scholarly journals Endovascular approach for acute limb ischemia without thrombolytic therapy

2020 ◽  
Vol 14 ◽  
pp. 175394472092457
Author(s):  
Keisuke Fukuda ◽  
Yoshiaki Yokoi
Keyword(s):  
Mortality Rate ◽  
Endovascular Therapy ◽  
Thrombolytic Agent ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Surgical Revascularization ◽  
Technical Success Rate ◽  
Kaplan Meier

Background: Endovascular therapy for acute lower limb ischemia (ALLI) has developed and demonstrated safety and efficacy. The purpose of this study was to assess clinical outcomes in patients treated for ALLI with conventional endovascular or surgical revascularization. Method: This study was a retrospective single-center review. Consecutive patients with ALLI treated with conventional endovascular revascularization (ER) without thrombolytic agent or surgical revascularization (SR) between 2008 and 2014 were investigated. The 1 year and 3 year amputation rate and mortality rate were assessed by time-to-event methods, including Kaplan–Meier estimation. Result: A total of 64 limbs in 62 patients with ALLI due to thromboembolism or thrombosis of a native artery, bypass graft, or previous stented vessel were included. The majority of limbs (90.9%) presented with Rutherford clinical categories 1 to 2 ischemia. Technical success rate was 95.5% in ER and 92.9% in SR group ( p = 0.547). Overall amputation rates were 9.1% in ER versus 9.5% in SR after 1 year ( p = 0.971) and 9.1% in ER versus 11.9% in SR after 3 year ( p = 0.742). Overall mortality rates were 15% in ER versus 7.1% in SR after 1 year ( p = 0.491) and 15% in ER versus 11.2% in SR after 3 year ( p = 0.878). Conclusion: Endovascular or surgical revascularization of ALLI resulted in comparable outcomes in limb salvage and mortality rate at 1 year and 3 year. Conventional endovascular therapy without thrombolytic agent such as stenting, balloon angioplasty, or catheter-directed thrombosuction may be considered as a treatment option for ALLI.

The Trellis Thrombectomy System in the Treatment of Acute Limb Ischemia

2003 ◽  
Vol 10 (2) ◽  
pp. 317-321 ◽  
Author(s):  
Karthikeshwar Kasirajan ◽  
Venkatesh G. Ramaiah ◽  
Edward B. Diethrich
Keyword(s):  
Thrombolytic Agent ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Graft Thrombosis ◽  
Percutaneous Mechanical Thrombectomy ◽  
Flow Restoration ◽  
Drug Dispersion ◽  
Thrombectomy Device ◽  
Distal Occlusion

Purpose: To report the use of a new percutaneous mechanical thrombectomy device in the treatment of acute limb-threatening ischemia. Technique: The Trellis Thrombectomy System is a 7-F drug dispersion catheter that features a treatment segment isolated by proximal and distal occlusion balloons, which help prevent distal embolization and systemic release of the infused thrombolytic agent. After inflating the distal balloon, the thrombolytic agent is infused and held at the target site by inflation of the proximal balloon. An oscillating dispersion wire optimizes dispersal of the thrombolytic agent as the thrombus is mechanically fragmented. The liquefied thrombus is then aspirated. Four consecutive patients with acute lower extremity ischemia secondary to bypass graft thrombosis were treated with the Trellis thrombectomy catheter. Overall, 95% of thrombus was successfully removed from the treatment zone, with no device-related complications. Only one patient required adjunctive thrombolytic therapy after thrombectomy with the Trellis device. Conclusions: The Trellis thrombectomy device is a safe and effective technique to isolate the infused thrombolytic agent in association with mechanical fragmentation for rapid blood flow restoration.

The association of opium dependence and postoperative complications following coronary artery bypass graft surgery: A propensity-matched study

2018 ◽  
Vol 5 (6) ◽  
pp. 365-372 ◽  
Author(s):  
Saeed Sadeghian, MD ◽  
Abbasali Karimi, MD ◽  
Samaneh Dowlatshahi, MD ◽  
Seyed Hossein Ahmadi, MD ◽  
Saeed Davoodi, MD ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Public Health Problem ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Preoperative Risk Factors ◽  
Post Operation ◽  
Matched Study

Objective: Opium is an overwhelming public health problem in some countries. Different studies have suggested this drug as a risk factor for cardiovascular disease. Although the effect of opium on immune system, lung disease, nephropathy, stroke, and cardiac arrhythmia has been found in different studies, its effect on postoperation complications is not clear yet. The authors conducted this study to assess the effect of opium on post operation in hospital complications among patients who underwent coronary artery bypass graft.Design: The authors retrospectively analyzed the data in this study.Setting: This study has been done at Tehran Heart Center.Patients: A total of 4,398 patients who had undergone isolated CABG were studied.Main outcome measure: Patients who fulfilled the DSM-IV-TR criteria for opium dependence (by smoking) were enrolled as Opium Dependent Patients. Also outcome variables were: Perioperative MI, septicemia, UTI, TIA, continuous coma, prolonged ventilation, pulmonary embolism, renal failure, acute limb ischemia, heart block, AF, mortality.Results: The prevalence of opium dependence was 15.6 percent among patients. The authors used a propensity matched model to analyze the relationship between opium and post operation complications. The authors adjusted opium and non-opium dependent patients in all of the baseline preoperative risk factors, so all of the matched patients were same and there was no bias in assessment.Conclusion: Opium dependent patients had significantly longer resource utilization. However, no significant relationship was found between opium dependence and other cardiac and non cardiac in hospital complications.

scholarly journals Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Saúl Pampa-Saico ◽  
Sara Jiménez-Alvaro ◽  
Fernando Caravaca-Fontán ◽  
Ana Fernández-Rodríguez ◽  
Maite Rivera-Gorrín ◽  
...  
Keyword(s):  
Renal Function ◽  
Severe Renal Impairment ◽  
Imaging Techniques ◽  
Bypass Graft ◽  
Graft Loss ◽  
Previous History ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Retrograde Flow ◽  
Aortobifemoral Bypass

Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal.

Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Grant W Reed ◽  
Negar Salehi ◽  
Pejman Raeisi-Giglou ◽  
Umair Malik ◽  
Rami Kafa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Proportional Hazards ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Kaplan Meier

Introduction: There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy. Methods: In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis. Results: A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005). Conclusions: A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.

Abstract 17605: Cost-Effectiveness of Contemporary Endovascular Treatment Compared to Open Surgical Revascularization for Cardioembolic Acute Limb Ischemia

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Elizabeth A Genovese ◽  
Kenneth J Smith ◽  
Neal R Barshes ◽  
Michel S Makaroun ◽  
Donald T Baril
Keyword(s):  
Mortality Rate ◽  
Endovascular Treatment ◽  
Cost Effective ◽  
Limb Ischemia ◽  
Morbidity And Mortality ◽  
Adverse Event Rate ◽  
Parameter Estimates ◽  
Acute Limb Ischemia ◽  
Technical Success ◽  
Life Years

Introduction: Treatment of acute limb ischemia (ALI) has a high morbidity and mortality given patients’ multiple comorbidities, poor physiologic reserve, and the need for emergent intervention. Traditionally ALI of embolic origin has been treated with open revascularization (OR), however with increasing experience with thrombolytic therapy and adjuvant techniques, endovascular revascularization (ER) for ALI has become a more common treatment due to the lower associated morbidity and mortality. Hypothesis: Although associated with higher initial costs and lower technical success rates, ER will be cost effective given the decreased adverse event rate and mortality in a frail patient population. Methods: A Markov state-transition model was created to simulate patient oriented outcomes, including technical success, adverse events, limb salvage, discharge facility and quality adjusted life years (QALY) for patients presenting with Rutherford Classification I/IIa/IIb ALI secondary to cardiac embolism. A societal perspective was assumed with a 10-year time horizon. Parameter estimates were derived from published literature and primary data of cardioembolic ALI patients treated at our institution from 2005-2011 with either ER or OR. Costs were adjusted to 2013 U.S. dollars. Results: In the model, OR was technically successful in 87% patients, with a $23,881 cost for the initial hospitalization and a 11.5% perioperative mortality rate; ER was technically successful in 71% of patients, with a $39,619 initial cost, and a 4% mortality rate. At 10 years, the ER strategy cost $92,659/QALY gained compared to OR. Sensitivity analyses demonstrated that ER was favorable at a willingness to pay (WTP) threshold of $100,000/QALY when ER technical success was >70%, initial ER hospitalization cost was <$41,052 or if OR mortality was >10%. At a WTP of $50,000/QALY, ER was cost effective if technical success reached 79%, if ER cost was <$31,287 or if OR mortality was >23%. Conclusions: Contemporary endovascular treatment of cardioembolic ALI carries a greater cost compared to open revascularization, however it is associated with a decreased mortality rate. ER is potentially cost-effective in patients who are at high risk of post-operative mortality following OR.

Abstract 214: The Association of Surgeon Experience With Expected Mortality of Coronary Artery Bypass Graft Surgery in New York State

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Swathi Raman ◽  
Ashwin Nathan ◽  
Sameed Ahmed M Khatana ◽  
Nimesh D Desai ◽  
Pavan Atluri ◽  
...  
Keyword(s):  
New York ◽  
Mortality Rate ◽  
Artery Bypass ◽  
Bypass Graft ◽  
New York State ◽  
Board Certification ◽  
Artery Bypass Graft ◽  
York State ◽  
Surgeon Experience ◽  
Expected Mortality

Purpose: Public reporting of surgical outcomes can promote quality improvement. However, this could also incentivize surgeons to avoid high-risk patients. Senior surgeons, with established referral networks, may select lower-risk cases than their junior colleagues. This study aimed to assess the relationship between surgeon experience and expected mortality rate of cases performed. Methods: Publicly available data on coronary artery bypass graft (CABG) surgeries between 2011-2013 were obtained from the New York State Department of Health. The 30-day expected mortality rate (EMR) for each CABG was calculated from validated models. Additionally, we obtained data on each surgeon’s medical school gradation year and board certification status from Internet sources, such as Doximity. Surgeon experience was calculated by subtracting the medical school graduation year from 2011, the start of the study period. A multivariable linear regression model was used to estimate the association between EMR and surgeon experience, adjusting for case volume and board certification status. Results: Between 2011-2013, there were 132 cardiac surgeons that performed CABG at 39 hospitals across New York State. The mean surgeon experience was 25.1 years (SD 9.1 years) and the overall mean EMR of CABG surgeries was 1.46% (SD 0.38%). The unadjusted analysis showed a 0.005% increase in EMR per additional year of surgeon experience. However, this was not statistically significant (p=0.25, 95% CI -0.0036 to 0.0013). Through the multivariable linear regression model, we did not find evidence of a significant association between operator experience and the EMR of cases performed (0.0040% per year, p=0.35, 95% CI -0.0044 to 0.012%). There was a significant association between the number of cases performed during the study period and the EMR, with an increase in EMR by 0.0005% per additional case performed (p=0.04, 95% CI 0.00004 to 0.001). There was no significant association between board certification status and EMR (p=0.10). Conclusion: Despite public reporting of CABG outcomes, our findings suggest that more experienced surgeons may not be exhibiting risk-avoidant behavior. Future research could focus on supplementing publicly reported physician-level data with patient-level datasets to better understand the association between surgeon experience and expected mortality rate of cases performed.

scholarly journals Outcomes and Complications after Intraarterial Thrombolysis for Limb Ischemia: a 4 Year Study at a Single Centre

2016 ◽  
Vol 16 (2) ◽  
pp. 3-7
Author(s):  
Arturs Ligers ◽  
Patricija Ivanova ◽  
Gvido Bergs ◽  
Andris Levis ◽  
Sanita Ponomarjova ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Thrombolytic Therapy ◽  
Clinical Outcomes ◽  
Abdominal Aorta ◽  
High Mortality ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Duration Of Symptoms ◽  
Intraarterial Thrombolysis ◽  
The Mean

SummaryIntroduction.The reason for using thrombolytic therapy is to eliminate vascular thrombosis and promote vascular permeability. Acute limb ischemia is associated with significant morbidity and mortality. ROCHESTER, STILE and TOPAS studies showed that thrombolytic therapy for acute limb ischemia decreases the rate of surgical interventions and significantly increases the rate of limb salvage.Aim of the Study.The purpose of this study is to assess the efficacy and outcomes of intra-arterial thrombolysis in the treatment of acute occlusions of the lower limb over a four-year period.Material and Methods.We analysed 103 patients who had been treated in our department. There were acute ischemias of stage IIa and IIb according to the Rutherford classification. The data prior to, and after thrombolysis was analysed. We usedAlteplaseas a thrombolytic agent (mean dose 62 mg ±23.5). Procedural success was based on angiographic and clinical outcomes. Statistics were calculated by SPSS 16.Results.The mean duration of symptoms prior to hospitalisation was 2.5 days (IQR 5-96 hours). The mean age at the time of thrombolysis was 63±11 for males 69±10 years for females. The success of intraarterial thrombolysis was defined by angiographic and clinical outcomes (successful in 86.4% and failed in 13.6%). Adjunctive angioplasty was performed on 39 (37.9%) patients, and immediate reconstructive surgery was required on 19 (18.4%) patients. The incidence of complications was 17,4 %, with the most common being-bleeding from the puncture side, the urinary tract or the gastrointestinal tract. Overall mortality was 8.7%. The women who required thrombolysis were older (p=0,034) and with a higher death rate (p=0.047). A CDT (catheter-directed thrombolysis) for an abdominal aorta thrombosis carries a significantly high mortality rate (p=0.00013). There were no statistically significant differences between the duration of symptoms and limb amputation and between other analysed data.Conclusions.Intraarterial thrombolysis is an effective treatment method in acute limb ischemia for selected patients, as long as accurate procedural monitoring is ensured. Thrombolysis often leads to the discovery of underlying vascular lesions. A CDT for an abdominal aorta thrombosis carries a significantly high mortality rate.

scholarly journals Endovascular therapy for acute limb ischemia

2011 ◽  
Vol 53 (2) ◽  
pp. 340-346 ◽  
Author(s):  
Vikram S. Kashyap ◽  
Ramyar Gilani ◽  
James F. Bena ◽  
Mohsen Bannazadeh ◽  
Timur P. Sarac
Keyword(s):  
Endovascular Therapy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia
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