Objective

The purpose of this study was to evaluate the influence of inframalleolar disease (Global Limb Anatomic Staging System Inframalleolar [GLASS IM] modifier) on long term outcomes of patients with chronic limb threatening ischaemia (CLTI) after distal bypass.

Methods

Patients who underwent distal bypass for CLTI from January 2012 to December 2019 at a single centre were reviewed retrospectively. Comparisons including baseline characteristics, procedural details, and long term outcomes were made between patients with an intact pedal arch (GLASS IM modifier P0), an absent or severely diseased pedal arch (P1), and no target artery crossing the ankle into the foot (P2), diagnosed by pre- and intra-operative high quality angiography. The primary endpoint was limb salvage. The secondary endpoints were graft patency and wound healing.

Results

A total of 254 distal bypasses were performed in 206 patients (139 males; median age, 76 years). The GLASS IM modifier was P0 in 80 (32%) limbs, P1 in 127 (50%), and P2 in 47 (18%). During the follow up period, 22 limbs (9%) required major amputation. The limb salvage rates at three years in P0, P1, and P2 cases were 94%, 89%, and 93%, respectively, with no significant differences among the modifiers. The primary patencies at three years in P0, P1, and P2 cases were 49%, 38% and 24%, respectively. The primary patency in P2 cases was significantly lower than that in P0 cases (p < .050). The respective wound healing rates at 12 months were 97%, 93%, and 79%, and again the wound healing rate in P2 cases was significantly lower than those in other cases (p < .050).

Conclusion

Long term outcomes including patency, limb salvage, and wound healing after distal bypass for CLTI patients with an infrapopliteal lesion were acceptable in cases in each GLASS IM modifier.

中文翻译：

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全球肢体解剖分期系统下踝下调节剂是否影响远端旁路术后慢性肢体严重缺血的长期结果？

客观的

本研究的目的是评估踝关节下疾病（全球肢体解剖分期系统下踝 [GLASS IM] 修饰符）对远端旁路术后慢性肢体威胁缺血 (CLTI) 患者长期预后的影响。

方法

回顾性分析了 2012 年 1 月至 2019 年 12 月在单中心接受 CLTI 远端旁路手术的患者。在足弓完好（GLASS IM 调节器 P0）、足弓缺失或严重病变（P1）和没有穿过踝部进入足部的目标动脉的患者之间进行了包括基线特征、手术细节和长期结果的比较。 P2)，由术前和术中高质量血管造影诊断。主要终点是保肢。次要终点是移植物通畅和伤口愈合。

结果

206 名患者（139 名男性；中位年龄 76 岁）共进行了 254 次远端旁路手术。GLASS IM 调节剂在 80 (32%) 条肢体中为 P0，在 127 (50%) 条肢体中为 P1，在 47 (18%) 条肢体中为 P2。在随访期间，22 条肢体（9%）需要大截肢。P0、P1 和 P2 病例的三年保肢率分别为 94%、89% 和 93%，修饰符之间没有显着差异。P0、P1 和 P2 病例在三年时的主要通畅率分别为 49%、38% 和 24%。P2 病例的主要通畅率显着低于 P0 病例（p < .050）。12 个月时的伤口愈合率分别为 97%、93% 和 79%，P2 病例的伤口愈合率再次显着低于其他病例 ( p < .050)。

结论

对于具有腘下病变的 CLTI 患者，在每个 GLASS IM 调节器的情况下，包括通畅、保肢和远端旁路术后伤口愈合的长期结果是可以接受的。