抄録
Objective: Although endovascular therapy (EVT) has been widely applied for patients with critical limb ischemia (CLI), the long-term results have not been systematically studied.
Method: We reviewed patients with CLI who were treated with EVT from January 2007 to December 2012. Outcomes included overall survival, freedom from major amputation rate, and freedom from reintervention rate.
Result: EVT was performed in 570 limbs of 459 patients (73±10 years, 64% male). Diabetes mellitus was present in 72% of patients and 52% were on dialysis. One- and 5-year overall survival rates were 81% and 45%, freedom from major amputation rate was 91% and 87%, and freedom from reintervention rate was 58% and 28%, respectively. Factors associated with death were age (hazard ratio [HR]: 1.04, P=0.001), non-ambulatory status (HR: 2.95, P<0,001), Rutherford 6 (HR: 1.87, P=0.013), heart failure (HR: 2.78, P<0.001), hemodialysis (HR: 1.82, P=0.018), and serum albumin score (HR: 0.50, P=0.001). Major amputation was associated with age (hazard ratio [HR]: 0.97, P=0.013), non-ambulatory status (HR: 4.07, P<0,001), vascular calcification (HR: 4.63, P<0.050), serum albumin score (HR: 0.61, P=0.050) and serum CRP(C-reactive protein) score (HR: 1.07, P<0.001). Reintervention was associated with hemodialysis (HR: 1.80, P<0.001) and number of run-off vessels below-the-knee.
Conclusion: Despite both high mortality and high reintervention rates, freedom from major amputation was acceptable after EVT for CLI with tissue loss. Revelation of risk factors on outcomes plays an important role not only in estimating their future occurrence, but also in deciding which revascularization strategy to pursue for CLI patients with tissue loss.
