{"title":"对依赖透析或独立透析的慢性肢体缺血和踝下疾病患者，旁路手术与血管内治疗后伤口愈合的比较：一项回顾性队列研究。","authors":"Shun Kurose, Koichi Morisaki, Daisuke Matsuda, Atsushi Guntani, Shinichiro Yoshino, Kentaro Inoue, Ken Nakayama, Terutoshi Yamaoka, Shinsuke Mii, Tomoharu Yoshizumi","doi":"10.1016/j.avsg.2025.05.038","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Patients with chronic limb-threatening ischemia (CLTI) and inframalleolar (IM) P1 disease present a substantial challenge, and the impact of dialysis on revascularization outcomes remains unclear. This study aimed to compare wound healing and limb salvage after bypass surgery (BSX) and endovascular therapy (EVT) in dialysis-dependent and dialysis-independent patients with CLTI and IM P1.</p><p><strong>Methods: </strong>We retrospectively analyzed the multicenter data from patients undergoing infrainguinal revascularization for CLTI with IM P1 between 2015 and 2023. Patients were categorized into four cohorts based on dialysis dependence and Wound, Ischemia, and foot Infection (WIfI) stages 3 and 4.</p><p><strong>Results: </strong>We reviewed collected data from 690 patients with CLTI and IM P1. After propensity score matching, we analyzed 42 dialysis-dependent patients with WIfI 3, 54 dialysis-dependent patients with WIfI 4, 41 dialysis-independent patients with WIfI 3, and 56 dialysis-independent patients with WIfI 4. In the dialysis-dependent cohort, BSX was associated with significantly higher wound healing rates than EVT in WIfI stages 3 and 4. In the dialysis-independent cohort, no significant difference in wound healing was observed between the groups in either WIfI stage. Overall survival did not significantly differ between BSX and EVT in any subgroup.</p><p><strong>Conclusion: </strong>In summary, BSX may lead to better wound healing than EVT in dialysis-dependent patients with IM P1 disease and WIfI stages 3 and 4. No significant differences were observed between treatment strategies in dialysis-independent patients. Thus, BSX might be a preferable revascularization strategy in selected dialysis-dependent patients, although prospective studies are needed to confirm this result.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of wound healing after bypass surgery versus endovascular therapy for dialysis-dependent or independent patients with chronic limb-threatening ischemia and inframalleolar disease: A retrospective cohort study.\",\"authors\":\"Shun Kurose, Koichi Morisaki, Daisuke Matsuda, Atsushi Guntani, Shinichiro Yoshino, Kentaro Inoue, Ken Nakayama, Terutoshi Yamaoka, Shinsuke Mii, Tomoharu Yoshizumi\",\"doi\":\"10.1016/j.avsg.2025.05.038\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Patients with chronic limb-threatening ischemia (CLTI) and inframalleolar (IM) P1 disease present a substantial challenge, and the impact of dialysis on revascularization outcomes remains unclear. This study aimed to compare wound healing and limb salvage after bypass surgery (BSX) and endovascular therapy (EVT) in dialysis-dependent and dialysis-independent patients with CLTI and IM P1.</p><p><strong>Methods: </strong>We retrospectively analyzed the multicenter data from patients undergoing infrainguinal revascularization for CLTI with IM P1 between 2015 and 2023. Patients were categorized into four cohorts based on dialysis dependence and Wound, Ischemia, and foot Infection (WIfI) stages 3 and 4.</p><p><strong>Results: </strong>We reviewed collected data from 690 patients with CLTI and IM P1. After propensity score matching, we analyzed 42 dialysis-dependent patients with WIfI 3, 54 dialysis-dependent patients with WIfI 4, 41 dialysis-independent patients with WIfI 3, and 56 dialysis-independent patients with WIfI 4. In the dialysis-dependent cohort, BSX was associated with significantly higher wound healing rates than EVT in WIfI stages 3 and 4. In the dialysis-independent cohort, no significant difference in wound healing was observed between the groups in either WIfI stage. Overall survival did not significantly differ between BSX and EVT in any subgroup.</p><p><strong>Conclusion: </strong>In summary, BSX may lead to better wound healing than EVT in dialysis-dependent patients with IM P1 disease and WIfI stages 3 and 4. No significant differences were observed between treatment strategies in dialysis-independent patients. Thus, BSX might be a preferable revascularization strategy in selected dialysis-dependent patients, although prospective studies are needed to confirm this result.</p>\",\"PeriodicalId\":8061,\"journal\":{\"name\":\"Annals of vascular surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2025-05-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of vascular surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.avsg.2025.05.038\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2025.05.038","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Comparison of wound healing after bypass surgery versus endovascular therapy for dialysis-dependent or independent patients with chronic limb-threatening ischemia and inframalleolar disease: A retrospective cohort study.
Purpose: Patients with chronic limb-threatening ischemia (CLTI) and inframalleolar (IM) P1 disease present a substantial challenge, and the impact of dialysis on revascularization outcomes remains unclear. This study aimed to compare wound healing and limb salvage after bypass surgery (BSX) and endovascular therapy (EVT) in dialysis-dependent and dialysis-independent patients with CLTI and IM P1.
Methods: We retrospectively analyzed the multicenter data from patients undergoing infrainguinal revascularization for CLTI with IM P1 between 2015 and 2023. Patients were categorized into four cohorts based on dialysis dependence and Wound, Ischemia, and foot Infection (WIfI) stages 3 and 4.
Results: We reviewed collected data from 690 patients with CLTI and IM P1. After propensity score matching, we analyzed 42 dialysis-dependent patients with WIfI 3, 54 dialysis-dependent patients with WIfI 4, 41 dialysis-independent patients with WIfI 3, and 56 dialysis-independent patients with WIfI 4. In the dialysis-dependent cohort, BSX was associated with significantly higher wound healing rates than EVT in WIfI stages 3 and 4. In the dialysis-independent cohort, no significant difference in wound healing was observed between the groups in either WIfI stage. Overall survival did not significantly differ between BSX and EVT in any subgroup.
Conclusion: In summary, BSX may lead to better wound healing than EVT in dialysis-dependent patients with IM P1 disease and WIfI stages 3 and 4. No significant differences were observed between treatment strategies in dialysis-independent patients. Thus, BSX might be a preferable revascularization strategy in selected dialysis-dependent patients, although prospective studies are needed to confirm this result.
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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