编辑的选择 - 手术后大截肢减少与内血管干预相比:BEST-CLI随机试验
Maarit A Venermo1, Alik Farber2, Andres Schanzer3
1Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
概括
使用单段大沙静脉 (SSGSV) 的外科绕道与内血管治疗相比,在慢性四肢威胁性缺血症 (CLTI) 患者中显著减少了主要截肢. 这主要是因为在最初的手术后,随后的大型截肢的数量较少.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 肢体救援程序 肢体救援程序
背景情况:
- 慢性四肢威胁性缺血症 (CLTI) 在血管护理中提出了重大挑战.
- 治疗选择包括手术旁路和内血管再血管化.
- 预防截肢的最佳治疗策略仍在调查中.
研究的目的:
- 在BEST-CLI试验的副研究中评估截肢率和重大截肢风险.
- 为了比较手术绕道和内血管治疗在CLTI患者之间的结果.
- 分析最初和随后的截肢事件.
主要方法:
- 一项BEST-CLI随机试验的副研究,涉及1830名CLTI患者.
- 患者被随机分配到两个队列,基于大石静脉可用性.
- 第1组 (n=1,434) 具有足够的SSGSV,第2组 (n=396) 没有足够的SSGSV.
- 评估的结果包括时间到第一次事件和截肢率.
主要成果:
- 在第1组中,与血管内治疗相比,外科绕道显示整体截肢事件 (45.6%与54.4%,p=.001) 和随后的大型截肢 (15.0%与25.6%,p=.002) 显著降低.
- 两组之间没有观察到最初主要截肢的显著差异.
- 在第2组中,在手术和内血管组之间没有发现截肢事件或重大截肢的显著差异.
结论:
- 使用SSGSV的外科绕道在预防CLTI患者的大型截肢方面比内血管治疗更有效.
- 手术绕道的好处在很大程度上归因于小截肢后发生的重大截肢减少.
- 治疗决策应该考虑静脉的可用性和肢体救援的可能性.
更多相关视频
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
3.4K
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
1.4K
相关概念视频
01:27Peripheral Artery Disease III: Interprofessional Care
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...