scholarly journals Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia

2016 ◽  
Vol 64 (5) ◽  
pp. 1344-1350 ◽  
Author(s):  
Rafael de Athayde Soares ◽  
Marcelo Fernando Matielo ◽  
Francisco Cardoso Brochado Neto ◽  
Marcus Vinícius Martins Cury ◽  
Régis Campos Marques ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Limb Salvage Rate ◽  
Infrapopliteal Arteries ◽  
Salvage Rate

scholarly journals Limb Salvage in Early Versus Delayed Revascularization of Acute Lower Limb Ischemia

2021 ◽  
Vol 15 (9) ◽  
pp. 2239-2241
Author(s):  
Salman Jamil Noor ◽  
Nauman Imtiaz ◽  
Wishal Shaukat ◽  
Athar Abbas Gilani ◽  
Palwasha Shahid ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Lower Limb ◽  
Limb Ischemia ◽  
P Value ◽  
Limb Salvage Rate ◽  
Lower Limb Ischemia ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Salvage Rate

Aim: To compare the limb salvage rate in early versus late presenting patients of Rutherford class IIB acute lower extremity ischemia undergoing revascularization. Study Design: Comparative/observational study Place and duration of study: Department of Surgery, CMH Peshawar from January 2019 to March 2021 Methodology: Twenty eight patients of both genders with ages 20 to 70 years presented with Rutherford class IIB acute lower limb ischemia were enrolled in this study. Patients were divided into two groups. Group I (presented after 6 hours of onset of symptoms) consisted of 20 patients and group II (presented within 6 hours of onset of symptoms) consisted of 8 patients. All the patients underwent femoral embolectomy. Limb salvage rate between both groups was examined at postoperative 3rd month. Data was analyzed by SPSS 24.0. P-value <0.05 was taken as significant. Results: There were 16(80%) male and 4(20%) females with mean age 50.52±11.74 years in group I, in group II 6(75%) were male and 2(25%) were females with mean age 50.08±10.94 years. No significant difference was observed between both groups regarding age and gender with p-value >0.05. In group I, limb salvage found in 19(95%) patients while in group II limb salvage found in 5(62.5%) patients, a significant difference was observed regarding limb salvage rate between both groups (p-value <0.05). Mortality rate was high in group II (delayed presentation) as compared to group I (12.5% Vs 0%) with p-value <0.05. Conclusion: The limb salvage rate was high in early presenting patients than late presenting patients with a significant difference. 30 days mortality rate and amputation rate were significantly high in delayed presentation as compared to early presented cases. Keywords: Acute lower limb ischemia, revascularization, limb salvage

scholarly journals Endovascular revascularization of multilevel arterial disease in patients with critical limb ischemia

2018 ◽  
Vol 5 (6) ◽  
pp. 2039
Author(s):  
Asser Abd El Hamid Goda
Keyword(s):  
Wound Healing ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Healing Rate ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Endovascular Revascularization ◽  
The Mean ◽  
Revascularization Procedures ◽  
Salvage Rate

Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease.  Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim this study is evaluation of the efficacy of endovascular intervention for multilevel arterial disease in patients with critical limb ischemia.Methods: This prospective study was included CLI patients due to multilevel arterial disease who underwent endovascular revascularization between January 2016 and January 2017 in our institution. Study end points were limb salvage and wound healing. Results: The mean age of patients was (61.7±7.47) years, with 13 (61.9%) men. Eight limbs were identified as Rutherford category 4 (38.1%), ten limbs as Rutherford category 5 (47.6%), and three limbs as Rutherford category 6 (14.3%). Limb salvage rate was (90.5%) at 1 year. Wound healing rate was 80.9%.Conclusions: This study proved that endovascular revascularization of multilevel arterial disease for patients with critical limb ischemia is effective.

Endovascular Treatment of the Infrapopliteal Arteries in Hemodialysis Patients with Critical Limb Ischemia: Is it Justified?

2014 ◽  
Vol 28 (1) ◽  
pp. 152-158 ◽  
Author(s):  
Claudio Bianchini Massoni ◽  
Antonio Freyrie ◽  
Natascia Muccini ◽  
Mauro Gargiulo ◽  
GianLuca Faggioli ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Hemodialysis Patients ◽  
Infrapopliteal Arteries

scholarly journals PS126. Limb Salvage and Survival Rate After Endovascular Treatment of Infrapopliteal Artery Occlusion in Diabetic Patients With Critical Limb Ischemia

2010 ◽  
Vol 51 (6) ◽  
pp. 54S
Author(s):  
Francesco Setacci ◽  
Pasqualino Sirignano ◽  
Francesca Iacoponi ◽  
Gianmarco de Donato ◽  
Emiliano Chisci ◽  
...  
Keyword(s):  
Survival Rate ◽  
Endovascular Treatment ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Diabetic Patients ◽  
Infrapopliteal Artery

scholarly journals P1280IMPACT OF HAEMODIALYSIS IN PATIENTS UNDERGOING BYPASS SURGERY FOR PERIPHERAL ARTERY DISEASE WITH CRITICAL LIMB ISCHEMIA - 10-YEAR FOLLOW-UP STUDY -

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yoshitaka Kumada ◽  
Hideki Ishii ◽  
Norio Umemoto ◽  
Ryuta Ito ◽  
Hiroshi Takahashi
Keyword(s):  
Survival Rate ◽  
Limb Salvage ◽  
Bypass Surgery ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Limb Salvage Rate ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Salvage Rate

Abstract Background and Aims Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease with critical limb ischemia (CLI) even in patients on haemodialysis (HD) as well as general population, higher amputation and/or mortality rates still remains major clinical problems after bypass surgery in this population. In this 10-year follow-up study, we investigated the impact of HD on outcomes after surgical revascularization in patients with CLI. Method A total of 464 patients undergoing successfully elective bypass surgery were enrolled. We compared 304 HD patients with 335 limbs and 160 non-HD (NHD) patients with 183 limbs during 10 years follow-up period. Primary outcome was amputation-free survival (AFS) rate defined as freedom rate from composited endpoint with major amputation (limb amputation above ankle level) or all-cause mortality. To minimize the differences of clinical characteristics between the two groups, propensity score-matching with all baseline variables was performed. Results Prevalence of diabetes (55.6% vs. 33.8%), ulcer/gangrene (99.1% vs. 63.5%) and infra-popliteal artery disease (58.9% vs. 32.5%) were significantly higher in HD group compared to NHD group (p&lt;0.0001 in all). Pre-procedural C-reactive protein (CRP) levels was also higher in HD group [14.0 (4.0-51.5) mg/l vs. 7.0 (2.0-34.0) mg/l, p=0.0015]. Inversely, age was younger in HD group than in NHD group (67±9 years vs. 72±8 years, p&lt;0.0001). The 30-day mortality rate was comparable (3.3% in HD group vs. 1.3% in NHD group, p=0.16). During follow-up period (median of 48 months), 53 amputation (17.4%) and 102 death (33.6%) in HD group, and 17 amputation (10.6%) and 23 death (14.4%) in NHD group occurred, respectively. The 10-year AFS rate was significantly lower in HD group compared to NHD group [41.3% vs. 71.3%, hazard ratio (HR) 2.33, 95% confidence interval (CI) 1.64-3.41, p&lt;0.0001). Similarly, limb salvage rate and survival rate was also lower in HD group than in NHD group (72.1% vs. 87.5%, HR 1.90, 95%CI 1.12-3.39, p=0.016, and 51.8% vs. 80.4%, HR 2.78, 95%CI 1.80-4.48, p&lt;0.0001, respectively). In the propensity score-matched cohort, having no significant differences of all baseline characteristics between HD and NHD group (n=125 in each), the 10-year AFS rate and survival rate was still lower in HD group compared to NHD group (53.1% vs. 72.8%, HR 2.11, 95% CI 1.34-3.39, p=0.0012 and 58.6% vs. 84.9%, HR 3.72, 95% CI 2.09-7.06, p&lt;0.0001, respectively). However, the limb salvage rate was statistically comparable between the two group (81.9% vs. 84.2%, HR 1.13, 95%CI 0.55-2.38, p=0.74). In addition, pre-procedural CRP levels could predict major amputation in HD patients (HR 1.06, 95%CI 1.01-1.10, p=0.024) but not NHD patients (HR 1.09, 95%CI 0.93-1.25, p=0.27). Conclusion The long-term AFS rate and survival rate were markedly lower in HD patients compared to NHD patients. However, the limb salvage rate was even between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcome. Pre-procedural inflammation status may also specifically affects the poor outcome in HD group.

Complex Endovascular Treatment for Critical Limb Ischemia in Poor Surgical Candidates: A Pilot Study

2002 ◽  
Vol 9 (5) ◽  
pp. 599-604 ◽  
Author(s):  
Bruce H. Gray ◽  
John R. Laird ◽  
Gary M. Ansel ◽  
John W. Shuck
Keyword(s):  
Endovascular Treatment ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Intention To Treat ◽  
Area Reduction ◽  
Tibial Arteries ◽  
Table Analysis ◽  
A Prospective Study

Purpose: To evaluate the effectiveness of complex endovascular treatment for limb salvage in patients with critical limb ischemia. Methods: In a prospective study, 23 patients (13 men; mean age 70 ± 11 years, range 44–87) with ischemic ulceration or gangrene of 25 lower limbs were enrolled at 4 sites to evaluate treatment with excimer laser recanalization followed by balloon angioplasty with optional stenting in the superficial femoral, popliteal, and/or tibial arteries. Results: Multiple lesions (mean 3.1, range 1–8) were treated in most cases. Reduction of stenosis/occlusion to <50% was achieved in 22 (88%) limbs. Individual cases of vessel perforation, inability to cross the lesion, and excessive residual stenosis accounted for the 3 failures. Over a 6-month period, 4 patients died of cardiac comorbidity and 1 was lost to follow-up. Adverse events included 4 minor and 2 below-knee amputations, 4 secondary angioplasties, and 4 femorodistal bypasses. The mean wound area reduction was 70% at 3 months, increasing to 89% at 6 months. According to life table analysis, the limb salvage rate was 90% with bypass and 69% without in the successfully treated patients (corresponding intention-to-treat rates were 79% and 61%). Conclusions: Complex endovascular treatment combining laser debulking and angioplasty/stenting offers an alternative for patients with critical limb ischemia who lack good surgical options.

scholarly journals Vascular Care Services during the Covid-19 Pandemic in a South Asian Country: Implications for Limb Salvage

2021 ◽  
Vol 8 (5) ◽  
Author(s):  
Bashar AHM ◽  
◽  
Rahman MM ◽  
Islam MF ◽  
Ghosh SK ◽  
...  
Keyword(s):  
Developing Country ◽  
Limb Salvage ◽  
Negative Impact ◽  
Surgical Care ◽  
Limb Ischemia ◽  
Asian Country ◽  
Vascular Trauma ◽  
Conservation Of Resources ◽  
Limb Salvage Rate ◽  
Salvage Rate

Objective: Covid-19 continues its negative impact on limb salvage in patients with limb ischemia and vascular trauma. Bangladesh fought the 1st and 2nd waves of the Covid-19 pandemic during April through August, 2020 and in April-May, 2021, respectively. Infections have been rising once again since early June 2021 to reach a positivity rate over 30%. With limited resources, vascular surgical care during the pandemic has been an unprecedented challenge for a developing country like Bangladesh. As a small vascular community, we have adopted a strategy focused on conserving essential resources including manpower while delivering essential vascular care. The present study evaluates the effectiveness of our pandemic-time guideline-based working strategy with a focus on limb salvage. Methods: Essential vascular services were provided by customized teams throughout the Covid-19 pandemic at two referral centers according to our working guidelines. Data were analyzed and key limb salvage outcomes compared between the two pandemic waves by chi-square test. Results: A total of 1792 vascular surgical cases were addressed during the pandemic- over 90% of which involved limb or life-saving procedures. Overall mortality was 0.6% and overall limb salvage rate for acute and Chronic Limb Threatening Ischemia (CLTI) were 95.3% and 76.8%, respectively. Limb salvage rate for CLTI was significantly higher in the 2nd wave compared with the 1st (P<0.05). Rate of Covid-19 infection among vascular workforce was about 20%. Conclusion: Emergency-focused altered working guideline has produced satisfactory results in terms of continuing emergency vascular services, improving limb salvage and safeguarding vascular workforce during Covid-19 pandemic in a developing country. Conservation of resources including manpower remains relevant in the context of a highly probable 3rd wave of infection.

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