Major lower extremity amputation in elderly patients with peripheral arterial disease: incidence and survival rates
Major lower extremity amputation in elderly patients with peripheral arterial disease: incidence and survival rates
复制标题
老年外周动脉疾病患者的重大下肢截肢：发生率和生存率
DOI：
10.1007/bf03325142
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发表时间：
2008
影响因子：
4
通讯作者：
P. Rautava
中科院分区：
文献类型：
--
作者：
Leena Remes;R. Isoaho;T. Vahlberg;H. Hiekkanen;K. Korhonen;M. Viitanen;P. Rautava
背景和目的：外周动脉疾病（PAD）的治疗方法已经发生了变化，变得更加预防性。本研究描述并分析了1）PAD导致的下肢大截肢（莱亚）的发生率，2）再次截肢的发生率，3）截肢者的生存率和预测生存率的因素。研究方法：该系列包括210例患者（平均年龄76.6岁，SD 10.7岁，45.2%为男性），他们于1998-2002年在芬兰图尔库市（人口175，000）因PAD接受了首次（即首次）大腿部截肢术。结果如下：1998-2002年，膝上和膝下联合截肢的年龄和性别标准化发病率为24.1/10万人年。34%的截肢者接受了重复截肢。一个月死亡率为21%（n=45），一年死亡率为52%（n=109），总死亡率为80%（n=168）。在年龄和性别校正分析中，心血管疾病同样能很好地预测31天、1年和总死亡率。在年龄和性别校正分析中，多种共病（p=0.023）和单侧膝上截肢（p=0.047）是总死亡率的重要预测因素。在多变量分析中，心血管疾病仍然是31天死亡率和总死亡率的重要预测因素（分别为p=0.008和p=0.015）。在考克斯模型中，截肢患者的既往血管手术对死亡率没有任何影响。大多数血运重建在首次/首次大莱亚前不到6个月进行。结论：大LEA似乎已经做了很晚，主要是为了缓解外周动脉疾病患者的终末期疼痛。
Background and aims: The methods of treating peripheral arterial disease (PAD) have changed and become more prophylactic. This study describes and analyzes 1) the incidence rates of major lower extremity amputation (LEA) due to PAD, 2) occurrence of re-amputation, and 3) the survival of amputees and factors predicting survival. Methods: The series consisted of 210 patients (mean age 76.6, SD 10.7 yrs, 45.2% men) who underwent their first, i.e. index, major leg amputation because of PAD, in 1998–2002, in the city of Turku, Finland, population 175,000. Results: Theage-and gender-standardized incidence rate of combined above-knee and below-knee amputations was 24.1/100,000 person-years during 1998–2002. Thirty-four per cent of amputees underwent repetitive amputation. One-month mortality was 21% (n=45), one-year mortality 52% (n=109) and overall mortality 80% (n=168). Cardiovascular diseases predicted equally well 31-day, one-year, and overall mortality in age- and gender-adjusted analysis. Multiple co-morbidities (p=0.023) and unilateral above-knee amputations (p=0.047) were significant predictors for overall mortality in age- and gender-adjusted analysis. Cardiovascular diseases remained a significant predictor for 31-day and overall mortality in multivariate analysis (p=0.008 and p=0.015, respectively). Amputated patients’ previous vascular procedures did not have any effect on mortality in the Cox model. Most revascularizations were performed less than six months before the index/first major LEA. Conclusion: Major LEAs seem to have been done late, and mainly for pain relief in the end-stage of patients with peripheral arterial disease.