The effectiveness of endovascular therapy for critical limb ischemia

2012 ◽  
Vol 4 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Yoshiaki Yokoi
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia

Predictors of non-healing in patients with critical limb ischemia and tissue loss following successful endovascular therapy

2014 ◽  
Vol 85 (5) ◽  
pp. 850-858 ◽  
Author(s):  
Norihiro Kobayashi ◽  
Keisuke Hirano ◽  
Masatsugu Nakano ◽  
Toshiya Muramatsu ◽  
Reiko Tsukahara ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Tissue Loss

scholarly journals No Association of Diabetic Duration or Insulin Use with the Prognosis of Critical Limb Ischemia after Endovascular Therapy

2011 ◽  
Vol 18 (12) ◽  
pp. 1102-1109 ◽  
Author(s):  
Mitsuyoshi Takahara ◽  
Hideaki Kaneto ◽  
Osamu Iida ◽  
Naoto Katakami ◽  
Fumie Sakamoto ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Insulin Use

scholarly journals Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 38-45
Author(s):  
Tadashi Furuyama ◽  
Toshihiro Onohara ◽  
Ryosuke Yoshiga ◽  
Keiji Yoshiya ◽  
Yutaka Matsubara ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Ulcer Healing ◽  
Therapy Group ◽  
Limb Ischemia ◽  
Direct Flow ◽  
Free Survival ◽  
Ambulatory Status ◽  
Bypass Group ◽  
One Year

Objective Patients with critical limb ischemia have serious systemic comorbidities and are at high risk of impairment of limb function. In this study, we assessed the prognostic factors of limbs after revascularization. Methods In this retrospective single-center cohort study, from April 2008 to December 2012, we treated 154 limbs of 121 patients with critical limb ischemia by the endovascular therapy-first approach based on the patients’ characteristics. The primary end point was amputation-free survival. Secondary end points were patency of a revascularized artery, major adverse limb events, or death. Furthermore, we investigated the ambulatory status one year after revascularization as prognosis of limb function. Results Endovascular therapy was performed in 85 limbs in 65 patients as the initial therapy (endovascular therapy group) and surgical reconstructive procedures (bypass group) were performed in 69 limbs in 56 patients. Early mortality within 30 days was not observed in either group. The primary patency rate was significantly better in the bypass group than in the endovascular therapy group ( p < 0.0001). Furthermore, the secondary patency rate was similar between the two groups ( p = 0.0096). There were no significant differences in amputation-free survival and major adverse limb event between the two groups. Univariate analysis showed that ulcer healing ( p < 0.0001), no hypoalbuminemia ( p = 0.0019), restoration of direct flow below the ankle ( p = 0.0219), no previous cerebrovascular disease ( p = 0.0389), and Rutherford 4 ( p = 0.0469) were predictive factors for preservation of ambulatory status one year after revascularization. In multivariate analysis, ulcer healing ( p < 0.0001) and restoration of direct flow below the ankle ( p = 0.0060) were significant predictors. Conclusions Ulcer healing and restoration of direct flow below the ankle are independently associated with prognosis of limb functions in patients who undergo infrainguinal arterial reconstruction.

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.

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