Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study
Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study
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DOI：
10.1016/j.ejvs.2017.07.005
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发表时间：
2017-10-01
影响因子：
5.7
通讯作者：
Nordanstig, J.
中科院分区：
文献类型：
--
作者：
Fridh, E. Baubeta;Andersson, M.;Nordanstig, J.
目的：这项以人群为基础的研究的目的是描述中期至长期截肢的风险，死亡或截肢的累积发生率，并在术前合并症的患者下肢外周动脉疾病（PAD）的血运重建的差异：这是一项观察性队列研究。来自瑞典国家血管外科质量登记处（Swedvasc）的数据与强制性国家医疗保健登记处和患者病历相结合。通过Swedvasc数据库确定了2008年5月至2013年5月期间在瑞典接受间歇性跛行（IC）或严重肢体缺血（CLI）血运重建的所有患者，年龄≥ 50岁。强制性的国家卫生保健登记处和医疗记录提供的数据共病，死亡率，和重大截肢。结果：共16,889例PAD患者（IC，n = 6272; CLI，n = 10,617）进行了研究。IC患者的截肢发生率为0.4%（范围0.3%-0.5%）/年。在CLI患者中，血运重建后前6个月内的截肢率为12.0%（95% CI 11.3-12.6）。此后，发病率下降到每年约2%。IC患者血运重建后3年死亡或截肢的累积合并发生率为12.9%（95% CI 12.0-13.9），CLI患者为48.8%（95% CI 47.7-49.8）。在CLI患者中，与IC患者相比，糖尿病，缺血性中风，心力衰竭和心房颤动的患病率约为两倍，肾功能衰竭几乎是三倍，即使在年龄标准化后。结论：截肢的风险是特别高，在第一个6个月后，血运重建CLI。IC患者在肢体丧失方面具有良性过程。IC和CLI患者的死亡率都很高。血运重建的CLI患者与IC患者有不同的合并症。(C)2017年欧洲血管外科学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: The aims of this population based study were to describe mid-to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD).Methods: This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia (CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health care registries and medical records provided data on comorbidities, mortality, and major amputations.Results: A total of 16,889 patients with PAD (IC, n = 6272; CLI, n = 10,617) were studied. The incidence of amputations in IC patients was 0.4% (range 0.3%-0.5%) per year. Among CLI patients, the amputation rate during the first 6 months following revascularisation was 12.0% (95% CI 11.3-12.6). Thereafter, the incidence declined to approximately 2% per year. The cumulative combined incidence of death or amputation 3 years after revascularisation was 12.9% (95% CI 12.0-13.9) in IC patients and 48.8% (95% CI 47.7-49.8) in CLI patients. Among CLI patients, compared with IC patients, the prevalence of diabetes, ischaemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled, even after age standardisation.Conclusion: The risk of amputation is particularly high during the first 6 months following revascularisation for CLI. IC patients have a benign course in terms of limb loss. Mortality in both IC and CLI patients is substantial. Revascularised CLI patients have different comorbidities from IC patients. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.