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71.
Anand Dayama Nikolaos Tsilimparis Stephen Kolakowski Nathaniel M. Matolo Misty D. Humphries 《Journal of vascular surgery》2019,69(1):156-163.e1
Background
Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease.Methods
We reviewed the American College of Surgeons National Surgical Quality Improvement Program targeted lower extremity revascularization database from 2012 to 2015 to identify patients with CLTI and isolated infrageniculate arterial disease who underwent primary infrageniculate bypass or endovascular intervention. We excluded patients with a history of ipsilateral revascularization and proximal interventions. The end points were major adverse limb event (MALE), major adverse cardiovascular event (MACE), amputation at 30 days, reintervention, patency, and mortality. Multivariable logistic regression was used to determine the association of a bypass-first or an endovascular-first intervention with outcomes.Results
There were 1355 CLTI patients undergoing first-time revascularization to the infrageniculate arteries (821 endovascular-first revascularizations and 534 bypass-first revascularizations) identified. There was no significant difference in adjusted rate of 30-day MALE in the bypass-first vs endovascular-first revascularization cohort (9% vs 11.2%; odds ratio [OR], 0.73; 95% confidence interval [CI], 0.50-1.08). However, the incidence of transtibial or proximal amputation was lower in the bypass-first cohort (4.3% vs 7.4%; OR, 0.60; CI, 0.36-0.98). Patients with bypass-first revascularization had higher wound complication rates (9.7% vs 3.7%; OR, 2.75; CI, 1.71-4.42) compared with patients in the endovascular-first cohort. Compared with the endovascular-first cohort, the incidence of 30-day MACE was significantly higher in bypass-first patients (6.9% vs 2.6%; adjusted OR, 3.88; CI, 2.18-6.88), and 30-day mortality rates were 3.23% vs 1.8% (adjusted OR, 2.77; CI, 1.26-6.11). There was no difference in 30-day untreated loss of patency, reintervention of treated arterial segment, readmissions, and reoperations between the two cohorts. In subgroup analysis after exclusion of dialysis patients, there was also no significant difference in MALE or amputation between the bypass-first and endovascular-first cohorts.Conclusions
CLTI patients with isolated infrageniculate arterial disease treated by a bypass-first approach have a significantly lower 30-day amputation. However, this benefit was not observed when dialysis patients were excluded. The bypass-first cohort had a higher incidence of MACE compared with an endovascular-first strategy. These results reaffirm the need for randomized controlled trials, such as the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL-2) trial and Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI), to provide level 1 evidence for the role of endovascular-first vs bypass-first revascularization strategies in the treatment of this population of challenging patients. 相似文献72.
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Spinal cord stimulation (SCS) is widely used for pain relief in patients with failed back surgery syndrome (FBSS), and muscle weakness is a common finding in patients with chronic pain. We present here a single case report of a 47‐year‐old woman, who, after SCS for FBSS, had continuous improvement in lower leg muscle strength and gait, but only transient and minimal pain relief. To the authors’ knowledge, this is only the second published case report of significant improvement in “motor” function, independent of the analgesic effect following SCS in FBSS. If SCS, in fact, does improve muscle strength, new strategies for the management of patients with chronic pain might be opened up. Further studies are needed to verify this hypothesis. 相似文献
76.
目的 观察不同钙离子浓度的透析液对血液透析患者透析后血清钙离子水平及血压变化的影响,为肾功能衰竭血液透析患者的高钙血症及高血压的防治提供依据。方法 选择不同钙离子浓度的透析液,将维持性血液透析患者分为高钙组(1.75mmol/L)和低钙组(1.25mmol/L),比较患者每次透析前后脉搏、血压,同时抽查患者透析前后血钙及血肌酐浓度的变化。结果透析后两组患者血肌酐浓度均显著下降,透析前后差异均具有统计学意义(P〈0.01);高钙组患者透析后血钙较透析前升高,差异具有统计学意义(P〈0.01),而低钙组患者血钙比透析前略降低,差异无统计学意义(P〉0.05)。高钙组患者透析后较透析前收缩压、舒张压及平均动脉压都升高,差异均具有统计学意义(P〈0.05),而低钙组患者透析后较透析前收缩压、舒张压及平均动脉压都降低,差异均具有统计学意义(P〈0.05)。透析后两组血钙比较差异具有统计学意义(P〈0.01);透析后低钙组较高钙组患者的收缩压、舒张压及平均动脉压都降低,三者差异均具有统计学意义(P〈0.01)。结论透析液钙离子浓度与血液透析患者血清钙离子水平及血压呈正相关,低钙透析液透析有助于维持性血液透析患者高血压的控制。 相似文献
77.
78.
凯时治疗慢性重型肝炎患者疗效观察 总被引:2,自引:0,他引:2
目的探讨凯时即前列地尔脂微球载体制剂(Lipo-PGE1)治疗慢性重型肝炎的疗效。方法将84例慢性重型肝炎患者随机分成两组,对照组予综合治疗及对症治疗,治疗组在该基础上加用凯时10μg溶于5%葡萄糖注射液250ml中静脉缓慢滴注,1次/d,疗程为4周。结果治疗组对慢性重型肝炎的疗效优于对照组(P〈0.01),肝功能改善优于对照组(P〈0.01)。结论Lipo-PCEI是一种治疗慢性重型肝炎安全、有效的药物。 相似文献
79.
80.
何云 《中华现代外科学杂志》2006,3(2):109-111
目的探讨重症急性胰腺炎的合理治疗方案。方法以1985年1月~2005年8月间收治的102例重症急性胰腺炎作研究对象,比较手术组与非手术组的主要并发症和死亡率。A组:1985年1月~1993年12月以手术治疗为主41例;B组:1994年1月~2005年8月以早期非手术治疗为主61例。结果手术组死亡率和并发症发生率明显高于非手术组,两组病死率及并发症发生率比较差异有显著性(P〈0.05)。结论重症急性胰腺炎采用早期非手术治疗能有效降低病死率和并发症发生率。大多数重症急性胰腺炎可经非手术治愈。 相似文献