McLafferty R B, Edwards J M, Taylor L M, Porter J M
Department of Surgery, Oregon Health Sciences University, Portland, USA.
J Vasc Surg. 1995 Oct;22(4):361-7; discussion 367-9. doi: 10.1016/s0741-5214(95)70003-x.
The long-term clinical outcome of patients diagnosed with digital artery obstruction and symptomatic hand ischemia is largely unknown. Our long-term experience with the diagnosis of symptomatic digital artery obstruction and the long-term natural history of this condition forms the basis for this report.
From 1971 to 1985, 44 patients with symptomatic hand ischemia and palmar or digital arterial obstruction underwent arteriography and digital photoplethysmography (PPG). Patients were grouped according to severity of hand ischemia symptoms, including ulceration and digital amputation and the presence of a connective tissue disease (CTD). Arteriography was compared with PPG by creating an objective severity scale (digital obstruction index [DOI]).
Average follow-up was 15.2 years (range 10 to 22 years). Initially 21 patients (48%) had moderate symptoms, and 23 patients (52%) had severe symptoms of hand ischemia. Follow-up symptoms in 28 patients improved (13 of 26 with CTD, 15 of 18 without CTD), in 15 patients (12 of 26 with CTD, 3 of 18 without CTD) remained unchanged, and in only 1 patient (1 of 26 with CTD) worsened. Seventeen (65%) patients with CTD (n = 26) had development of one or more ulcers, and six (24%) underwent one or more digital amputations. Four (22%) patients without CTD (n = 18) had finger ulceration (p < 0.012 compared with patients with CTD), and one patient (6%) underwent subsequent digital amputation (p = NS). The arteriography-DOI and PPG-DOI were equally accurate in determining severity of finger ischemia as manifested by severity of symptoms or ulcer development.
The favorable long-term prognosis of symptomatic finger artery occlusion described herein mandates the avoidance of premature finger amputation. Patients with CTD fare worse, but even in this group tissue loss is modest. Finger PPG is as accurate as arteriography for determining severity of hand ischemia.
被诊断为指动脉阻塞和有症状的手部缺血的患者的长期临床结果在很大程度上尚不清楚。我们对有症状的指动脉阻塞的诊断以及这种疾病的长期自然病史的长期经验构成了本报告的基础。
1971年至1985年，44例有症状的手部缺血和掌部或指动脉阻塞的患者接受了血管造影和指光电容积描记法（PPG）检查。患者根据手部缺血症状的严重程度进行分组，包括溃疡和指截肢以及结缔组织病（CTD）的存在情况。通过创建一个客观严重程度量表（指阻塞指数[DOI]）将血管造影与PPG进行比较。
平均随访15.2年（范围10至22年）。最初，21例患者（48%）有中度症状，23例患者（52%）有严重的手部缺血症状。28例患者的随访症状改善（26例CTD患者中的13例，18例非CTD患者中的15例），15例患者（26例CTD患者中的12例，18例非CTD患者中的3例）症状保持不变，仅1例患者（26例CTD患者中的1例）症状恶化。17例（65%）CTD患者（n = 26）出现一个或多个溃疡，6例（24%）接受了一次或多次指截肢。4例（22%）非CTD患者（n = 18）出现手指溃疡（与CTD患者相比，p < 0.012），1例患者（6%）随后接受了指截肢（p = 无显著性差异）。血管造影-DOI和PPG-DOI在通过症状严重程度或溃疡发展来确定手指缺血严重程度方面同样准确。
本文所述的有症状的指动脉闭塞的良好长期预后要求避免过早进行指截肢。CTD患者情况更糟，但即使在该组中组织损失也较小。指PPG在确定手部缺血严重程度方面与血管造影一样准确。
