首页> 外文OA文献 >Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia
【2h】

Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia

机译:尽管在接受严重肢体缺血的腹股沟下肢旁路术患者中移植物通畅,但未能实现临床改善

代理获取
本网站仅为用户提供外文OA文献查询和代理获取服务,本网站没有原文。下单后我们将采用程序或人工为您竭诚获取高质量的原文,但由于OA文献来源多样且变更频繁,仍可能出现获取不到、文献不完整或与标题不符等情况,如果获取不到我们将提供退款服务。请知悉。

摘要

OBJECTIVE: Studies of infrainguinal lower extremity bypass for critical limb ischemia (CLI) have traditionally emphasized outcomes of patency, limb salvage, and death. Because functional outcomes are equally important, our objectives were to describe the proportion of CLI patients who did not achieve symptomatic improvement 1 year after bypass, despite having patent grafts, and identify preoperative factors associated with this outcome.METHODS: The prospectively collected Vascular Study Group of Northern New England database was used to identify all patients with elective infrainguinal lower extremity bypass for CLI (2003 to 2007) for whom long-term follow-up data were available. The primary composite study end point was clinical failure at 1 year after bypass, defined as amputation or persistent or worsened ischemic symptoms (rest pain or tissue loss), despite a patent graft. Variables identified on univariate screening (inclusion threshold, P \u3c .20) were included in a multivariable logistic regression model to identify independent predictors.RESULTS: Long-term follow-up data were available for 1012 patients who underwent infrainguinal bypasses for CLI, of which 788 (78%) remained patent at 1 year. Of these, 79 (10%) met criteria for the composite end point of clinical failure: 21 (2.7%) for major amputations and 58 (7.4%) for persistent rest pain or tissue loss. In multivariable analysis, significant predictors of clinical failure included dialysis dependence (odds ratio [OR], 3.74; 95% confidence interval [CI], 1.84-7.62; P \u3c .001) and preoperative inability to ambulate independently (OR, 2.17; 95% CI, 1.26-3.73; P = .005). A history of coronary artery bypass graft or percutaneous coronary intervention was protective (OR, 0.52; 95% CI, 0.29-0.93; P = .03).CONCLUSIONS: After infrainguinal lower extremity bypass for CLI, 10% of patients with a patent graft did not achieve clinical improvement at 1 year. Preoperative identification of this specific patient subgroup remains challenging. To improve surgical decision making and the overall care of CLI patients, further emphasis needs to be placed on functional outcomes in addition to traditional surgical end points. Inc. All rights reserved.
机译:目的:针对严重肢体缺血(CLI)进行的射频下下肢旁路术的研究传统上强调了通畅,抢救和死亡的结果。由于功能结局同样重要,因此我们的目标是描述尽管进行了专利移植,但在搭桥后1年内仍未实现症状改善的CLI患者的比例,并确定与该结局相关的术前因素。方法:前瞻性收集的血管研究小组新英格兰北部数据库(Norman New England Database)使用该数据库确定了可进行长期随访的所有CLI患者(2003年至2007年)行选择性行下支路下肢旁路手术的患者。主要的复合研究终点是旁路手术后1年的临床失败,尽管有专利移植,但定义为截肢或持续或恶化的缺血性症状(休息疼痛或组织丢失)。在单因素筛查中确定的变量(包括阈值,P \ u3c .20)被包括在多变量logistic回归模型中,以识别独立的预测因素。结果:1012例接受了CLI膀胱下旁路手术的患者可获得长期随访数据。其中788件(78%)的1年专利权。其中,有79名(10%)达到了临床失败的复合终点标准:大型截肢手术达到21名(2.7%),持续性休息疼痛或组织丢失为58名(7.4%)。在多变量分析中,临床失败的重要预测因素包括透析依赖性(比值比[OR],3.74; 95%置信区间[CI],1.84-7.62; P <0.001)和术前无法独立移动(OR,2.17; 1.01,0.12,0.13,0.13,0.13,0.13,0.13,0.13,0.13,0.13,0.13,0.12,0.13,0.13,0.12,0.13)。 95%CI,1.26-3.73; P = .005)。冠状动脉搭桥术或经皮冠状动脉介入治疗史是保护性的(OR,0.52; 95%CI,0.29-0.93; P = .03)。结论:在下腹下肢体旁路搭桥术后,有10%的患者进行了专利移植一年后仍未取得临床改善。术前确定该特定患者亚组仍然具有挑战性。为了改善外科手术决策和CLI患者的整体护理,除了传统的外科手术终点外,还需要进一步强调功能结局。 Inc.保留所有权利。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
代理获取

客服邮箱:kefu@zhangqiaokeyan.com

京公网安备:11010802029741号 ICP备案号:京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有
  • 客服微信

  • 服务号