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.
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。