Editor's Choice - Diabetic Limb Salvage With Endovascular Revascularisation and Free Tissue Transfer: Long-Term Follow up.
Editor's Choice - Diabetic Limb Salvage With Endovascular Revascularisation and Free Tissue Transfer: Long-Term Follow up.
复制标题
编辑精选 - 血管内血运重建和游离组织移植的糖尿病肢体挽救：长期随访。
DOI：
10.1016/j.ejvs.2018.11.010
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Shih
中科院分区：
文献类型：
--
作者：
Chien;Chieh‐Chi Huang;H. Hsu;Chih;Shih
目的血管搭桥手术与游离皮瓣覆盖相结合是缺血性下肢复杂软组织缺损的治疗方法之一。血管内血运重建已成为许多中心治疗肢体缺血的一线治疗方法。外科医生现在在血管成形术后进行游离组织移植。评估接受腘窝下血管内血运重建和游离皮瓣重建的糖尿病患者的早期和长期保肢率。方法对2008年至2014年间连续接受血管内血运重建和游离皮瓣重建的下肢患者进行回顾性研究，随访至少2年或至死亡 （平均随访 39 ± 17 个月）。使用Cox回归分析来分析影响结果的变量。结果有55名患者接受了60次手术。五名患者接受了对侧腿的手术。所有组织病变均为 Wagner-Meggit 分类 3 级或 4 级。36 例患者为 TASC C 病变，24 例患者为 TASC D 病变。 30%的病例合并膝下三支血管病变，28%同时累及胫前动脉和后动脉，7%和2%累及胫前动脉或胫后动脉和腓动脉。游离皮瓣成功率为95%。围手术期死亡率为1.7%。二十一例需要再次手术干预。平均入院时间为 32 ± 9 天。一年和五年无截肢生存率分别为94%和68%，患者生存率分别为95%和67%，保肢率分别为93%和91%。 结论结果表明，基于腘下动脉血管内血运重建的游离组织移植可以实现良好的早期和晚期保肢效果。这可以成为具有复杂软组织缺陷的糖尿病患者的进一步治疗选择。
ObjectiveCombining vascular bypass surgery with free flap coverage is one of the treatment methods for complex soft tissue defects in the ischaemic lower limb. Endovascular revascularisation has become the first line treatment for limb ischaemia in many centres. Surgeons now perform free tissue transfer after angioplasty. The early and long-term limb salvage rate in diabetic patients who had undergone infrapopliteal endovascular revascularisation and free flap reconstruction are assessed.MethodsThis was retrospective study of all consecutive diabetic patients who had undergone endovascular revascularisation with free flap reconstruction for lower limb salvage between 2008 and 2014. They were followed up for at least 2 years or to death (mean follow up 39 ± 17 months). Cox regression analysis was used to analyse variables influencing outcome.ResultsThere were 55 patients who had undergone 60 procedures. Five patients had undergone the procedure to the contralateral leg. All tissue lesions were Wagner–Meggit classification Grades 3 or 4. Thirty-six patients had TASC C lesions and 24 patients with TASC D lesions. Combined below knee triple vessel disease was seen in 30% of the cases, 28% involved both the anterior and posterior tibial artery, 7% and 2% involved the anterior tibial or the posterior tibial and the peroneal arteries. The free flap success rate was 95%. The peri-operative mortality was 1.7%. Twenty-one cases required surgical re-intervention. Mean length of hospital admission was 32 ± 9 days. One and five year amputation free survival rates were 94% and 68%, patient survival rates were 95% and 67%, limb salvage rates were 93% and 91% and respectively.ConclusionsThe results show that excellent early and late limb salvage can be achieved with free tissue transfer based on endovascular revascularisation of infrapopliteal arteries. This can be a further treatment option in diabetic patients with complex soft tissue defects.