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首页> 外文期刊>Vascular and endovascular surgery >Improving Outcomes for Lower Extremity Amputations Using Intraoperative Fluorescent Angiography to Predict Flap Viability
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Improving Outcomes for Lower Extremity Amputations Using Intraoperative Fluorescent Angiography to Predict Flap Viability

机译：使用术中荧光血管造影改善下肢截肢的结果预测皮瓣存活

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Objectives: Nearly 25% of vascular surgery patients operated on for peripheral vascular disease are readmitted within 30 days. Development of adjuncts to minimize wound complications remains an area of great interest. Here, we present our experience with intraoperative fluorescent angiography (IFA) as a tool to predict skin flap viability following lower extremity amputations (LEAs). Methods: Experience with IFA using indocyanine green (ICG) dye was reviewed retrospectively at a single institution. Records of patients undergoing LEA with use of IFA by 2 vascular surgeons from 2013 to 2014 were reviewed. Absolute and relative tissue perfusion values were evaluated for sensitivity and specificity in regard to skin flap viability. Results: Thirteen patients with a mean age of 70.5 years (standard deviation [SD] = 12.0, range: 49-93 years) underwent 17 amputations. Indications included rest pain, tissue gangrene, and vascular disease unsuitable for revascularization. Amputation levels included toe (23%), transmetatarsal (18%), below knee (41%), and above knee (18%). Six (35%) amputations required revision with a mean time-to-revision of 26.1 days (SD = 19.9, range: 9-61 days). Of these revisions, 14 (83%) patients proceeded to a proximal-level amputation. Mean follow-up was 235 days (SD = 148, range: 5-448 days), and IFA was used in all cases. Absolute perfusion values (APVs) between 5 and 9 displayed sensitivity and specificity of 50% and 64%, respectively. Additionally, a relative perfusion value (RPV) of ≤31% displayed 100% sensitivity and specificity. Sensitivity and specificity fell to 83% at a relative perfusion of ≤27% and ≤35%, respectively. Conclusion: IFA during LEA is safe and easily performed by the vascular surgeon. The RPVs as a predictor of skin flap viability correlate well with those reported in breast reconstructive surgery. Unfortunately, APVs fail to support any predication for flap failure or success. Patient comorbidities and intraoperative variables such as vasopressor use may contribute to this finding.
机译：目的：在30天内预留了对外周血管疾病进行的近25％的血管手术患者。制定最小化伤口并发症的辅助性仍然是一个极大兴趣的领域。在这里，我们向术中荧光血管造影（IFA）作为一种预测下肢截肢（叶子）后的皮肤皮瓣活力的工具。方法：使用吲哚菁绿（ICG）染料的IFA经验，回顾性地在单一机构进行审查。综述了从2013年到2014年使用2血管外科医生的IFA患者的患者记录。评估绝对和相对组织灌注值，用于对皮肤皮瓣活力进行敏感性和特异性。结果：13例平均年龄为70.5岁（标准差[SD] = 12.0，范围：49-93岁）接受了17次截肢。适应症包括休息疼痛，组织坏疽和不适合血运重建的血管疾病。截肢水平包括趾（23％），缩小剂（18％），低于膝关节（41％），膝关节（18％）。六（35％）截肢需要修改26.1天的平均修订（SD = 19.9，范围：9-61天）。在这些修订中，14名（83％）患者进行了近期级截肢。平均随访时间为235天（SD = 148，范围：5-448天），在所有情况下使用IFA。 5至9之间的绝对灌注值（APV）显示的敏感性和特异性分别为50％和64％。另外，≤31％的相对灌注值（RPV）显示100％的灵敏度和特异性。敏感性和特异性分别在相对灌注≤27％和≤35％的相对灌注下降至83％。结论：IFA在LEA期间是安全的，容易由血管外科医生进行。作为皮瓣活力的预测因子的RPV与乳腺重建手术中报道的那些相比良好。不幸的是，APVS无法支持襟翼故障或成功的任何预测。患者的合并症和术中变量，如血管加压器使用可能有助于这种发现。

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