Luther M, Albäck A
Surgical Department, Vasa Central Hospital, Finland.
Ann Chir Gynaecol. 1995;84(4):373-8.
To evaluate the change in the type of acute leg ischaemia and the outcome of its treatment in relation to the experience of the surgeon responsible for the treatment.
A 12-year (1980-1991) retrospective study based on hospital records and population vital statistics.
A defined population of 165,000 served by one central hospital (CH) and two district hospitals (DH).
282 interventions performed for acute leg ischaemia.
Type of leg ischaemia, reintervention, amputation and survival rates in relation to the type of ischaemia, treatment and surgical expertise.
Thrombotic acute ischaemia increased by 91% and graft occlusions by 130% while embolisation numbers remained unchanged during the period. With junior, general and vascular surgeons operating on acute ischaemia, the respective 30-day amputation rates were 25%, 18% and 9%. Postoperative mortality was 29%, 33% and 8% respectively. The reconstruction rate for the vascular surgeon was 67% with 33% thrombectomies, while the figures for junior surgeons were 2% and 98% and for senior surgeons 6% and 94%.
Mortality and amputation rates in acute ischaemia are high. By judicious use of different treatment modalities, as judged by vascular surgical experience, better limb salvage rates may be achieved especially in patients with acute on chronic ischaemia.
评估急性下肢缺血类型的变化及其治疗结果与负责治疗的外科医生经验之间的关系。
基于医院记录和人口生命统计数据的12年（1980 - 1991年）回顾性研究。
由一家中心医院（CH）和两家地区医院（DH）服务的165,000特定人群。
针对急性下肢缺血进行的282例干预措施。
下肢缺血类型、再次干预、截肢率和生存率与缺血类型、治疗方法及手术专业水平的关系。
在此期间，血栓形成性急性缺血增加了91%，移植物闭塞增加了130%，而栓塞病例数保持不变。由初级外科医生、普通外科医生和血管外科医生对急性缺血进行手术时，各自的30天截肢率分别为25%、18%和9%。术后死亡率分别为29%、33%和8%。血管外科医生的重建率为67%，血栓切除术为33%，而初级外科医生的数字分别为2%和98%，高级外科医生为6%和94%。
急性缺血的死亡率和截肢率很高。根据血管外科经验判断，明智地使用不同治疗方式，尤其是在慢性缺血急性发作的患者中，可能会获得更好的肢体保全率。
