Clinical effects of single or double tibial artery revascularization in critical limb ischemia patients with tissue loss
Clinical effects of single or double tibial artery revascularization in critical limb ischemia patients with tissue loss
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DOI：
10.1016/j.jvs.2016.08.106
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发表时间：
2017-03-01
影响因子：
4.3
通讯作者：
Ito, Yoshiaki
中科院分区：
文献类型：
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作者：
Kobayashi, Norihiro;Hirano, Keisuke;Ito, Yoshiaki
目的：对于伴有组织缺损的严重肢体缺血（CLI）患者，实现单血管流入伤口是外周血管介入治疗的可接受终点。然而，CLI患者往往有多胫动脉病变。我们评价了单或双胫动脉血运重建术治疗CLI患者的临床效果。2007年4月至2015年1月期间，我们治疗了123名胫前动脉和胫后动脉均存在病变的CLI患者（137条肢体）。其中，单一胫动脉S组84条肢体行胫前或胫后动脉重建术，结果：D组53条患肢行胫前、胫后动脉血管重建术（87% vs 79%; P = 0.003），伤口愈合时间较短（中位数，83 vs 142天; P = 0.01），D组的重复外周血管介入率低于S组（15% vs 35%; P = 0.03）。根据血管外科伤口、缺血和足部感染学会的评估，两组临床分期较低的患者的伤口愈合率几乎相似（D组为90%，S组为93%; P = .20）;然而，在高临床分期患者中，D组的伤口愈合率显著更高结论：通过双胫动脉血运重建实现双血管流入伤口对伤口愈合有积极影响，特别是在严重CLI患者中。
Objective: The achievement of single vessel inflow to the wound is an acceptable end point of peripheral vascular intervention for patients with critical limb ischemia (CLI) with tissue loss. However, CLI patients often have multitibial artery lesions. We evaluated the clinical effects of single or double tibial artery revascularization for CLI patients.Methods: This study was conducted retrospectively in a single center. Between April 2007 and January 2015, we treated 123 CLI patients (137 limbs) who had lesions in both the anterior tibial artery and the posterior tibial artery. Of these, single tibial artery (anterior or posterior tibial artery) revascularization was performed in 84 limbs (group S) and double tibial artery (both anterior and posterior tibial arteries) revascularization was performed in 53 limbs (group D).Results: The wound healing rate was significantly higher (87% vs 79%; P = .003), the time to wound healing was shorter (median, 83 vs 142 days; P = .01), and the repeat peripheral vascular intervention rate was lower (15% vs 35%; P = .03) in group D than in group S. The wound healing rate was nearly similar between the 2 groups in patients with a low clinical stage as assessed by Society for Vascular Surgery Wound, Ischemia, and foot Infection (90% in group D vs 93% in group S; P = .20); however, the wound healing rate was significantly higher in group D in patients with a high clinical stage (85% vs 72%; P = .007).Conclusions: The achievement of double vessel inflows to the wound by double tibial artery revascularization positively affects wound healing, particularly in severe CLI patients.