Critical analysis of clinical success after surgical bypass for lower-extremity ischemic tissue loss using a standardized definition combining multiple parameters: A new paradigm of outcomes assessment
Critical analysis of clinical success after surgical bypass for lower-extremity ischemic tissue loss using a standardized definition combining multiple parameters: A new paradigm of outcomes assessment
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DOI：
10.1016/j.jamcollsurg.2007.01.037
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发表时间：
2007-05-01
影响因子：
5.2
通讯作者：
Youkey, Jerry R.
中科院分区：
文献类型：
--
作者：
Taylor, Spence M.;Cull, David L.;Youkey, Jerry R.
背景：传统上以移植物通畅率或肢体保存率来定义的下肢血管重建手术后的成功，没有考虑其他直观的重要指标。这项研究的目的是构建一个更全面的临床成功的定义，并确定失败的临床预测因素。STUDY设计：为了这项研究的目的，临床成功被定义为达到以下所有标准：移植物通畅到伤口愈合点；肢体保全1年；维持1年的步行状态；以及存活6个月。在1998至2004年间，连续331名因卢瑟福III号严重肢体缺血而接受搭桥手术的患者接受了临床成功的评估。结果：尽管获得了可接受的移植物通畅率(36个月时为72.7%)和肢体保存率(36个月时为73.3%)，但结合所有4个定义参数的临床成功率仅为44.4%。失败的独立预测因素包括入院时活动状态受损(OR[OR]=6.44)、腹股沟下病变(OR=3.93)、终末期肾病(OR=2.48)、坏疽(OR=2.40)和高脂血症(OR=0.56)。除出现高脂血症外，具有所有预测指标的患者失败的概率为97%(OR 150.6)。结论：尽管获得了可接受的移植物通畅和保肢，但使用结合多个参数的定义时，成功的患者不到一半。有必要重新评估我们目前对某些高危患者的严重肢体缺血的治疗方法。
BACKGROUND: Success after surgical revascularization of the lower extremities, traditionally defined by graft patency or limb salvage, fails to consider other intuitive measures of importance. The purpose of the study was to construct a more comprehensive definition of clinical success and to identify clinical predictors of failure.STUDY DESIGN: For the purpose of this study, clinical success was defined as achieving all of the following criteria: graft patency to the point of wound healing; limb salvage for I year; maintenance of ambulatory status for I year; and survival for 6 months. Between 1998 and 2004, 331 consecutive patients undergoing bypass for Rutherford III critical limb ischemia were measured for clinical success. Bivariate and logistic regression analyses were performed to determine demographic differences between success and failure.RESULTS: Despite achieving acceptable graft patency (72.7% at 36 months) and limb salvage (73.3% at 36 months), clinical success combining all 4 defined parameters was only 44.4%. Independent predictors of failure included impaired ambulatory status at presentation (odds ratio [OR] = 6.44), presence of infrainguinal disease (OR = 3.93), end-stage renal disease (OR = 2.48), presence of gangrene (OR = 2.40), and hyperlipidemia (OR = 0.56). Probability of failure in patients possessing every predictor except hyperlipidemia at presentation was 97% (OR 150.6).CONCLUSIONS: Despite achieving acceptable graft patency and limb salvage, fewer than half of the patients achieved success when using a definition combining multiple parameters. A reappraisal of our current approach to critical limb ischemia in certain high-risk patients is warranted.