通过皮肤深静脉动脉化的结果在多个实践环境中的比较
Neginder Saini1, Laura Marrone2, Sanket Desai3
1Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY.
Journal of vascular surgery
|June 3, 2024
概括
穿皮深静脉动脉 (pDVA) 是一种安全有效的治疗慢性肢体威胁性缺血症的方法. 无论手术是在医院还是办公室实验室环境中进行,结果都是相似的.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 内血管程序 内血管程序
背景情况:
- 慢性四肢威胁性缺血症 (CLTI) 是一个重大挑战,特别是对于被认为不适合常规重血管化的患者.
- 透皮深静脉动脉化 (pDVA) 为"没有选择"的CLTI患者提供了一个潜在的解决方案,通过创建一个动脉化的静脉系统.
研究的目的:
- 为了比较pDVA在医院环境中进行的疗效和安全性,与办公室实验室 (OBL) 相比.
- 评估关键结果,包括主要的无截肢生存率,肢体救援和伤口愈合率.
主要方法:
- 一个回顾性图表审查73名Rutherford分类IV或更高CLTI的患者,他们在2018年1月至2023年3月期间接受了pDVA.
- 患者被分为两组:基于医院的pDVA (n=41) 和基于OBL的pDVA (n=32).
- 使用卡普兰-梅尔分析评估了结果,比较了没有截肢的主要存活率,技术成功,肢体救援,穿透性,伤口愈合和不良事件.
主要成果:
- 在这两种情况下,技术上的成功率都很高 (96%).
- 虽然OBL在6个月和1年后的无截肢生存率和伤口愈合率在数值上更高,但在2年后,这些差异在统计学上并不显著.
- 医院和OBL设置之间没有观察到重大截肢无生存率 (P=.13),肢体挽救 (P=.07) 或伤口愈合 (分别为部分和完整的P=.08和P=.79) 的显著差异.
结论:
- 对于没有选择的关键四肢缺血症患者来说,pDVA是一种可行的和安全的内血管选择.
- 该程序在医院或办公室实验室中进行时,在干预后两年内显示出可比结果.
- 这些发现支持pDVA在不同的临床环境中作为可行的肢体救援策略的扩展.
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