{"title":"血运重建术与非血运重建术治疗后慢性肢体威胁的预后比较：日本地区保险索赔分析。","authors":"Tsunehiro Shintani, Eiji Nakatani, Hideaki Kaneda, Philip Hawke, Hideaki Obara, Takeshi Usui","doi":"10.1016/j.ejvs.2025.05.036","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>While the prevailing practice for treating chronic limb threatening ischaemia (CLTI) is revascularisation, we have a limited understanding of disease progression in patients with CLTI who do not undergo this intervention. This study compared the prognosis of CLTI patients with tissue loss who underwent revascularisation with the prognosis of those who were managed with non-revascularisation treatment, investigating the efficacy of revascularisation in improving the outcome of CLTI patients.</p><p><strong>Methods: </strong>Utilising the Shizuoka Kokuho Database, a regionally representative longitudinal cohort in Japan, this retrospective analysis examined CLTI patients with tissue loss (ulcer and gangrene), between April 2012 and September 2020, identifying two distinct cohorts: those receiving non-revascularisation treatment and those undergoing revascularisation. The primary endpoint was amputation free survival, evaluated in both cohorts after applying post-propensity score matching.</p><p><strong>Results: </strong>Of the 3 160 CLTI patients with tissue loss, 559 received non-revascularisation treatment, and 589 underwent revascularisation. The non-revascularisation treatment predominantly involved prostaglandin E1 injections (99.1%). After one to one propensity score matching, the revascularisation cohort (372 patients) exhibited a markedly enhanced amputation free survival rate compared with their non-revascularisation counterparts (amputation free survival rate at one year: 58.0% vs. 45.7%, p = .014). Subgroup analyses underscored the greater efficacy of revascularisation across multiple categories, including male (hazard ratio [HR] 0.59, 95% confidence interval (CI) 0.47 - 0.75), diabetes mellitus (HR 0.67, 95% CI 0.50 - 0.89), and patients with severe wounds (HR 0.76, 95% CI 0.61 - 0.93). However, the analysis did not find differences between the revascularisation and non-revascularisation treatment groups among female patients (HR 1.06, 95% CI 0.78 - 1.45) and patients with non-severe wounds (HR 0.87, 95% CI 0.58 - 1.30).</p><p><strong>Conclusion: </strong>This regional Japanese cohort study reveals a potential enhancement in the amputation free survival rate post-revascularisation for CLTI patients with tissue loss compared with non-revascularisation treatment, except in female patients and patients with non-severe wounds. Additional studies are needed to further elucidate these results.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of Prognosis in Chronic Limb Threatening after Revascularisation Versus Non-revascularisation Treatment: Analysis of Japanese Regional Insurance Claims.\",\"authors\":\"Tsunehiro Shintani, Eiji Nakatani, Hideaki Kaneda, Philip Hawke, Hideaki Obara, Takeshi Usui\",\"doi\":\"10.1016/j.ejvs.2025.05.036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>While the prevailing practice for treating chronic limb threatening ischaemia (CLTI) is revascularisation, we have a limited understanding of disease progression in patients with CLTI who do not undergo this intervention. This study compared the prognosis of CLTI patients with tissue loss who underwent revascularisation with the prognosis of those who were managed with non-revascularisation treatment, investigating the efficacy of revascularisation in improving the outcome of CLTI patients.</p><p><strong>Methods: </strong>Utilising the Shizuoka Kokuho Database, a regionally representative longitudinal cohort in Japan, this retrospective analysis examined CLTI patients with tissue loss (ulcer and gangrene), between April 2012 and September 2020, identifying two distinct cohorts: those receiving non-revascularisation treatment and those undergoing revascularisation. The primary endpoint was amputation free survival, evaluated in both cohorts after applying post-propensity score matching.</p><p><strong>Results: </strong>Of the 3 160 CLTI patients with tissue loss, 559 received non-revascularisation treatment, and 589 underwent revascularisation. The non-revascularisation treatment predominantly involved prostaglandin E1 injections (99.1%). After one to one propensity score matching, the revascularisation cohort (372 patients) exhibited a markedly enhanced amputation free survival rate compared with their non-revascularisation counterparts (amputation free survival rate at one year: 58.0% vs. 45.7%, p = .014). Subgroup analyses underscored the greater efficacy of revascularisation across multiple categories, including male (hazard ratio [HR] 0.59, 95% confidence interval (CI) 0.47 - 0.75), diabetes mellitus (HR 0.67, 95% CI 0.50 - 0.89), and patients with severe wounds (HR 0.76, 95% CI 0.61 - 0.93). However, the analysis did not find differences between the revascularisation and non-revascularisation treatment groups among female patients (HR 1.06, 95% CI 0.78 - 1.45) and patients with non-severe wounds (HR 0.87, 95% CI 0.58 - 1.30).</p><p><strong>Conclusion: </strong>This regional Japanese cohort study reveals a potential enhancement in the amputation free survival rate post-revascularisation for CLTI patients with tissue loss compared with non-revascularisation treatment, except in female patients and patients with non-severe wounds. Additional studies are needed to further elucidate these results.</p>\",\"PeriodicalId\":55160,\"journal\":{\"name\":\"European Journal of Vascular and Endovascular Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2025-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Vascular and Endovascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ejvs.2025.05.036\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ejvs.2025.05.036","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的：虽然治疗慢性肢体威胁性缺血（CLTI）的普遍做法是血管重建，但我们对未接受这种干预的CLTI患者的疾病进展了解有限。本研究比较了组织丢失的CLTI患者接受血运重建术与不接受血运重建术治疗的预后，探讨了血运重建术对改善CLTI患者预后的作用。方法：利用日本具有区域代表性的纵向队列静冈国浩数据库，回顾性分析了2012年4月至2020年9月期间患有组织丧失（溃疡和坏疽）的CLTI患者，确定了两个不同的队列：接受非血管重建治疗的队列和接受血管重建的队列。主要终点是无截肢生存，在应用倾向评分匹配后对两个队列进行评估。结果：3160例组织丢失的CLTI患者中，559例接受非血运重建治疗，589例接受血运重建。非血运重建治疗主要涉及前列腺素E1注射（99.1%）。在一对一倾向评分匹配后，血管重建组（372例患者）与非血管重建组相比，无截肢生存率显著提高（1年无截肢生存率：58.0%对45.7%,p = 0.014）。亚组分析强调了在多个类别中血管重建的更大疗效，包括男性（风险比[HR] 0.59, 95%可信区间（CI） 0.47 - 0.75），糖尿病（HR 0.67, 95% CI 0.50 - 0.89）和严重伤口患者（HR 0.76, 95% CI 0.61 - 0.93）。然而，在女性患者（HR 1.06, 95% CI 0.78 - 1.45）和非严重创伤患者（HR 0.87, 95% CI 0.58 - 1.30）中，分析没有发现血运重建和非血运重建治疗组之间的差异。结论：这项区域性日本队列研究显示，除了女性患者和非严重创伤患者外，与非血管重建术治疗相比，组织丢失的CLTI患者在血管重建术后的无截肢生存率有潜在的提高。需要进一步的研究来进一步阐明这些结果。
Comparison of Prognosis in Chronic Limb Threatening after Revascularisation Versus Non-revascularisation Treatment: Analysis of Japanese Regional Insurance Claims.
Objective: While the prevailing practice for treating chronic limb threatening ischaemia (CLTI) is revascularisation, we have a limited understanding of disease progression in patients with CLTI who do not undergo this intervention. This study compared the prognosis of CLTI patients with tissue loss who underwent revascularisation with the prognosis of those who were managed with non-revascularisation treatment, investigating the efficacy of revascularisation in improving the outcome of CLTI patients.
Methods: Utilising the Shizuoka Kokuho Database, a regionally representative longitudinal cohort in Japan, this retrospective analysis examined CLTI patients with tissue loss (ulcer and gangrene), between April 2012 and September 2020, identifying two distinct cohorts: those receiving non-revascularisation treatment and those undergoing revascularisation. The primary endpoint was amputation free survival, evaluated in both cohorts after applying post-propensity score matching.
Results: Of the 3 160 CLTI patients with tissue loss, 559 received non-revascularisation treatment, and 589 underwent revascularisation. The non-revascularisation treatment predominantly involved prostaglandin E1 injections (99.1%). After one to one propensity score matching, the revascularisation cohort (372 patients) exhibited a markedly enhanced amputation free survival rate compared with their non-revascularisation counterparts (amputation free survival rate at one year: 58.0% vs. 45.7%, p = .014). Subgroup analyses underscored the greater efficacy of revascularisation across multiple categories, including male (hazard ratio [HR] 0.59, 95% confidence interval (CI) 0.47 - 0.75), diabetes mellitus (HR 0.67, 95% CI 0.50 - 0.89), and patients with severe wounds (HR 0.76, 95% CI 0.61 - 0.93). However, the analysis did not find differences between the revascularisation and non-revascularisation treatment groups among female patients (HR 1.06, 95% CI 0.78 - 1.45) and patients with non-severe wounds (HR 0.87, 95% CI 0.58 - 1.30).
Conclusion: This regional Japanese cohort study reveals a potential enhancement in the amputation free survival rate post-revascularisation for CLTI patients with tissue loss compared with non-revascularisation treatment, except in female patients and patients with non-severe wounds. Additional studies are needed to further elucidate these results.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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