Abstract：
OBJECTIVE: This study aimed to compare the influence of inframalleolar (IM) P0/P1 on wound healing in bypass surgery vs endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI).
METHODS: We retrospectively analyzed the multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. IM P represents target artery crossing into foot, with intact pedal arch (P0) and absent or severely diseased pedal arch (P1). The endpoints were wound healing, limb salvage (LS), and postoperative complications.
RESULTS: We analyzed 66 and 189 propensity score-matched pairs in the IM P0 and IM P1 cohorts, respectively. In the IM P0 cohort, the 1-year wound healing rates were 94.5% and 85.7% in the bypass surgery and EVT groups, respectively (P = .092), whereas those in the IM P1 cohort were 86.2% and 66.2% in the bypass surgery and EVT groups, respectively (P < .001). In the IM P0 cohort, the 2-year LS rates were 96.7% and 94.1% in the bypass surgery and EVT groups, respectively (P = .625), and those in the IM P1 cohort were 91.8% and 81.5% in the bypass surgery and EVT groups, respectively (P = .004). No significant differences were observed between the bypass surgery and EVT in terms of postoperative complication rates in either the IM P0 or P1 cohorts.
CONCLUSIONS: Bypass surgery facilitated better wound healing and LS than EVT in patients with IM P1. Conversely, no differences in wound healing or LS were observed between groups in patients with IM P0. Bypass surgery should be considered a better revascularization strategy than EVT in patients with tissue loss and IM P1 disease.
METHODS: We retrospectively analyzed the multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. IM P represents target artery crossing into foot, with intact pedal arch (P0) and absent or severely diseased pedal arch (P1). The endpoints were wound healing, limb salvage (LS), and postoperative complications.
RESULTS: We analyzed 66 and 189 propensity score-matched pairs in the IM P0 and IM P1 cohorts, respectively. In the IM P0 cohort, the 1-year wound healing rates were 94.5% and 85.7% in the bypass surgery and EVT groups, respectively (P = .092), whereas those in the IM P1 cohort were 86.2% and 66.2% in the bypass surgery and EVT groups, respectively (P < .001). In the IM P0 cohort, the 2-year LS rates were 96.7% and 94.1% in the bypass surgery and EVT groups, respectively (P = .625), and those in the IM P1 cohort were 91.8% and 81.5% in the bypass surgery and EVT groups, respectively (P = .004). No significant differences were observed between the bypass surgery and EVT in terms of postoperative complication rates in either the IM P0 or P1 cohorts.
CONCLUSIONS: Bypass surgery facilitated better wound healing and LS than EVT in patients with IM P1. Conversely, no differences in wound healing or LS were observed between groups in patients with IM P0. Bypass surgery should be considered a better revascularization strategy than EVT in patients with tissue loss and IM P1 disease.
摘要：
目的：本研究旨在比较踝下（IM）P0/P1对慢性威胁肢体缺血（CLTI）患者旁路手术和血管内治疗（EVT）伤口愈合的影响。
方法：我们回顾性分析了2015年至2022年间接受CLTI腹股沟下血运重建的患者的多中心数据。IMP代表穿过脚的目标动脉，具有完整的踏板弓（P0）和缺失或严重病变的踏板弓（P1）。终点是伤口愈合，肢体抢救（LS），术后并发症。
结果：我们分析了IMP0和IMP1队列中66和189个倾向得分匹配对，分别。在IMP0队列中，术后1年伤口愈合率分别为94.5%和85.7%,分别（p=.092），而在转流手术和EVT组中，IMP1队列的患者分别为86.2%和66.2%，分别（p<.001）。在IMP0队列中，搭桥手术和EVT组的2年LS率分别为96.7%和94.1%，分别(p=.625)，在转流手术和EVT组中，IMP1队列中的比例分别为91.8%和81.5%，分别(p=.004)。在IMP0或P1队列中，搭桥手术和EVT在术后并发症发生率方面均未观察到显着差异。
结论：在IMP1患者中，旁路手术比EVT更有利于伤口愈合和LS。相反，IMP0患者的伤口愈合或LS无差异。对于有组织丢失和IMP1疾病的患者，旁路手术应被认为是比EVT更好的血运重建策略。
方法：我们回顾性分析了2015年至2022年间接受CLTI腹股沟下血运重建的患者的多中心数据。IMP代表穿过脚的目标动脉，具有完整的踏板弓（P0）和缺失或严重病变的踏板弓（P1）。终点是伤口愈合，肢体抢救（LS），术后并发症。
结果：我们分析了IMP0和IMP1队列中66和189个倾向得分匹配对，分别。在IMP0队列中，术后1年伤口愈合率分别为94.5%和85.7%,分别（p=.092），而在转流手术和EVT组中，IMP1队列的患者分别为86.2%和66.2%，分别（p<.001）。在IMP0队列中，搭桥手术和EVT组的2年LS率分别为96.7%和94.1%，分别(p=.625)，在转流手术和EVT组中，IMP1队列中的比例分别为91.8%和81.5%，分别(p=.004)。在IMP0或P1队列中，搭桥手术和EVT在术后并发症发生率方面均未观察到显着差异。
结论：在IMP1患者中，旁路手术比EVT更有利于伤口愈合和LS。相反，IMP0患者的伤口愈合或LS无差异。对于有组织丢失和IMP1疾病的患者，旁路手术应被认为是比EVT更好的血运重建策略。
