLAN concept, we recommend to use GermanVasc, WIfI, and the Global Limb Anatomic Staging System.
《2019年全球血管指南》建议基于首字母缩写词PLAN进行基于证据的血运重建风险评估，即患者风险、肢体严重程度和疾病解剖复杂性。本荟萃分析比较了这些类别中的多种预后测试。
对估计1年主要事件（无截肢生存率和主要肢体不良事件）概率的测试进行系统评价和荟萃分析。从生存估计曲线重建个体患者数据。根据是否发生主要事件，计算敏感性、特异性和受试者操作特征曲线下面积（AUC）。纳入AUC≥70%或与血运重建可行性相关的测试。评估测试的实际应用情况，以便对PLAN的实施提出建议。
纳入了96项描述77种独特预测技术的研究，其中13项足够充分。这13项测试分为四项患者风险测试（5项研究）、三项肢体严重程度测试（3项研究）和六项疾病解剖复杂性测试（9项研究）。患者风险：纳入了三项测试：钙卫蛋白和C反应蛋白的生化评估、肌肉减少症的放射学测量以及德国血管慢性肢体威胁性缺血（CLTI）评分的预测评分。这些测试的AUC分别为82.0%、72.7%和71.8%，其中德国血管CLTI评分被认为在临床实践中最适用。肢体严重程度：调整后的伤口缺血足部感染评分（WIfI）是最佳预测评分（AUC，78.8%），但由于缺乏外部验证，原始WIfI评分被认为最适用。疾病解剖复杂性：没有测试在1年事件估计中超过70%的AUC，并且与血运重建可行性相关，后者仅由全球肢体解剖分期系统提供。
在根据PLAN概念对CLTI患者进行基于证据的血运重建中，我们建议使用德国血管评分、WIfI和全球肢体解剖分期系统。
