Limb Salvage After Percutaneous Mechanical Thrombectomy in Patients with Acute Lower Limb Ischemia: A Retrospective Analysis from Two Institutions
Limb Salvage After Percutaneous Mechanical Thrombectomy in Patients with Acute Lower Limb Ischemia: A Retrospective Analysis from Two Institutions
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DOI：
10.1016/j.avsg.2018.11.025
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发表时间：
2019-07-01
影响因子：
1.5
通讯作者：
Lu, Xinwu
中科院分区：
文献类型：
--
作者：
Liang, Siyuan;Zhou, Long;Lu, Xinwu
背景：评价经皮机械取栓(PMT)治疗急性下肢缺血(ALI)的近期疗效，分析不同病因的ALI对肢体挽救的影响。材料与方法：对2015年1月至2017年12月在2家血管机构接受PMT治疗的112例ALI患者(平均年龄66.5岁，共117条肢体；男性61条，66条肢体)进行回顾性分析。117条肢体中，急性动脉栓塞44条(41条)，急性动脉血栓36条(34条)，急性支架或移植血管血栓37条(31条31条肢体，6条6条)。主要终点是肢体保留率，并根据病因对亚组进行分析。次要终点包括通畅率、主要出血并发症、30天死亡率和再干预率。结果：30天死亡率为3.6%。主要出血并发症发生率为2.7%。随访1年和2年的肢体保留率分别为83.8%和74.7%。亚组分析显示，术后2年急性动脉栓塞组的肢体保留率为92.9%，高于急性动脉血栓组(73.3%，P=0.04，危险比：3.6，95%可信区间：1.1~11.7)和急性支架/移植物血栓组(62.5%，P=0.01，HR：4.7，P<0.05)。95%可信区间：1.5~13.6)。结论：急性肺损伤患者行PMT治疗可有效预防3年内截肢的发生，且安全性合理，尤其是对急性动脉栓塞患者。
Background: To evaluate the short-term outcomes of percutaneous mechanical thrombectomy (PMT) in patients with acute lower limb ischemia (ALI) and to analyze the effect of ALI of different etiologies on the limb salvage.Materials and Methods: From January 2015 to December 2017, a retrospective analysis was performed on 112 patients (mean age: 66.5 years; 117 limbs in total; 66 limbs in 61 males) with ALI treated with PMT at 2 vascular institutions. Of the 117 limbs, 44 (41 patients) had acute arterial embolism, 36 (34 patients) had acute arterial thrombosis, and 37 (37 patients) had acute stent (31 limbs in 31 patients) or graft (6 limbs in 6 patients) thrombosis. The primary end point was limb salvage rate, and subgroups were analyzed by etiological factors. The secondary end points included patency rates, major bleeding complications, 30-day mortality, and reintervention rates.Results: The 30-day mortality rate was 3.6%. The incidence of major bleeding complications was 2.7%. During the follow-up, the limb salvage rates at 1 year and 2 years were 83.8% and 74.7%, respectively. Subgroup analysis showed that the limb salvage rate in patients with acute arterial embolism was 92.9% at 2 years after PMT, which was higher than that in patients with acute arterial thrombosis (73.3%, P = 0.04, hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 1.1-11.7) and acute stent/graft thrombosis (62.5%, P = 0.01, HR: 4.7, 95% CI: 1.5-13.6).Conclusions: PMT in patients with ALI is effective in preventing amputations over the 3-year study period with a reasonable safety profile, especially in patients with acute arterial embolism.