Risk of major amputation in patients with intermittent claudication undergoing early revascularization
Risk of major amputation in patients with intermittent claudication undergoing early revascularization
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DOI：
10.1002/bjs.10765
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发表时间：
2018-05-01
影响因子：
9.6
通讯作者：
Morris, D. R.
中科院分区：
文献类型：
--
作者：
Golledge, J.;Moxon, J. V.;Morris, D. R.
背景：血管重建术越来越多地被用于间歇性跛行的治疗，但很少有研究报道这一策略的长期结果。这项研究的目的是比较接受血管重建术的间歇性跛行患者和最初未接受血管重建术的患者的长期预后。方法：从澳大利亚昆士兰州三家医院的门诊招募有间歇性跛行症状并被诊断为外周动脉疾病的患者。根据不同血管专家的不同做法，患者要么接受早期血运重建治疗，要么接受最初的保守治疗。使用关联的入院记录数据在门诊对患者进行跟踪。主要结果是要求进行大范围截肢。采用Kaplan-Meier曲线、Cox回归和竞争风险分析比较截肢率。结果：共纳入456例患者，178例(390%)接受早期血管重建术，278例(610%)接受初始保守治疗。对患者进行平均(S.D.)随访。距今500年(337年)。在接受早期血运重建和初始保守治疗的患者中，估计5年大腿截肢率分别为62%和07%(P=0003)。在调整了其他危险因素的模型中，早期血管重建与主要截肢需求增加相关(不同模型中的相对风险为540至422)。结论：早期接受血管重建的间歇性跛行患者截肢的风险似乎高于最初接受保守治疗的患者。
Background: Revascularization is being used increasingly for the treatment of intermittent claudication and yet few studies have reported the long-term outcomes of this strategy. The aim of this study was to compare the long-term outcome of patients with intermittent claudication who underwent revascularization compared with a group initially treated without revascularization.Methods: Patients with symptoms of intermittent claudication and a diagnosis of peripheral arterial disease were recruited from outpatient clinics at three hospitals in Queensland, Australia. Based on variation in the practices of different vascular specialists, patients were either treated by early revascularization or received initial conservative treatment. Patients were followed in outpatient clinics using linked hospital admission record data. The primary outcome was the requirement for major amputation. Kaplan-Meier curves, Cox regression and competing risks analyses were used to compare major amputation rates.Results: Some 456 patients were recruited; 178 (390 per cent) underwent early revascularization and 278 (610 per cent) had initial conservative treatment. Patients were followed for a mean(s.d.) of 500(337) years. The estimated 5-year major amputation rate was 62 and 07 per cent in patients undergoing early revascularization and initial conservative treatment respectively (P = 0003). Early revascularization was associated with an increased requirement for major amputation in models adjusted for other risk factors (relative risk 540 to 422 in different models).Conclusion: Patients presenting with intermittent claudication who underwent early revascularization appeared to be at higher risk of amputation than those who had initial conservative treatment.