在BEST-CLI试验中,慢性肢体威胁性缺血的开放式或内血管再血管化后的外科并发症
Jeffrey J Siracuse1, Alik Farber1, Matthew T Menard2
1Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA.
Journal of vascular surgery
|June 15, 2023
概括
对于慢性四肢威胁性缺血症 (CLTI),手术和内血管再血管化在BEST-CLI试验中显示了类似的30天并发症率. 患者的因素超出了术前风险,应指导CLTI的治疗决策.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 心血管研究研究心血管研究
背景情况:
- 预测外科手术期间的发病率对于选择慢性四肢威胁性缺血症 (CLTI) 的重血管化方法至关重要.
- 在患有CLTI的患者中,最佳内血管与最佳外科治疗 (BEST-CLI) 试验比较了外科和内血管方法.
研究的目的:
- 评估和比较手术和内血管再血管化之间的系统性外科手术后并发症,在患有CLTI的患者中.
- 通过评估不同复血管化策略的安全概况,为临床决策提供信息.
主要方法:
- 预期随机试验 (BEST-CLI) 对比开放式 (OPEN) 和内血管 (ENDO) 重血管化.
- 两个队列:第1队列 (足够的大石静脉) 和第2队列 (没有足够的大石静脉).
- 在手术后30天内收集有关主要不良心血管事件 (MACE),严重不良事件 (SAE) 和非严重不良事件 (non-SAE) 的数据.
主要成果:
- 在任何一个队列中,OPEN和ENDO之间30天的MACE或急性功能衰竭没有显著差异.
- 静脉血栓栓塞率较低,在各组之间相似.
- 第1队列在OPEN组 (23.4%) 与ENDO组 (17.9%) 相比,非SAE的比例更高.
- 在OPEN和ENDO之间,SAE率在两个队列中都相似 (队列1:35.3%对31.6%;队列2:25.5%对23.6%).
结论:
- 对于适合开放 बाईपास的CLTI患者,在开放和内血管再血管化中,围绕程序并发症的风险与开放和内血管再血管化类似.
- 对于CLTI的治疗策略决定,应优先考虑诸如输液恢复有效性和患者偏好等因素,而不是围绕程序并发症的担忧.
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