Early ABI Testing May Decrease Risk of Amputation for Patients With Lower Extremity Ulcers.
Early ABI Testing May Decrease Risk of Amputation for Patients With Lower Extremity Ulcers.
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DOI：
10.1016/j.avsg.2021.08.015
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发表时间：
2022-02
影响因子：
1.5
通讯作者：
Humphries, Misty D.
中科院分区：
文献类型：
--
作者：
Aguirre, Angela;Sharma, Kritika;Arora, Aman;Humphries, Misty D.
患有糖尿病或外周动脉疾病（PAD）下肢伤口的患者截肢的风险高达25%。在动脉疾病患者中，血运重建降低了截肢的风险。我们的目的是确定动脉灌注的早期评估是否与截肢的风险相关。我们回顾性分析了18个月内因Rutherford 5级和6级慢性肢体威胁性缺血转诊至血管诊所的患者，以确定患者在确定伤口时是否进行了脉搏检查，以及何时进行踝臂指数（ABI）测试以评估灌注。Kaplan Meier分析用于确定ABI测试的时间是否影响血运重建时间、伤口愈合和截肢风险。确定了93例下肢伤口患者。其中，59名患者（63%）在发现伤口时没有接受初级保健提供者的脉搏检查。根据患者何时接受踝臂指数测试以评估动脉灌注情况对患者进行分类。24例患者进行了早期ABI（< 30天）测试，其余69例患者进行了晚期ABI测试。早期ABI组患者比晚期组患者更有可能通过PCP进行脉搏检查，12例（50%）vs. 22例（32%），P = 0.03。早期ABI患者的血管转诊时间更快（13天比91天，P < 0.001）。早期ABI患者的伤口愈合时间也比晚期ABI患者快（117天对287天，P < 0.001）。最后，接受早期ABI的患者不太可能需要截肢（图1），尽管这没有达到统计学显著性（P = 0.07）。早期ABI检测可加快专科转诊和血运重建时间。它可以缩短伤口愈合的时间。需要更大的队列研究来确定早期ABI测试对降低截肢率的总体影响。
Patients with lower extremity wounds from diabetes mellitus or peripheral artery disease (PAD) have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine if the early assessment of arterial perfusion correlates with the risk of amputation. We retrospectively reviewed patients referred to the vascular clinic over 18 months with Rutherford Grade 5 and 6 chronic limb-threatening ischemia to determine if patients had a pulse exam done at the time the wound was identified and when ankle brachial index (ABI) testing to evaluate perfusion was performed. Kaplan Meier analysis was used to determine if the timing of ABI testing affected the time to revascularization, wound healing, and risk of amputation. Ninety-three patients with lower extremity wounds were identified. Of these, 59 patients (63%) did not have a pulse exam performed by their primary care provider when the wound was identified. Patients were classified by when they underwent ankle brachial index testing to assess arterial perfusion. Twenty-four had early ABI (< 30 days) testing, with the remaining 69 patients having late ABI testing. Patients in the early ABI group were more likely to have a pulse exam done by their PCP than those in the late group, 12 (50%) vs. 22 (32%), P = 0.03. Early ABI patients had a quicker time to vascular referral (13 days vs. 91 days, P < 0.001). Early ABI patients also had quicker times to wound healing than those in the late group (117 days vs. 287 days, P < 0.001). Finally, patients that underwent early ABI were less likely to require amputation (Fig. 1), although this did not reach statistical significance (P = 0.07). Early ABI testing expedites specialty referral and time to revascularization. It can decrease the time to wound healing. Larger cohort studies are needed to determine the overall effect of early ABI testing to decrease amputation rates.
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影响因子：
37.8
作者：
Gerhard-Herman MD;Gornik HL;Barrett C;Barshes NR;Corriere MA;Drachman DE;Fleisher LA;Fowkes FG;Hamburg NM;Kinlay S;Lookstein R;Misra S;Mureebe L;Olin JW;Patel RA;Regensteiner JG;Schanzer A;Shishehbor MH;Stewart KJ;Treat-Jacobson D;Walsh ME
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作者：
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通讯作者：
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影响因子：
3.7
作者：
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作者：
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通讯作者：
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