Does the Introduction of a Vascular Limb Salvage Service Improve One Year Amputation Outcomes for Patients with Chronic Limb-Threatening Ischaemia?
Does the Introduction of a Vascular Limb Salvage Service Improve One Year Amputation Outcomes for Patients with Chronic Limb-Threatening Ischaemia?
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DOI：
10.1016/j.ejvs.2020.12.007
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发表时间：
2021-04-14
影响因子：
5.7
通讯作者：
Davies, Robert S. M.
中科院分区：
文献类型：
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作者：
Nickinson, Andrew T. O.;Dimitrova, Jivka;Davies, Robert S. M.
目的：全球血管指南推荐血管保肢服务，以帮助改善慢性肢体威胁性缺血（CLTI）患者的结局，尽管文献中对其的描述有限。本研究报告了12个月的结果为门诊为基础的血管保肢（VaLS）clinic.Methods：前瞻性维护数据库的分析，涉及所有连续患者诊断CLTI内VaLS诊所从2018年2月至2019年2月，进行。将数据与从编码数据中识别的两个对照队列进行比较：1）2017年5月至2018年2月期间在诊所前接受治疗的患者（诊所前[PC]）; 2）2018年2月至2019年2月期间在诊所外接受治疗的患者（替代途径[AP]）。12个月时无大截肢是主要结局。Kaplan-Meier曲线和调整后的考克斯比例风险模型（aHR）被用来比较outcomes.Results：566例患者（VaLS 158，AP 173，PC 235）被纳入（中位年龄74岁）。在VaLS队列中治疗的患者更有可能免于大截肢，这在统计学上具有显著性（90.5%）与AP（82.1%，aHR 0.52，95%置信区间[CI] 0.28 - 0.98，p = 0.041）和PC（80.0%; aHR 0.50，95% CI 0.28 - 0.91，p = 0.022）队列，校正年龄、疾病严重程度和糖尿病后。这项研究支持全球血管指南的建议，即血管保肢诊所可以提高大截肢率。此外，该研究提供了一种可重复的服务模式，可在门诊环境中提供及时的血管评估。需要进一步评价，以评估长期结果。
Objective: Vascular limb salvage services are recommended by the Global Vascular Guidelines to help improve outcomes for patients with chronic limb-threatening ischaemia (CLTI), although their description within the literature is limited. This study reports the 12 month outcomes for an outpatient based vascular limb salvage (VaLS) clinic.Methods: An analysis of a prospectively maintained database, involving all consecutive patients diagnosed with CLTI within the VaLS clinic from February 2018-February 2019, was undertaken. Data were compared with two comparator cohorts, identified from coding data: 1) patients managed prior to the clinic, between May 2017 and February 2018 (Pre-Clinic [PC]); and 2) patients managed outside of clinic, between February 2018 and February 2019 (Alternative Pathways [AP]). Freedom from major amputation at 12 months was the primary outcome. Kaplan-Meier plots and adjusted Cox's proportional hazard models (aHR) were used to compare outcomes.Results: Five hundred and sixty-six patients (VaLS 158, AP 173, PC 235) were included (median age 74 years). Patients managed within the VaLS cohort were statistically significantly more likely to be free from major amputation (90.5%) compared with both the AP (82.1%, aHR 0.52, 95% confidence interval [CI] 0.28 - 0.98, p = .041) and the PC (80.0%; aHR 0.50, 95% CI 0.28 - 0.91, p = .022) cohorts at 12 months, after adjustment for age, disease severity, and presence of diabetes.Conclusion: This study supports the recommendations of the Global Vascular Guidelines that vascular limb salvage clinics may improve the rate of major amputation. Furthermore, the study provides a reproducible service model that delivers timely vascular assessment in an ambulatory setting. Further evaluation is required to assess longer term outcomes.