Readmissions to an alternate hospital in patients undergoing vascular intervention for claudication and critical limb ischemia associated with significantly higher mortality

2019 ◽  
Vol 70 (6) ◽  
pp. 1960-1972 ◽  
Author(s):  
Rennier A. Martinez ◽  
Kelsey N. Franklin ◽  
Alexandra E. Hernandez ◽  
Joshua Parreco ◽  
Nicholas Cortolillo ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Vascular Intervention

Isolated femoral artery revascularisation with or without iliac inflow improvement – a less invasive surgical option in critical limb ischemia

VASA ◽  
2021 ◽  
pp. 1-7
Author(s):  
Andreas S. Peters ◽  
Katrin Meisenbacher ◽  
Dorothea Weber ◽  
Theodosios Bisdas ◽  
Giovanni Torsello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Negative Impact ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lesion Length ◽  
Vascular Intervention ◽  
Selection Of Variables ◽  
Surgical Option

Summary: Background: Isolated femoral artery revascularisation (iFAR) represents a well-established surgical method in the treatment of peripheral arterial disease (PAD) involving common femoral artery disease. Data for iFAR in multilevel PAD are inconsistent, particularly in patients with critical limb ischemia (CLI). The aim of the study was to evaluate the outcome of iFAR in CLI regarding major amputation and reintervention and to identify associated risk factors for this outcome. Patients and methods: The data used have been derived from the German Registry of Firstline Treatment in Critical Limb Ischemia (CRITISCH). A total of 1200 patients were enrolled in 27 vascular centres. This sub-analysis included patients, which were treated with iFAR with/without concomitant iliac intervention. For detection of risk factors for the combined endpoint of major amputation and/or reintervention, selection of variables for multiple regression was conducted using stepwise forward/backward selection by Akaike’s information criterion. Results: 95 patients were included (mean age: 72 years ± 10.82; 64.2% male). Of those, 32 (33.7%) participants reached the combined endpoint. Risk factor analysis revealed continued tobacco use (odds ratio [OR] 2.316, confidence interval [CI] 0.832–6.674), TASC D-lesion (OR: 2.293, CI: 0.869–6.261) and previous vascular intervention in the trial leg (OR: 2.720, CI: 1.037–7.381) to be associated with reaching the combined endpoint. Conclusions: iFAR provides a reasonable, surgical option to treat CLI. Lesion length (TASC D) seems to have a negative impact on outcome. Further research is required to better define the future role of iFAR for combined femoro-popliteal lesions in CLI – best in terms of a randomised controlled trial.

Early Identification of Argatroban Resistance and the Consideration of Factor VIII

2019 ◽  
pp. 089719001988523 ◽  
Author(s):  
Janelle O. Poyant ◽  
Augustus M. Gleason
Keyword(s):  
Case Report ◽  
Factor Viii ◽  
Critical Limb Ischemia ◽  
Early Identification ◽  
Single Case ◽  
Limb Ischemia ◽  
Thrombin Inhibitor ◽  
Early Assessment ◽  
Vascular Intervention ◽  
Heparin Resistance

Background: Argatroban, a synthetic, parenteral, nonheparin anticoagulant, is a direct thrombin inhibitor indicated for the prophylaxis or treatment of venous thromboembolism (VTE) in patients with heparin-induced thrombocytopenia with thrombosis (HITT) and for use during percutaneous coronary intervention (PCI) in patients who have or are at risk for developing HITT. Although heparin resistance occurs in approximately 0.5% to 5% of heparin-treated patients and is well documented in the literature, argatroban resistance is limited to a single case report. The objective of this case is to describe a case in which argatroban resistance was suspected in a patient with critical limb ischemia. Methods: This is a case report of a single patient. Results: A 68-year-old female admitted for critical limb ischemia requiring vascular intervention was treated for presumed HITT with argatroban. A therapeutic activated partial thromboplastin time (aPTT) was not attained (31 seconds) despite multiple uptitrations of the dose to 2.8 μg/kg/min (adjusted based on the institutional protocol and with consideration of organ dysfunction). A coagulopathy workup revealed a high level of factor VIII (265%). Conclusion: This case supports early assessment of factor VIII levels and the consideration of argatroban resistance and in patients who have a subtherapeutic aPTT, despite multiple increases in dose with an elevated factor VIII level. Early identification should prompt the use of an alternative anticoagulant to ensure efficacy.

Article Commentary: Current Status of Heroic Limb Salvage for Critical Limb Ischemia

2008 ◽  
Vol 74 (4) ◽  
pp. 275-284
Author(s):  
Spence M. Taylor
Keyword(s):  
Critical Limb Ischemia ◽  
Current Method ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Current Status ◽  
Limb Amputation ◽  
Vascular Intervention ◽  
Ambulatory Ability ◽  
Original Measure ◽  
Peripheral Arterial

The treatment of chronic lower extremity peripheral arterial disease is in a state of flux. During the past decade, vascular surgeons have assumed the responsibility for the endovascular care of patients needing vascular intervention. Once surgeons began performing these procedures, a change in attitude toward angioplasty resulted in an “endovascular explosion” and an overall reassessment of the traditional approaches to critical limb ischemia. Our current method of assessing outcomes is also in a state of flux. The original measure of procedural success, reconstruction patency, has been found to be a poor predictor of both patient palliation and functional success. A shift toward determining more accurate, patient-oriented outcome measures is ongoing. Until then, evidence would suggest that there are patients with such severe medical comorbidities, which include impaired ambulatory ability at presentation, that the benefits of revascularization seem to be insignificant. As our patient population ages and our healthcare system continues to fail financially, economic rationing motivated by lack of evidence-based data to the contrary may dictate that these patients are best served by primary limb amputation.

scholarly journals Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

2016 ◽  
Vol 22 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Caitlin W Hicks ◽  
Alireza Najafian ◽  
Alik Farber ◽  
Matthew T Menard ◽  
Mahmoud B Malas ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Multivariable Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Primary Patency ◽  
Tissue Loss ◽  
Vascular Intervention ◽  
Below The Knee ◽  
Endovascular Interventions ◽  
One Year

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

scholarly journals Review: Quality of life in lower limb peripheral vascular surgery

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 88-95 ◽  
Author(s):  
JMW Donker ◽  
J de Vries ◽  
GH Ho ◽  
F Bastos Gonçalves ◽  
SE Hoeks ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peripheral Arterial Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Invasive Treatment ◽  
Vascular Intervention ◽  
Peripheral Arterial

Purpose Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffering from either claudication or critical limb ischemia. Basic methods A review of the literature was undertaken in the Medline library. A search was performed on quality of life in peripheral arterial disease. Results were stratified according to treatment groups. Principal findings Twenty-one articles described quality of life in approximately 4600 patients suffering from peripheral arterial disease. Invasive treatment generally results in better quality of life scores (at a maximum of 2 years of follow-up), compared with non-invasive treatment. In patients with critical limb ischemia, successful revascularization improves quality of life scores. Only one study reported long-term results. Conclusions Increase in quality of life scores can be found for any intervention performed for peripheral arterial disease. However, there is scarce information on long-term quality of life after vascular intervention.

Postoperative Outcomes According to Preoperative Medical and Functional Status after Infrainguinal Revascularization for Critical Limb Ischemia in Patients 80 Years and Older

2005 ◽  
Vol 71 (8) ◽  
pp. 640-646 ◽  
Author(s):  
Spence M. Taylor ◽  
Corey A. Kalbaugh ◽  
Dawn W. Blackhurst ◽  
Eugene M. Langan ◽  
David L. Cull ◽  
...  
Keyword(s):  
Functional Status ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Independent Living ◽  
Limb Ischemia ◽  
Secondary Patency ◽  
End Points ◽  
Vascular Intervention ◽  
Free Survival ◽  
Open Operation

The purpose of this study was to provide outcomes after intervention for critical limb ischemia (CLI) in elderly patients (≥80 years) according to medical and functional status at presentation. From January 1998 to September 2003, 140 limbs/122 patients (age range 80–97 years) were treated (57 patients/66 limbs, infrainguinal bypass; 65 patients/74 limbs, infrainguinal angioplasty) for CLI. At presentation, 71 (58.2%) patients were functionally ambulatory, 41 (33.6%) were home-bound ambulators, and 10 (8.2%) were transfer-only ambulators. Overall end points after treatment as well as outcomes according to type of treatment and preoperative medical and functional status were determined. End points included reconstruction patency, limb salvage, survival, amputation-free survival, and maintenance of ambulatory and independent living status. Results for the 140 limbs/122 patients at 3 years (Kaplan-Meier curves) include primary patency, 55.3%; secondary patency, 73.2%; limb salvage, 78.3%; survival, 62.5%; amputation-free survival, 49.7%; maintenance of ambulation, 77.8%; and maintenance of independent living status, 82.9%. There was essentially no difference in outcomes based on type of treatment (endovascular vs open operation). When analyzing 2-year outcomes by functional status (ambulatory vs homebound vs transfer), there was deterioration in outcomes according to declining functional status at presentation for mortality (84.7% vs 66.4% vs 42%; P < 0.001), amputation-free survival (73.3% vs 48.2% vs 36.9%; P < 0.001), limb salvage (86% vs 66.5% vs 71.9%; P = 0.022), and secondary patency (84.3% vs 61.5% vs 69.2%; P = 0.005) regardless of treatment. Homebound ambulators were two times and transfer-only patients five times more likely to experience death (Cox hazard model); diabetics were four times more likely to lose a limb and experience a decline in ambulation and living status. Overall medical and functional status at presentation predicts postoperative functional outcomes. These data support a policy of aggressive vascular intervention in the functional elderly and clinical restraint in the functionally impaired patient with CLI.

scholarly journals SS14. Prior Failed Ipsilateral Percutaneous Vascular Intervention (PVI) in Patients With Critical Limb Ischemia Predicts Poor Outcome After Lower Extremity Bypass

2010 ◽  
Vol 51 (6) ◽  
pp. 10S-11S ◽  
Author(s):  
Brian W. Nolan ◽  
Randall R. De Martino ◽  
Adam W. Beck ◽  
Andres Schanzer ◽  
Philip P. Goodney ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Vascular Intervention ◽  
Poor Outcome

scholarly journals Determinants of Amputation-Free Survival After Peripheral Vascular Intervention for Critical Limb Ischemia

2013 ◽  
Vol 58 (3) ◽  
pp. 855
Author(s):  
Luke Vierthaler ◽  
Philip P. Goodney ◽  
Andres Schanzer ◽  
Virenda I. Patel ◽  
Jack L. Cronenwett ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Free Survival ◽  
Peripheral Vascular Intervention
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