Multidisciplinary team model: its value and application experience in diagnosis and treatment of patients with lower extremity arteriosclerosis obliterans_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FANG Yuan ¹ , REN Bichen ¹ , FANG Gang ¹ , JIANG Jingjing ² , CUI Jie ³ , ZHANG Xiaoguang ⁴ , FANG Yi ⁵ , JU Shuai ⁶ , CAI Yunmin ⁶ , SHI Xiaohong ⁷ , ZHANG Yong ⁸ , DING Jing ⁹ , ZHANG Yiqun ¹⁰ , LU Zhiqiang ² ,  DONG Zhihui ¹ , FU Weiguo ¹

1. Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
2. Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
3. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
4. Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
5. Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
6. Vascular and Wound Care Center, Jinshan Hospital, Fudan University, Shanghai 200540, P. R. China;
7. Department of Endocrinology, Jinshan Hospital, Fudan University, Shanghai 200540, P. R. China;
8. Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
9. Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
10. Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;

Corresponding?author：

DONG Zhihui, Email: dzh926@126.com

Keywords：

lower extremity arteriosclerosis obliterans; critical limb ischemia; multidisciplinary team

DOI：

10.7507/1007-9424.202511112

Video：

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Objective To evaluate the value and experience of a multi-disciplinary team (MDT) approach in the management of patients with lower extremity arteriosclerosis obliterans (ASO). Methods A retrospective analysis was conducted of 46 consecutive patients with ASO who were treated with MDT model at Zhongshan Hospital, Fudan University, from May 2021 to April 2024. All subjects had critical limb ischemia (Rutherford grade 4 or more) and at least one major organ dysfunction. Overall mortality, above-ankle amputation rate, and below-ankle amputation rate were recorded. The frequency and depth of involvement of each specialty in the MDT process were also documented. Results Of the 46 patients, 37 (80.4 %) were male and 9 (19.6 %) were female, with a mean age of (74.33±11.8) years. Major comorbidities included diabetes mellitus in 40 cases, cardiac disease in 30, hypertension in 31, renal insufficiency in 22, prior cerebral infarction in 14, and chronic obstructive pulmonary disease in 11. Overall mortality was 13.04% (6/46). The total amputation rate was 32.61% (15/46), comprising above-ankle amputation in 19.57% (9/46) and below-ankle amputation in 13.04% (6/46). Seventeen disciplines participated in the MDT; in addition to vascular surgery, the most actively involved departments were endocrinology, cardiology, and nephrology. Conclusion The MDT model offers unique advantages in the management of critical lower-extremity ASO. By coordinating revascularization timing, extent, and modality, prioritizing comorbid conditions, tailoring operative plans, and optimizing peri-operative support, the MDT approach reduces mortality, improves limb-salvage rates, and enhances both prognosis and quality of life.

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10.	Krishnan S, Nash F, Baker N, et al. Reduction in diabetic amputations over 11 years in a defined U. K. population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care, 2008, 31(1): 99-101.
11.	Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg, 1997, 26(3): 517-538.
12.	Mills JL, Conte MS, Armstrong DG, et al. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg, 2014, 59(1): 220-234.
13.	國家衛生健康委員會衛生發展研究中心. 中國衛生總費用研究報告(2022). 北京: 人民衛生出版社, 2023.
14.	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
15.	中國醫療保險研究院. 外周動脈疾病介入術后復發率及影響因素分析. 中國循環雜志, 2023, 38(9): 897-903.

1. Song P, Rudan D, Wang M, et al. National and subnational estimation of the prevalence of peripheral artery disease (PAD) in China: a systematic review and meta-analysis. J Glob Health, 2019, 9(1): 010601. doi: 10.7189/jogh.09.010601.
2. Peach G, Griffin M, Jones KG, et al. Diagnosis and management of peripheral arterial disease. BMJ, 2012, 345: e5208. doi: 10.1136/bmj.e5208.
3. Center For Cardiovascular Diseases The Writing Committee Of The Report On Cardiovascular Health And Diseases In China N. Report on cardiovascular health and diseases in China 2023: an updated summary. Biomed Environ Sci, 2024, 37(9): 949-992.
4. Hu Y, Gao J, Zhuo Q, et al. The burden of peripheral artery disease in China from 1990 to 2019 and forecasts for 2030: findings from the global burden of disease study 2019. Int J Public Health, 2024, 69: 1607352. doi: 10.3389/ijph.2024.1607352.
5. Hou XZ, Wu Q, Yang YT, et al. The epidemiology and burden of atherosclerotic cardiovascular disease in China from 1990 to 2021: findings from the global burden of disease 2021. Front Public Health, 2025, 13: 1529506. doi: 10.3389/fpubh.2025.1529506.
6. Fowkes FG, Aboyans V, Fowkes FJ, et al. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol, 2017, 14(3): 156-170.
7. 中華醫學會糖尿病學分會, 中華醫學會感染病學分會, 中華醫學會組織修復與再生分會. 中國糖尿病足防治指南(2019版)(Ⅰ). 中華糖尿病雜志, 2019, 11(2): 92-108.
8. Musuuza J, Sutherland BL, Kurter S, et al. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg, 2020, 71(4): 1433-1446.
9. Anichini R, Zecchini F, Cerretini I, et al. Improvement of diabetic foot care after the Implementation of the International Consensus on the Diabetic Foot (ICDF): results of a 5-year prospective study. Diabetes Res Clin Pract, 2007, 75(2): 153-158.
10. Krishnan S, Nash F, Baker N, et al. Reduction in diabetic amputations over 11 years in a defined U. K. population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care, 2008, 31(1): 99-101.
11. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg, 1997, 26(3): 517-538.
12. Mills JL, Conte MS, Armstrong DG, et al. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg, 2014, 59(1): 220-234.
13. 國家衛生健康委員會衛生發展研究中心. 中國衛生總費用研究報告(2022). 北京: 人民衛生出版社, 2023.
14. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
15. 中國醫療保險研究院. 外周動脈疾病介入術后復發率及影響因素分析. 中國循環雜志, 2023, 38(9): 897-903.

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