Analysis of the Elective Treatment Process for Critical Limb lschaemia with Tissue Loss: Diabetic Patients Require Rapid Revascularisation
Analysis of the Elective Treatment Process for Critical Limb lschaemia with Tissue Loss: Diabetic Patients Require Rapid Revascularisation
复制标题
DOI：
10.1016/j.ejvs.2016.10.023
复制
发表时间：
2017-02-01
影响因子：
5.7
通讯作者：
Venermo, M.
中科院分区：
文献类型：
--
作者：
Noronen, K.;Saarinen, E.;Venermo, M.
目的：老年人的数量正在增加;不可避免的是，未来将有更多的重症肢体缺血（CLI）患者。CLI中的组织损失与大截肢的高风险相关。本研究的目的是分析从转诊到血运重建的治疗过程，发现可能的延迟及其背后的原因，并区分患者从早期血运重建中获益最多。方法：对394例连续患者的447条患肢进行了回顾性分析，2010-2011年因疑似缺血性组织缺损转诊至门诊。结果：246条肢体安排了血运重建。在改变初始治疗策略后，对221条肢体进行了血管内治疗（ET），对45条肢体进行了开放手术（OS）。值得注意的是，17.0%的手术在ET后发生交叉，ET后40.1%和OS后31.1%需要血运重建，从转诊到血运重建的中位时间为43天（范围1-657天），ET和OS之间无显著差异。（11.8%）的患者缺血肢体需要在首次门诊就诊时安排急诊手术。25例（10.2%）患者在等待择期血运重建时情况恶化，并进行了紧急手术。糖尿病患者构成了研究人群的大多数; 159例糖尿病足接受了血运重建。在多变量分析中，糖尿病与保肢不良相关。当在2周内实现血运重建时，在保肢方面没有观察到差异。然而，当延迟从第一次访问到血运重建超过2周，保肢显着较差的糖尿病patients.Conclusions：糖尿病溃疡总是需要血管评估，当。缺血是可疑的诊断应迅速组织，以确保血运重建没有延迟，根据这项研究在2周内从第一次评估。(C)2016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 number of elderly people is increasing; inevitably, the result will be more patients with critical limb ischaemia (CLI) in the future. Tissue loss in CLI is related to a high risk of major amputation. The aim of this study was to analyze the treatment process from referral to revascularisation, to discover possible delays and reasons behind them, and to distinguish patients benefitting the most from early revascularisation.Methods: A retrospective analysis was performed of 394 consecutive patients with a combined 447 affected limbs, referred to the outpatient clinic during 2010-2011 for tissue loss of suspected ischaemic origin.Results: For 246 limbs revascularisation was scheduled. After changes in the initial treatment strategy, endovascular treatment (ET) was performed on 221 and open surgery (OS) on 45 limbs. Notably there was crossover after ET in 17.0% of the procedures, and re-revascularisations were required in 40.1% after ET and 31.1% after OS. The median time from referral to revascularisation was 43 days (range 1-657 days) with no significant difference between ET and OS. For 29 (11.8%) patients the ischaemic limb required an emergency operation scheduled at the first visit to the outpatient clinic. For 25 (10.2%) patients the situation worsened while waiting for elective revascularisation and an emergency procedure was performed. Diabetic patients formed the majority of the study population; with 159 diabetic feet undergoing revascularisation. In multivariate analysis, diabetes was associated with poor limb salvage. When revascularisation was achieved within 2 weeks, no difference was seen in limb salvage. However, when the delay from first visit to revascularisation exceeded 2 weeks, limb salvage was significantly poorer in diabetic patients.Conclusions: Diabetic ulcers always require vascular evaluation, and when.ischaemia is suspected the diagnostics should be organised rapidly to ensure revascularisation without delay, according to this study within 2 weeks from the first evaluation. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.