Abstract：
BACKGROUND: Critical limb threatening ischemia (CLTI), particularly in patients with ischemic ulceration has been associated with significant morbidity and mortality. Typically, endovascular therapy has been first-line therapy for our patients, but this strategy has come into question based upon the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Threatening Ischemia (BEST-CLI) trial data.
RESULTS: For comparative purposes, we evaluated outcomes from 150 CLTI patients with ischemic ulceration treated with endovascular-first therapy. The mean age was 72 years in this predominate male, Caucasian, ambulatory group. The major co-morbidities were smoking history in 49% and diabetes mellitus in 67%.` Anatomic scoring, using Society for Vascular Surgery criteria, revealed only 35.6% had favorable anatomy (Global Limb Anatomical Staging System stage of 0,1) for long-term patency compared to 64.4% of limbs with unfavorable anatomy for long-term patency (Global Limb Anatomical Staging System stage 2,3). Stents were used in 47% of cases. Reintervention occurred in 36% over 24 months follow-up. At 12 and 24 months, the Kaplan-Meier projections for survival was 0.80 (0.73, 0.87) and 0.69 (0.59, 0.79); amputation was 0.69 (0.61, 0.77) and 0.59 (0.46, 0.71); amputation-free survival (AFS) was 0.56 (0.48, 0.65) and 0.38 (0.27, 0.50), respectively. Amputation was more common in those with reinterventions (P = 0.033). Mortality was predicted with ankle brachial index ≤0.40 or ≥1.30 (P = 0.0019) and the presence of infection (P = 0.0047). AFS was predicted by the presence of any infection (P = 0.0001).
CONCLUSIONS: Despite technically successful endovascular treatment, patients who present with CLTI maintain a high-risk for limb loss and mortality. Amputation prevention must vigilantly address infection risk. These data correlate with outcomes from BEST-CLI trial enhancing applicability to patient-centered care.
RESULTS: For comparative purposes, we evaluated outcomes from 150 CLTI patients with ischemic ulceration treated with endovascular-first therapy. The mean age was 72 years in this predominate male, Caucasian, ambulatory group. The major co-morbidities were smoking history in 49% and diabetes mellitus in 67%.` Anatomic scoring, using Society for Vascular Surgery criteria, revealed only 35.6% had favorable anatomy (Global Limb Anatomical Staging System stage of 0,1) for long-term patency compared to 64.4% of limbs with unfavorable anatomy for long-term patency (Global Limb Anatomical Staging System stage 2,3). Stents were used in 47% of cases. Reintervention occurred in 36% over 24 months follow-up. At 12 and 24 months, the Kaplan-Meier projections for survival was 0.80 (0.73, 0.87) and 0.69 (0.59, 0.79); amputation was 0.69 (0.61, 0.77) and 0.59 (0.46, 0.71); amputation-free survival (AFS) was 0.56 (0.48, 0.65) and 0.38 (0.27, 0.50), respectively. Amputation was more common in those with reinterventions (P = 0.033). Mortality was predicted with ankle brachial index ≤0.40 or ≥1.30 (P = 0.0019) and the presence of infection (P = 0.0047). AFS was predicted by the presence of any infection (P = 0.0001).
CONCLUSIONS: Despite technically successful endovascular treatment, patients who present with CLTI maintain a high-risk for limb loss and mortality. Amputation prevention must vigilantly address infection risk. These data correlate with outcomes from BEST-CLI trial enhancing applicability to patient-centered care.
摘要：
背景：严重威胁肢体缺血（CLTI），尤其是在缺血性溃疡患者中,其发病率和死亡率显著升高.通常,血管内治疗一直是我们患者的一线治疗，但根据危重性肢体威胁性缺血患者的最佳血管内治疗和最佳手术治疗(BEST-CLI)试验数据,这一策略受到质疑.
方法：&结果：出于比较目的，我们评估了150例接受血管内先行治疗的CLTI缺血性溃疡患者的结局.这位前占主导地位的男性的平均年龄是72岁，高加索人,门诊组。主要合并症为吸烟史的49%和糖尿病史的67%。解剖计分,使用SVS标准，显示只有35.6％的人具有长期通畅的有利解剖结构（GLASS为0,1），而64.4％的四肢具有长期通畅的不利解剖结构（GLASS2,3）。47%的病例使用支架。在24个月的随访中，有36％的人再次干预。在12个月和24个月时，生存的Kaplan-Meier预测为0.80（0.73，0.87）和0.69（0.59，0.79）；截肢为0.69（0.61，0.77）和0.59（0.46，0.71）；无截肢生存率为0.56（0.48，0.65）和0.38（0.27，0.50），分别。截肢在再次干预者中更为常见(p=0.033)。在ABI<0.40或>1.30(p=0.0019)和存在感染(p=0.0047)的情况下预测死亡率。通过任何感染的存在来预测无截肢存活(p=0.0001)。
结论：尽管技术上成功的血管内治疗，存在CLTI的患者存在较高的肢体丢失和死亡风险.预防截肢必须警惕地解决感染风险。这些数据与BEST-CLI试验的结果相关，增强了对以患者为中心的护理的适用性。
方法：&结果：出于比较目的，我们评估了150例接受血管内先行治疗的CLTI缺血性溃疡患者的结局.这位前占主导地位的男性的平均年龄是72岁，高加索人,门诊组。主要合并症为吸烟史的49%和糖尿病史的67%。解剖计分,使用SVS标准，显示只有35.6％的人具有长期通畅的有利解剖结构（GLASS为0,1），而64.4％的四肢具有长期通畅的不利解剖结构（GLASS2,3）。47%的病例使用支架。在24个月的随访中，有36％的人再次干预。在12个月和24个月时，生存的Kaplan-Meier预测为0.80（0.73，0.87）和0.69（0.59，0.79）；截肢为0.69（0.61，0.77）和0.59（0.46，0.71）；无截肢生存率为0.56（0.48，0.65）和0.38（0.27，0.50），分别。截肢在再次干预者中更为常见(p=0.033)。在ABI<0.40或>1.30(p=0.0019)和存在感染(p=0.0047)的情况下预测死亡率。通过任何感染的存在来预测无截肢存活(p=0.0001)。
结论：尽管技术上成功的血管内治疗，存在CLTI的患者存在较高的肢体丢失和死亡风险.预防截肢必须警惕地解决感染风险。这些数据与BEST-CLI试验的结果相关，增强了对以患者为中心的护理的适用性。
