Short Term Outcomes of a Prospective Registry in Popliteal and Infrapopliteal Endovascular Interventions for Chronic Limb Threatening Ischaemia.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE European Journal of Vascular and Endovascular Surgery Pub Date : 2024-09-26 DOI:10.1016/j.ejvs.2024.09.033

Michael J Nugteren, Constantijn E V B Hazenberg, Olaf J Bakker, Maarten K Dinkelman, Bram Fioole, Jan-Willem Hinnen, Maurice Pierie, Gert J de Borst, Çağdaş Ünlü

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Abstract

Objective: The prevalence of chronic limb threatening ischaemia (CLTI) is increasing worldwide, resulting in the need for more patients undergoing revascularisation, especially for below the knee pathology. Nevertheless, prospective data on below the knee endovascular interventions are lacking. The aim of the study was to provide large scale, real world data on procedural and short term outcomes of popliteal and infrapopliteal endovascular interventions in patients with CLTI.

Methods: This study is an analysis of the first 1 000 interventions of the Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER). It includes all patients with CLTI undergoing popliteal or infrapopliteal endovascular revascularisation in seven hospitals in the Netherlands. The primary outcomes were limb salvage and amputation free survival (AFS) at three months estimated with the Kaplan-Meier method. Secondary outcomes were procedural complications and primary patency.

Results: Between February 2021 and July 2023, 1 000 endovascular procedures were performed in 840 patients (947 limbs), treating 486 popliteal and 1 209 tibial lesions. Wound, Ischemia, and foot Infection (WIfI) stages 1 - 4 were present in 16.8%, 17.2%, 25.4%, and 40.6% of the limbs, respectively. Technical success was hampered by arterial perforation, acute thrombosis, and distal embolisation in 8.7%, 1.0%, and 2.3% of the interventions, respectively. Limb salvage was 100.0%, 96.9%, 94.9%, and 86.1% (p < .001), whereas AFS was 96.9%, 93.2%, 86.6%, and 76.4% for WIfI stages 1 - 4 at three months (p < .001), respectively. Primary patency at the 6 - 8 week visit was 86.4% for popliteal and 74.3% for tibial lesions, respectively.

Conclusion: THRILLER presents a large prospective database on outcomes of CLTI endovascular interventions. Popliteal and infrapopliteal endovascular revascularisation for CLTI is safe. Interventions with initial technical success have high rates of limb salvage and survival at three months. The WIfI classification provides a reliable instrument to predict limb salvage and AFS independently at three months.

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腘窝和腘下血管内介入治疗慢性肢体缺血的前瞻性登记的短期效果。

目的：慢性肢体缺血（CLTI）的发病率在全球范围内不断上升，因此需要对更多患者进行血管重建，尤其是膝下病变患者。然而，目前还缺乏膝下血管内介入治疗的前瞻性数据。该研究旨在提供大规模的真实数据，说明腘动脉和膝下动脉血管内介入治疗CLTI患者的程序和短期疗效：本研究是对荷兰慢性下肢危重缺血登记处（THRILLER）前 1000 例介入治疗的分析。研究对象包括在荷兰七家医院接受腘部或腘下血管内再通术的所有慢性下肢危重缺血患者。主要结果是三个月后的肢体挽救率和无截肢存活率（AFS），采用 Kaplan-Meier 法进行估算。次要结果为手术并发症和主要通畅率：结果：2021 年 2 月至 2023 年 7 月期间，为 840 名患者（947 条肢体）实施了 1000 例血管内手术，治疗了 486 例腘动脉病变和 1 209 例胫骨病变。分别有16.8%、17.2%、25.4%和40.6%的肢体出现伤口、缺血和足部感染（WIfI）1-4期。分别有8.7%、1.0%和2.3%的介入手术因动脉穿孔、急性血栓形成和远端栓塞而影响了技术成功率。三个月后，肢体挽救率分别为 100.0%、96.9%、94.9% 和 86.1%（P < .001），而 WIfI 1 - 4 期的 AFS 分别为 96.9%、93.2%、86.6% 和 76.4%（P < .001）。腘窝和胫骨病变在6-8周就诊时的初次通畅率分别为86.4%和74.3%：THRILLER提供了一个大型前瞻性数据库，用于研究CLTI血管内介入治疗的效果。腘窝和胫骨下血管内血运重建治疗CLTI是安全的。最初技术成功的介入治疗具有较高的肢体挽救率和三个月的存活率。WIfI分类法是独立预测三个月后肢体挽救率和AFS的可靠工具。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

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.