Cieri Isabella Ferlini, Rodriguez Alvarez Adriana A, Patel Shiv, Boya Mounika, Nurko Andrea, Teeple William, Dua Anahita
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Ann Vasc Surg. 2025 Apr;113:227-234. doi: 10.1016/j.avsg.2025.01.020. Epub 2025 Jan 27.
The Rutherford Classification for chronic limb-threatening ischemia (CLTI) is used to categorize peripheral artery disease severity through history and physical examination. This study investigated whether higher Rutherford Classification correlates with worse clinical outcomes and could serve as a predictive tool.
In this prospective single-center study, 252 patients undergoing lower extremity revascularization were followed for 3 years (2020-2023). Rutherford classification was determined at presentation. Outcomes included reintervention for stenosis/occlusion, amputation rates, and mortality. Statistical analysis used chi-squared tests for categorical data and one-way ANOVA for continuous data.
Higher Rutherford classifications (3-6) showed increased reoperation rates versus lower classifications (28.2% vs. 10.3%, P = 0.043), with the largest increase between classes 2 and 3 (4.7-26.8%). Amputation rates were significantly higher in classifications 4-6 vs. 0-3 (31.9% vs. 7.2%, P < 0.001), particularly between classes 4 and 5 (19.0-37.6%). Mortality rates were also higher in classes 4-6 vs. 0-3 (22.6% vs. 7.2%, P < 0.001). Rutherford Classification effectively predicts major adverse outcomes, with marked increases at specific classification transitions suggesting critical thresholds for risk stratification. Early intervention may be warranted in higher classifications. These findings support its use as a valuable prognostic tool in preoperative planning and patient counseling.
This study validates Rutherford Classification as an effective tool for predicting adverse outcomes in CLTI patients. The clear correlation between higher classifications and increased complications supports its use in clinical decision-making, risk stratification, and determining optimal timing for surgical intervention.
慢性肢体威胁性缺血（CLTI）的卢瑟福分类用于通过病史和体格检查对周围动脉疾病的严重程度进行分类。本研究调查了较高的卢瑟福分类是否与更差的临床结局相关，以及是否可作为一种预测工具。
在这项前瞻性单中心研究中，对252例接受下肢血管重建术的患者进行了3年（2020 - 2023年）的随访。在就诊时确定卢瑟福分类。结局包括因狭窄/闭塞进行的再次干预、截肢率和死亡率。统计分析对分类数据使用卡方检验，对连续数据使用单因素方差分析。
较高的卢瑟福分类（3 - 6级）与较低分类相比，再次手术率增加（28.2%对10.3%，P = 0.043），其中2级和3级之间增加幅度最大（4.7% - 26.8%）。4 - 6级的截肢率显著高于0 - 3级（31.9%对7.2%，P < 0.001），特别是4级和5级之间（19.0% - 37.6%）。4 - 6级的死亡率也高于0 - 3级（22.6%对7.2%，P < 0.001）。卢瑟福分类有效地预测了主要不良结局，在特定分类转换时显著增加表明存在风险分层的关键阈值。对于较高分类可能需要早期干预。这些发现支持将其用作术前规划和患者咨询中有价值的预后工具。
本研究验证了卢瑟福分类作为预测CLTI患者不良结局的有效工具。较高分类与并发症增加之间的明确相关性支持其在临床决策、风险分层以及确定手术干预最佳时机方面的应用。
