在外周血管干预后,末期脏病和主要不良四肢事件之间的关联
Yonatan Babore1, Ansar Z Vance1, Raphael Cohen2
1Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Journal of vascular and interventional radiology : JVIR
|September 7, 2023
概括
末期病 (ESRD) 显著增加了主要不良四肢事件 (MALEs) 和截肢的风险,包括膝下截肢 (BKA),在关键四肢缺血症 (CLI) 的皮肤血管干预 (PVI) 后. 患有ESRD的患者需要更密切地监测四肢救援.
科学领域:
- 血管外科 血管外科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心血管研究研究心血管研究
背景情况:
- 关键肢体缺血 (CLI) 构成肢体丧失的重大风险.
- 末期病 (ESRD) 是一种已知的并发症,与血管患者的不良结果有关.
- 皮肤血管干预 (PVI) 是对症状性CLI的常见治疗方法.
研究的目的:
- 研究末期病 (ESRD) 对雷瑟福4-6类关键肢体缺血症 (CLI) 经皮血管干预 (PVI) 的患者主要不良肢体事件 (MALEs) 的影响.
主要方法:
- 倾向性得分匹配用于比较2012年至2022年期间接受PVI的CLI患者的两个队列,在ESRD状态上有所不同.
- 使用Kaplan-Meier和Cox的比例危险分析来评估MALE的发病率,包括主要截肢和重新干预.
- 该研究分析了147名匹配患者 (每组90名) 来自628名患者的数据库,其中1297名患者接受了下肢再血管化手术.
主要成果:
- 与非ESRD患者相比,在PVI后,ESRD患者的MALE (45.7%与18.2%) 和重大截肢 (27.1%与5.2%) 发生率明显高于非ESRD患者.
- 确定ESRD是MALE (HR, 3.15) 和重大截肢 (HR, 7.00),包括膝下截肢 (BKA) (HR, 7.56) 的独立预测因素.
结论:
- 末期病 (ESRD) 是主要不良肢体事件和截肢风险的强有力的预测因素,在经过PVI的晚期关键肢体缺血症患者中.
- 患有ESRD的患者接受CLI的PVI需要加强监测和潜在的新策略来减轻截肢风险.
- 膝下截肢 (BKA) 的风险在ESRD患者中特别高,CLI患者接受PVI治疗.
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