scholarly journals Outcomes for critical limb ischemia are driven by lower extremity revascularization volume, not distance to hospital

2017 ◽  
Vol 66 (2) ◽  
pp. 476-487.e1 ◽  
Author(s):  
Ankit N. Medhekar ◽  
Doran S. Mix ◽  
Christopher T. Aquina ◽  
Lauren E. Trakimas ◽  
Katia Noyes ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Lower Extremity Revascularization

P1256THE ASSOCIATION PROTEIN-ENERGY WASTING AND INFLAMMATION STATUS WITH MORTALITY AFTER LOWER EXTREMITIES REVASCULARIZATION IN PATIENTS ON HAEMODIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hiroshi Takahashi ◽  
Yoshitaka Kumada ◽  
Hideki Ishii ◽  
Norio Umemoto ◽  
Ryuta Ito ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Chronic Haemodialysis ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Nutritional Risk Index ◽  
Artery Disease ◽  
Lower Extremity Revascularization

Abstract Background and Aims Although lower extremity revascularization has been commonly performed in chronic haemodialysis (HD) patients with peripheral artery disease (PAD), poorer prognosis still remains major problems in such population. Recently, protein-energy wasting (PEW) or malnutrition have been considered to be strongly associated with chronic inflammation and advanced atherosclerosis in HD patients. We investigated the association of geriatric nutritional risk index (GNRI) as a surrogate marker of the PEW, C-reactive protein (CRP) and these joint role with prediction of amputation and/or mortality after lower extremity revascularization in chronic HD patients. Method We enrolled a total of 862 HD patients (age 67±10 years, diabetes 62.9%, critical limb ischemia 53.5%) who successfully underwent lower extremity revascularization (552 with endovascular therapy and 310 with bypass surgery). Patients were divided into tertiles according to GNRI levels; tertile 1 (T1): <80.0, T2: 80.0-96.6and T3: >96.6, and CRP levels; T1: <2.0mg/l, T2: 2.0-12.6mg/l and T3: >12.6mg/l, respectively. They were followed up for up to 8 years. Results During follow-up period (median: 43 months), 63 (7.3%) patients needed major amputation and 202 (23.4%) patients died. Kaplan-Meier analysis shows that amputation-free survival rates for 8 years were 47.5%, 51.6% and 66.5% in T1, T2 and T3 of GNRI, and were 65.8%, 58.7% and 33.2% in T1, T2 and T3 of CRP, respectively (p<0.0001 in both). After adjustment for age, previous coronary artery disease and critical limb ischemia as covariates with p<0.05 by univariate analysis, declined GNRI [hazard ratio (HR) 2.18, 95% confidence interval (CI) 1.57-3.07, p<0.0001 for T1 vs. T3] and elevated CRP (HR 1.78, 95%CI 1.24-2.59, p=0.0016 for T3 vs. T1) were identified as independent predictors of amputation and/or mortality. In the combined setting of both variables, the risk of amputation and/or mortality was 3.77-fold higher (95%CI 1.97-7.69, p<0.0001) in theT1 of GNRI with T3 of CRP than in the T3 of GNRI with T1 of CRP. Similar results were obtained for amputation and mortality, respectively (Figure). Conclusion Among HD patients undergoing lower extremity revascularization, those with pre-procedural declined GNRI and elevated CRP frequently experienced amputation and/or mortality, furthermore, combination of both variables could stratify the risk of amputation and/or mortality.

scholarly journals High-quality Outpatient Diabetic Care Improves Amputation-Free Survival After Lower Extremity Revascularization for Critical Limb Ischemia

2013 ◽  
Vol 57 (5) ◽  
pp. 13S-14S
Author(s):  
Benjamin S. Brooke ◽  
David H. Stone ◽  
Brian Nolan ◽  
Randall R. De Martino ◽  
David C. Goodman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
High Quality ◽  
Free Survival ◽  
Lower Extremity Revascularization ◽  
Diabetic Care

scholarly journals Open versus endoscopic great saphenous vein harvest for lower extremity revascularization of critical limb ischemia

2014 ◽  
Vol 59 (2) ◽  
pp. 427-434 ◽  
Author(s):  
Vincent J. Santo ◽  
Phong T. Dargon ◽  
Amir F. Azarbal ◽  
Timothy K. Liem ◽  
Erica L. Mitchell ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Limb Ischemia ◽  
Open Versus ◽  
Lower Extremity Revascularization

Outcomes after Open Lower Extremity Revascularization in Patients with Critical Limb Ischemia

2020 ◽  
Vol 67 ◽  
pp. 417-424
Author(s):  
Mitri K. Khoury ◽  
John E. Rectenwald ◽  
Shirling Tsai ◽  
Melissa L. Kirkwood ◽  
Bala Ramanan ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Lower Extremity Revascularization

Complete Lower Extremity Revascularization via a Hybrid Procedure for Patients with Critical Limb Ischemia

2018 ◽  
Vol 52 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Toshio Takayama ◽  
Jon S. Matsumura
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Patency Rate ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Primary Patency ◽  
Hybrid Procedure ◽  
Complete Revascularization ◽  
Primary Patency Rate ◽  
Lower Extremity Revascularization

Background: Complete revascularization, achieving inline flow to the foot through at least 1 patent tibioperoneal artery, is considered to be desirable for treating critical limb ischemia (CLI). Hybrid procedure, combined femoral endarterectomy and endovascular treatment, is commonly performed on patients with CLI because they often present with complicated lower extremity lesions involving the common femoral artery. This study aimed to investigate the efficacy of complete revascularization (CR) achieved by hybrid procedure on limb salvage in patients with CLI. Methods: Between February 2010 and January 2016, 95 limbs (82 patients) were treated by lower extremity hybrid procedure; of these 95 procedures, 61 were for patients with CLI. We defined CR as achieving inline flow to the foot through at least 1 patent tibioperoneal artery. Complete revascularization was performed on 37 limbs, and incomplete revascularization (IR) was performed on 24 limbs. Specific variables, including patient age, male–female ratio, Rutherford classification, preoperative and postoperative ankle–brachial pressure indices (ABIs), follow-up duration (months), primary patency rate, assisted primary patency rate, secondary patency rate, and major amputation rate, were analyzed. Results: The mean age was similar between the groups 67.2 years in the CR group and 70.7 years in the IR group ( P = .11). Limb ischemia severity was significantly higher in the CR group: 63% of the patients scored Rutherford 5 in the CR group, compared to 30% in the IR group ( P = .027). Mean postoperative ABI was significantly higher in the CR group (CR: 0.87, IR: 0.53; P = .0001). Major amputation rate was higher in the IR group (CR: 2.7%, IR: 13%; P = .29), and major amputation-free survival rate at 3 years after the index procedure was higher in the CR group (CR: 97%, IR: 81%; P = .054). Conclusion: Complete lower extremity revascularization was beneficial for patients with CLI, avoiding major amputation.

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