目的:为了检查慢性威胁肢体缺血(CLTI)患者的搭桥手术和血管内治疗(EVT)之间的结局,根据全球血管指南(GVG)分类为旁路优先。
方法:我们回顾性分析了因CLTI伴伤口行腹股沟下血运重建术患者的多中心数据,缺血,和足部感染(WIfI)阶段3-4和全球肢体解剖分期系统(GLASS)阶段III,在2015年至2020年期间,GVG将其归类为旁路首选类别。终点是肢体抢救和伤口愈合。
结果:我们分析了156例搭桥手术和183例EVT手术后的301例患者和339条肢体。2年保肢率搭桥手术组为92.2%,EVT组为76.3%,分别(P<0.01)。搭桥手术组1年伤口愈合率为86.7%,EVT组为67.8%(P<0.01)。多因素分析显示血清白蛋白水平降低(P<0.01),伤口等级增加(P=.04),EVT(P<0.01)是严重截肢的危险因素。血清白蛋白水平降低(P<0.01),伤口等级增加(P<0.01),GLASS膝下坡度(P=.02),和下踝(IM)P等级(P=0.01),和EVT(P<0.01)是伤口愈合受损的危险因素。EVT术后患者保肢的亚组分析,血清白蛋白水平降低(P<0.01),伤口等级增加(P=0.03),增加IMP等级(P=.04),充血性心力衰竭(P<0.01)是严重截肢的危险因素。根据这些危险因素的存在进行评分,EVT后2年保肢率分别为83.0%和42.8%,总分0-2和3-4(P<0.01)。
结论:旁路手术在WIfI3-4期和GLASSIII期患者中提供了更好的保肢和伤口愈合,被GVG归类为旁路首选类别。在EVT后的患者中,血清白蛋白水平,伤口等级,IMP等级,充血性心力衰竭与严重截肢有关。尽管搭桥手术可被视为被归类为搭桥首选类别的患者的初始血运重建手术,如果必须选择EVT,这些危险因素较少的患者可以预期相对可接受的结局.
The aim of this study was to examine outcomes between bypass surgery and endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI), classified as bypass-preferred according to the Global Vascular
Guidelines (GVG).
We retrospectively analyzed the multi-center data of patients who underwent infrainguinal revascularization for CLTI with Wound, Ischemia, and foot Infection (WIfI) Stage 3 to 4 and Global Limb Anatomical Staging System (GLASS) Stage III, which is classified as bypass-preferred category by the GVG between 2015 and 2020. The endpoints were limb salvage and wound healing.
We analyzed 301 patients and 339 limbs following 156 bypass surgeries and 183 EVTs. The 2-year limb salvage rates were 92.2% in the bypass surgery group and 76.3% in the EVT group, respectively (P < .01). The 1-year wound healing rates were 86.7% in the bypass surgery group and 67.8% in the EVT group (P < .01). Multivariate analysis shows decreased serum albumin level (P < .01), increased wound grade (P = .04), and EVT (P < .01) were risk factors for major amputation. Decreased serum albumin level (P < .01), increased wound grade (P < .01), GLASS infrapopliteal grade (P = .02), inframalleolar (IM) P grade (P = .01), and EVT (P < .01) were risk factors for impaired wound healing. Subgroup analysis of limb salvage in patients after EVT, decreased serum albumin level (P < .01), increased wound grade (P = .03), increased IM P grade (P = .04), and congestive heart failure (P < .01) were risk factors for major amputation. According to scoring by existence of these risk factors, 2-year limb salvage rates following EVT were 83.0% and 42.8% for the total score of 0 to 2 and of 3 to 4, respectively (P < .01).
Bypass surgery provides better limb salvage and wound healing in patients with WIfI Stage 3 to 4 and GLASS Stage III, which is classified as bypass-preferred category by the GVG. In patients after EVT, serum albumin level, wound grade, IM P grade, and congestive heart failure were related to major amputation. Although bypass surgery may be considered as initial revascularization procedure in patients classified as bypass-preferred category, in case that EVT has to be selected, relatively acceptable outcomes can be expected in patients with less of these risk factors.