{"title":"中期随访急性肢体缺血血管内治疗患者主要肢体不良事件的危险因素分析。","authors":"Chun-Cheng Wang, Chiung-Ray Lu, Li-Chuan Hsieh, Kuan-Cheng Chang, Chiz-Tzung Chang, Chung-Ho Hsu","doi":"10.1024/0301-1526/a001209","DOIUrl":null,"url":null,"abstract":"<p><p><b></b> <i>Background:</i> Endovascular treatment is the standard practice for the management of acute limb ischemia (ALI). The risk factors affecting the clinical outcomes of endovascular intervention during mid-term follow-up remain unclear. <i>Patients and methods:</i> 139 patients who presented with ALI, Rutherford I - IIb, undergoing endovascular treatment from October 2016 to December 2021 were retrospectively enrolled. Baseline data, and clinical outcomes were obtained by chart reviews. Major adverse limb events (MALEs) were defined as the occurrence of all-cause mortality, any amputation, and any re-occlusion at the affected limb. All patients were monitored until the time of their death, loss of contact, the incidence of MALEs, or the end of June, 2022. <i>Results:</i> At median follow-up of 17 months, the prevalence of MALEs, all-cause mortality, all amputations, and all re-occlusions were 33.1%, 9.4%, 5.0%, and 24.5%. The technical success rate between catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) groups were comparable (91.9% vs. 95.1%; p=.50). Compared with the CDT group, the PMT group exhibited a higher proportion of extensive thrombus distribution (62.7% vs. 35.1%, p<.01), while required less total urokinase dosage (x 10<sup>6</sup> units) [1.20 (0.84;1.65) vs. 1.90 (1.40;2.70), p<.01] to achieve a comparable technical success rate (95.1% vs. 91.9%, p=.5). Multivariate Cox-proportional hazards analysis revealed that PMT (hazard ratio [HR] : 0.48, 95% confidence interval [CI] : 0.25-0.92; P=.03), ≧2 patent calf arteries after intervention (HR: 0.30, 95% CI: 0.10-0.97; P=.045) and Rutherford stage IIb, compared with Rutherford I and IIa, (HR: 3.51, 95% CI: 1.02-13.29; P=.047) were independently associated with MALEs. <i>Conclusions:</i> PMT and ≧2 patent calf arteries post-intervention are associated with lower occurrence of MALEs, while Rutherford IIb at presentation is associated with a higher risk of MALEs.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":"337-346"},"PeriodicalIF":2.4000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk factors of major adverse limb events in patients with acute limb ischemia undergoing endovascular treatment during mid-term follow-up.\",\"authors\":\"Chun-Cheng Wang, Chiung-Ray Lu, Li-Chuan Hsieh, Kuan-Cheng Chang, Chiz-Tzung Chang, Chung-Ho Hsu\",\"doi\":\"10.1024/0301-1526/a001209\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b></b> <i>Background:</i> Endovascular treatment is the standard practice for the management of acute limb ischemia (ALI). The risk factors affecting the clinical outcomes of endovascular intervention during mid-term follow-up remain unclear. <i>Patients and methods:</i> 139 patients who presented with ALI, Rutherford I - IIb, undergoing endovascular treatment from October 2016 to December 2021 were retrospectively enrolled. Baseline data, and clinical outcomes were obtained by chart reviews. Major adverse limb events (MALEs) were defined as the occurrence of all-cause mortality, any amputation, and any re-occlusion at the affected limb. All patients were monitored until the time of their death, loss of contact, the incidence of MALEs, or the end of June, 2022. <i>Results:</i> At median follow-up of 17 months, the prevalence of MALEs, all-cause mortality, all amputations, and all re-occlusions were 33.1%, 9.4%, 5.0%, and 24.5%. The technical success rate between catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) groups were comparable (91.9% vs. 95.1%; p=.50). Compared with the CDT group, the PMT group exhibited a higher proportion of extensive thrombus distribution (62.7% vs. 35.1%, p<.01), while required less total urokinase dosage (x 10<sup>6</sup> units) [1.20 (0.84;1.65) vs. 1.90 (1.40;2.70), p<.01] to achieve a comparable technical success rate (95.1% vs. 91.9%, p=.5). Multivariate Cox-proportional hazards analysis revealed that PMT (hazard ratio [HR] : 0.48, 95% confidence interval [CI] : 0.25-0.92; P=.03), ≧2 patent calf arteries after intervention (HR: 0.30, 95% CI: 0.10-0.97; P=.045) and Rutherford stage IIb, compared with Rutherford I and IIa, (HR: 3.51, 95% CI: 1.02-13.29; P=.047) were independently associated with MALEs. <i>Conclusions:</i> PMT and ≧2 patent calf arteries post-intervention are associated with lower occurrence of MALEs, while Rutherford IIb at presentation is associated with a higher risk of MALEs.</p>\",\"PeriodicalId\":23528,\"journal\":{\"name\":\"Vasa-european Journal of Vascular Medicine\",\"volume\":\" \",\"pages\":\"337-346\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Vasa-european Journal of Vascular Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1024/0301-1526/a001209\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vasa-european Journal of Vascular Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1024/0301-1526/a001209","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/18 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
背景:血管内治疗是处理急性肢体缺血(ALI)的标准做法。中期随访中影响血管内介入治疗临床结果的危险因素尚不清楚。患者和方法:从2016年10月至2021年12月,139例接受血管内治疗的ALI(卢瑟福I - IIb)患者被回顾性纳入研究。通过图表回顾获得基线数据和临床结果。主要肢体不良事件(男性)定义为全因死亡率、截肢和受影响肢体再闭塞的发生。对所有患者进行监测,直至其死亡、失联、男性发病或2022年6月底。结果:中位随访17个月时,男性患病率、全因死亡率、全截肢率和再闭塞率分别为33.1%、9.4%、5.0%和24.5%。导管溶栓(CDT)组和经皮机械取栓(PMT)组的技术成功率相当(91.9% vs. 95.1%;p = 50)。与CDT组相比,PMT组血栓广泛分布的比例更高(62.7% vs. 35.1%, p6单位)[1.20 (0.84;1.65)vs. 1.90(1.40;2.70)]。结论:干预后PMT和小腿动脉≧2通畅与较低的男性发生率相关,而出现时Rutherford IIb与较高的男性风险相关。
Risk factors of major adverse limb events in patients with acute limb ischemia undergoing endovascular treatment during mid-term follow-up.
Background: Endovascular treatment is the standard practice for the management of acute limb ischemia (ALI). The risk factors affecting the clinical outcomes of endovascular intervention during mid-term follow-up remain unclear. Patients and methods: 139 patients who presented with ALI, Rutherford I - IIb, undergoing endovascular treatment from October 2016 to December 2021 were retrospectively enrolled. Baseline data, and clinical outcomes were obtained by chart reviews. Major adverse limb events (MALEs) were defined as the occurrence of all-cause mortality, any amputation, and any re-occlusion at the affected limb. All patients were monitored until the time of their death, loss of contact, the incidence of MALEs, or the end of June, 2022. Results: At median follow-up of 17 months, the prevalence of MALEs, all-cause mortality, all amputations, and all re-occlusions were 33.1%, 9.4%, 5.0%, and 24.5%. The technical success rate between catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) groups were comparable (91.9% vs. 95.1%; p=.50). Compared with the CDT group, the PMT group exhibited a higher proportion of extensive thrombus distribution (62.7% vs. 35.1%, p<.01), while required less total urokinase dosage (x 106 units) [1.20 (0.84;1.65) vs. 1.90 (1.40;2.70), p<.01] to achieve a comparable technical success rate (95.1% vs. 91.9%, p=.5). Multivariate Cox-proportional hazards analysis revealed that PMT (hazard ratio [HR] : 0.48, 95% confidence interval [CI] : 0.25-0.92; P=.03), ≧2 patent calf arteries after intervention (HR: 0.30, 95% CI: 0.10-0.97; P=.045) and Rutherford stage IIb, compared with Rutherford I and IIa, (HR: 3.51, 95% CI: 1.02-13.29; P=.047) were independently associated with MALEs. Conclusions: PMT and ≧2 patent calf arteries post-intervention are associated with lower occurrence of MALEs, while Rutherford IIb at presentation is associated with a higher risk of MALEs.
期刊介绍:
Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology.
The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation.
Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.