The influence of the characteristics of ischemic tissue lesions on ulcer healing time after infrainguinal bypass for critical leg ischemia
The influence of the characteristics of ischemic tissue lesions on ulcer healing time after infrainguinal bypass for critical leg ischemia
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DOI：
10.1016/j.jvs.2008.11.045
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发表时间：
2009-04-01
影响因子：
4.3
通讯作者：
Alback, Anders
中科院分区：
文献类型：
--
作者：
Soderstrom, Maria;Aho, Pekka-Sakari;Alback, Anders
目的：溃疡愈合在严重下肢缺血（CLI）的研究中很少报道。本研究的目的是分析局部因素影响溃疡愈合时间后腹股沟下旁路手术（IBS）CLI方丹IV。方法：在这项前瞻性单中心队列研究中，110例（113条腿）接受IBS由于CLI缺血性组织缺损在2006年进行了前瞻性随访1年后的旁路。在就诊时确定溃疡位置、持续时间、坏疽的存在和德克萨斯大学伤口分类（UTWCS）。计算缺血性组织缺损的愈合时间、下肢挽救时间、通畅率和生存率。缺血性组织病变和患者合并症的特点进行了分析，以确定不良outcome.Results的危险因素：完全溃疡愈合（+/- SE），达到74% +/- 5%的腿IBS后12个月。中位溃疡愈合时间为186天（范围：11至> 365天）。12个月时的下肢挽救率、二期通畅率和生存率分别为87% +/-3%、82% +/-4%和76% +/-5%。12个月时，55%的患者实现了溃疡愈合的无截肢生存率。位于中足和后足的缺血性组织病变显著延长了溃疡愈合时间（风险比[HR] 0.4，95%置信区间[CI] 0.1至0.9，P = 0.044）。UTWCS分类均不能预测溃疡愈合时间或腿部挽救。肠易激综合征前溃疡持续时间中位数为68天，范围为6 - 1154天。溃疡持续时间与溃疡愈合时间无关（斯皮尔曼r = 0.138，P = 0.267）。缺血性溃疡伴坏疽与溃疡愈合时间延长无关（P = 0.353）。结论：缺血性组织病变的位置影响溃疡愈合时间。根据我们的研究，UTWCS可用作缺血性溃疡的描述性分类，但不能预测腹股沟下旁路手术后溃疡愈合时间或腿部挽救。（J Vase Surg 2009;49：932-7.）
Objective: Ulcer healing is a seldom reported outcome in studies of critical leg ischemia (CLI). The aim of this study was to analyze local factors affecting ulcer healing time after infrainguinal bypass surgery (IBS) for CLI Fontaine IV.Methods: In this prospective single center cohort study, 110 patients (113 legs) undergoing IBS due to CLI with ischemic tissue defects during year 2006 were followed prospectively for 1 year after the bypass. Ulcer location, duration, presence of gangrene, and the University of Texas wound classification (UTWCS) were determined at presentation. Healing time of the ischemic tissue defects, leg salvage, patency, and survival were calculated. The characteristics of the ischemic tissue lesions and patient comorbidities were analyzed to determine risk factors for adverse outcome.Results: Complete ulcer healing (+/- SE) was achieved in 74% +/- 5% of the legs 12 months after IBS. Median ulcer healing time was 186 days (range, 11 to > 365 days). Leg salvage, secondary patency, and survival at 12 months were 87% +/- 3%, 82% +/- 4%, and 76% +/- 5%, respectively. Amputation-free survival with healed ulcers was attained in 55% at 12 months. Ischemic tissue lesions located in the mid- and hindfoot had significantly prolonged ulcer healing time (hazard ratio [HR] 0.4, 95% confidence interval [CI] 0.1 to 0.9, P = .044). None of the UTWCS classes predicted either ulcer healing time or leg salvage. Median ulcer duration before IBS was 68 days, range, 6 to 1154 days. Ulcer duration did not correlate with ulcer healing time (Spearman r = 0.138, P = .267). Ischemic ulcers with gangrene were not associated with prolonged ulcer healing time (P = .353).Conclusion: The location of the ischemic tissue lesions influences ulcer healing time. According to our study UTWCS can be used as descriptive classification of ischemic ulcers but it does not predict the ulcer healing time or leg salvage after infrainguinal bypass surgery. (J Vase Surg 2009;49:932-7.)