■慢性威胁肢体缺血的治疗存在很大差异,包括实践范式,血管提供者专业,使用的设备,和先进的开放和/或血管内治疗的经验,在其他因素中。我们独特的实践包括以患者为中心,临床导向的介入放射科医师和血管外科医师,在办公室介入套房(OIS)进行治疗,门诊手术中心(ASC),和医院住院/门诊设置。我们评估我们的结果,集中在主要截肢率,同时将病例复杂性和比率与以前发表的数据进行比较。
■对2015年至2021年在我们的实践中接受治疗的所有卢瑟福4、5和6名患者进行了回顾性审查。基线患者特征,病变的复杂性,并收集主要截肢率。对患有更复杂疾病或需要重新干预的患者进行了多学科公开讨论,以确定该小组的血运重建方法。肢体抢救,临床驱动的靶病变血运重建(TLR),重复干预,随访时间,和死亡率进行了评估。
■对351名女性和478名男性的829条肢体进行了治疗,慢性威胁肢体缺血.在829个案例中,541例至少有1例慢性完全闭塞(CTO),包括115个肢体,2个CTO和24个肢体,3个CTO,63.5%的病例需要多级干预。一年死亡率为6.2%,下肢截肢率为2.3%,平均随访时间为22.3个月。在12个月内重复干预的163例患者中,一年无临床驱动的TLR率为78.7%。在研究过程中,在股pop支架子集内,当采用较新的支架技术如编织镍钛诺和药物洗脱技术时,再介入时间显著增加(p=0.03).1年无截肢生存率(AFS)为91.5。
■手术和血管内治疗的多学科方法可能为患者提供AFS的最佳机会。
结论:在多学科实践中,严重威胁肢体缺血的真实世界实践表明,在如此庞大的人群中,对于报告最好的一年无截肢生存率的患者,结果良好。基于密切常规随访和动脉双工监测的强大临床实践是一个主要因素,以及利用药物洗脱支架和药物涂层球囊的最新技术,以获得最佳患者预后。我们希望这项研究为其他实践提供指导,以建立或修改其实践以获得最佳的程序和临床结果。
UNASSIGNED: There is great variability in the treatment of chronic limb-threatening ischemia, including the practice paradigm, vascular provider specialty, devices utilized, and experience with advanced open and/or endovascular treatments, among other factors. Our unique practice consists of patient-centered, clinically oriented Interventional Radiologists and Vascular Surgeons, with treatments being performed in Office Interventional Suites (OIS), Ambulatory surgery center (ASC), and hospital inpatient/outpatient settings. We evaluate our results, centered on major amputation rates while comparing case complexity and rates with previously published data.
UNASSIGNED: A retrospective review was performed of all Rutherford 4, 5, and 6 patients who underwent treatment in our practice from 2015 to 2021. Baseline patient characteristics, complexity of lesions, and major amputation rates were collected. Patients with more complex diseases or requiring re-interventions were openly discussed in multidisciplinary fashion to determine the group\'s approach to revascularization. Limb salvage, clinically driven target lesion revascularization (TLR), repeat interventions, length of follow-up, and mortality were assessed.
UNASSIGNED: Treatment was performed in 829 limbs in 351 females and 478 males, with chronic limb-threatening ischemia. Of the 829 cases, 541 cases had at least 1 chronic total occlusion (CTO), including 115 limbs with 2 CTOs and 24 limbs with 3 CTOs with 63.5% of cases requiring multilevel intervention. One year mortality rate was 6.2% with a major lower extremity amputation rate of 2.3% with a mean length of follow-up of 22.3 months. One-year freedom from clinically driven TLR rate was 78.7% with repeat intervention in 163 cases within 12 months. Over the course of the study, within the femoropopliteal stent subset, there was a significant increase in time to reintervention when newer stent technologies were utilized such as woven nitinol and drug-eluting technology (p=0.03). The overall 1-year amputation-free survival (AFS) was 91.5.
UNASSIGNED: Multidisciplinary approach with surgical and endovascular treatment may provide patients with the best chance of AFS.
CONCLUSIONS: Real world practice of critical limb-threatening ischemia in a multidisciplinary practice demonstrates favorable outcomes for patients with the best reported one year major amputation free survival in a population this large. A strong clinical practice based on close routine follow up and arterial duplex monitoring is a major contributing factor, as well as utilization of the latest technology in drug eluting stents and drug coated balloons for best patient outcomes. We hope this study provides other practices with a guideline for establishing or modifying their practice to attain the best procedural and clinical outcomes.