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Calidad de vida en pacientes con isquemia crónica que amenaza a los miembros tratados con revascularización

Matthew T Menard1, Alik Farber2, Richard J Powell3

  • 1Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.), Harvard Medical School, Boston, MA.

Circulation
|April 10, 2024
PubMed
Resumen

La revascularización mejoró significativamente la calidad de vida relacionada con la salud (HRQoL) de los pacientes con isquemia crónica que amenaza a las extremidades. La intervención endovascular mostró ligeras ventajas en las medidas específicas de la CQR para los pacientes con vena safena grande adecuada, pero las diferencias no fueron clínicamente significativas.

Palabras clave:
Isquemia que amenaza las extremidades críticasdiferencias mínimas de importancia clínicaEnfermedad arterial periféricacalidad de vidaensayo controlado aleatorioVena saphenous Vena saphenous

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Área de la Ciencia:

  • Cirugía vascular
  • Resultados informados por los pacientes
  • Economía de la salud

Sus antecedentes:

  • La isquemia crónica que amenaza las extremidades (ICL) afecta significativamente la calidad de vida de los pacientes.
  • Las estrategias de revascularización tienen como objetivo mejorar tanto el rescate de extremidades como el bienestar del paciente.
  • El ensayo BEST-CLI comparó el bypass quirúrgico (Bypass) con la intervención endovascular (Endo) para el CLTI.

Objetivo del estudio:

  • Evaluar el impacto de la estrategia de revascularización en la calidad de vida relacionada con la salud (HRQoL) en pacientes con ITLC.
  • Comparar los resultados de HRQoL entre el bypass quirúrgico y la intervención endovascular dentro del ensayo BEST-CLI.
  • Para analizar las diferencias de HRQoL basadas en la disponibilidad de grandes venas safenales para el bypass.

Principales métodos:

  • Ensayo controlado aleatorio comparando Bypass y Endo en dos cohortes basado en una gran disponibilidad de la vena safena.
  • HRQoL evaluado utilizando múltiples instrumentos validados: VascuQoL, EQ-5D, SF-12 (PCS y MCS), SF-6D y escalas de dolor.
  • Análisis estadístico utilizando regresión lineal de modelo mixto para comparar los cambios en la CQR dentro y entre los grupos de tratamiento.

Principales resultados:

  • Tanto el Bypass como el Endo mejoraron significativamente la HRQoL con respecto al valor basal en ambas cohortes.
  • En la cohorte 1 (vena safenosa grande adecuada), Endo mostró ventajas estadísticamente significativas en las puntuaciones de VascuQoL, SF- 12 MCS, SF- 6D y dolor en comparación con Bypass.
  • No se observaron diferencias significativas en la CQR entre Bypass y Endo en la cohorte 2 (no hay vena safenosa grande adecuada) o en EQ-5D y SF-12 PCS en la cohorte 1.

Conclusiones:

  • Las estrategias de revascularización conducen a mejoras significativas y significativas en la CQR de los pacientes con ITLC.
  • Si bien la intervención endovascular demostró una superioridad estadística en ciertas medidas de la CQR para los pacientes con una gran vena safena disponible, estas diferencias no alcanzaron significación clínica.
  • Tanto el bypass quirúrgico como la intervención endovascular son eficaces para mejorar la CQR de los pacientes con ITLC.