Jácome Filipa, Freitas Alberto, Sampaio Sérgio, Dias-Neto Marina, Castro-Ferreira Ricardo
Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Portugal.
Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal.
Port J Card Thorac Vasc Surg. 2024 Oct 12;31(3):47-54. doi: 10.48729/pjctvs.437.
Effective revascularization is the cornerstone of limb salvage in chronic limb threatening ischemia. In recent years, less invasive endovascular revascularization techniques have supplanted surgical bypass as the primary mode of revascularization. The real impact of this transition is being increasingly questioned. This study aims to evaluate the endovascular evolution, and how it impacted the amputation rates nationwide since de beginning of the century.
Patients admitted to Portuguese public hospitals with peripheral arterial disease between 2000 and 2015 were selected. Of these, patients that underwent to limb revascularization and/ or limb amputation were evaluated. The information was obtained through the National Health Service administrative database. Three time periods (2000-2004, 2005-2009, 2010-2015) were considered to evaluate the evolution in amputation rates and type of revascularization.
The global number of revascularization episodes consistently increased along the 15 analyzed years. There were 25252 admissions for revascularization (55.1% open and 44.9% endovascular). The mean incidence of endovascular procedures significantly increased 5.8 times (p<0.01), and open surgery increased 1.3 times (p<0.01) when comparing the three time periods. 34633 limb amputations (65.3% major vs 34.7% minor) were realized along 15 years. The mean incidence of lower limb amputations increased by 1.5 times thanks to minor amputation, whose mean incidence increased two-fold while with the incidence of major amputations remained stable. Additionally, mean hospital mortality associated with revascularization episodes decreased from 10.6% to 8.2% (p<0.01), on 15-year follow-up.
There was a significative increase in revascularization episodes over the 15 years, suggesting better access to health services and/or better diagnostic accuracy. Endovascular procedures were the most practiced. This was along with an increase in the minor limb amputation, a stabilization in major amputations incidence. This nationwide study adds to the increasing body of knowledge in the ever-pertinent discussion of revascularization types and their benefits.
有效的血运重建是挽救慢性肢体威胁性缺血患者肢体的基石。近年来，侵入性较小的血管内血运重建技术已取代外科搭桥术，成为血运重建的主要方式。这种转变的实际影响受到越来越多的质疑。本研究旨在评估血管内治疗的发展历程，以及自本世纪初以来其对全国截肢率的影响。
选取2000年至2015年间入住葡萄牙公立医院且患有外周动脉疾病的患者。其中，对接受肢体血运重建和/或肢体截肢的患者进行评估。信息通过国家卫生服务行政数据库获取。考虑三个时间段（2000 - 2004年、2005 - 2009年、2010 - 2015年）来评估截肢率和血运重建类型的变化。
在分析的15年中，血运重建事件的总数持续增加。共有25252例血运重建住院病例（55.1%为开放手术，44.9%为血管内治疗）。与三个时间段相比，血管内手术的平均发生率显著增加了5.8倍（p<0.01），开放手术增加了1.3倍（p<0.01）。15年间共进行了34633例肢体截肢手术（65.3%为大截肢，34.7%为小截肢）。由于小截肢，下肢截肢的平均发生率增加了1.5倍，小截肢的平均发生率增加了两倍，而大截肢的发生率保持稳定。此外，在15年的随访中，与血运重建事件相关的平均医院死亡率从10.6%降至8.2%（p<0.01）。
在15年中，血运重建事件显著增加，这表明获得医疗服务的机会增加和/或诊断准确性提高。血管内治疗是最常用的方法。这伴随着小肢体截肢的增加，大截肢发生率的稳定。这项全国性研究为有关血运重建类型及其益处的持续相关讨论增添了越来越多的知识。
