在肢体缺血症的内血管治疗之前,现实世界的静脉映射实践模式
Patrick Heindel1, James J Fitzgibbon1, Kerri McKie2
1Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
The Journal of surgical research
|June 25, 2024
概括
大多数患有关键四肢缺血症 (CLTI) 的患者在内血管治疗之前没有进行术前静脉测绘,尽管试验结果有利于在存在充足的大石静脉 (GSV) 时进行手术. 这突显了临床试验结果与CLTI管理的现实实践之间的差距.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在关键四肢缺血症患者中,最佳内血管与最佳外科治疗 (BEST-CLI) 试验表明,当有足够的大静脉 (GSV) 时,慢性四肢威胁性缺血症 (CLTI) 的外科优势.
- 术前静脉测绘用于内血管第一CLTI治疗的现实世界使用情况尚不清楚.
研究的目的:
- 评估在接受内血管第一治疗的患者进行手术前静脉测绘的频率.
- 为了评估单段大沙静脉 (SSGSV) 在接受测绘的患者中的充分性.
- 确定术前特征与静脉测绘利用之间的关联.
主要方法:
- 与医疗保险索赔 (2008-2019) 相关的多中心临床数据仓库的回顾性分析.
- 纳入符合BEST-CLI试验条件的患者,接受内血管-首先内内性CLTI治疗.
- 适当的SSGSV的定义是从沟到膝盖的直径>3.0毫米.
- 术前特征和静脉映射的后勤回归;不良结果的生存方法.
主要成果:
- 在142名符合BEST-CLI条件的患者中,有76%的患者在内血管干预之前缺乏大沙静脉 (GSV) 的术前超声评估.
- 在被绘制图中的那些人中,只有44%的人有足够的SSGSV来绕道.
- 一年后的结果包括12.0%的人接受了开放式手术旁路,54.7%的人经历了主要的不良肢体事件或死亡.
结论:
- 大多数接受内血管第一CLTI干预的现实患者缺乏程序前的GSV评估.
- 目前用于管道评估的实践模式与BEST-CLI试验建议有所不同.
- 根据试验证据,重新考虑静脉管道评估协议是有必要的.
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