Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study

Fridh, Erik Baubeta; Andersson, Manne; Thuresson, Marcus; Sigvant, Birgitta; Kragsterman, Björn; Johansson, Saga; Hasvold, Pål; Falkenberg, Mårten; Nordanstig, Joakim

doi:10.1016/j.ejvs.2017.07.005

Cited by 148 publications

(73 citation statements)

References 18 publications

(25 reference statements)

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“…Baubeta Fridh and co-workers analysed mortality and amputation rates during 3 years in a heterogeneous group of PAD patients in Swedvasc having undergone either open or endovascular surgery for CLTI or IC caused by supra- or infrainguinal disease. 19 Mortality in the IC group was 3.4% after 1 year and 12.0% after 3 years. Their 1 year mortality rate is comparable to ours despite our more narrow inclusion criteria, whereas the 5 year mortality in our study cannot be directly compared with their figures due to their shorter follow-up.…”

Section: Discussionmentioning

confidence: 89%

Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Dakhel

Zarrouk

Ekelund³

et al. 2020

Therapeutic Advances in Endocrinology

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Background: Diabetes mellitus (DM) is an established risk factor for intermittent claudication (IC) and other manifestations of atherosclerotic peripheral arterial disease. Indications for surgery in infrainguinal IC are debated, and there are conflicting reports regarding its outcomes in patients with DM. Aims of this study were to compare both short- and long-term effects on total- and cardiovascular (CV) mortality, major adverse cardiovascular events (MACEs), acute myocardial infarction (AMI), stroke, and major amputation following infrainguinal endovascular surgery for IC in patients with and without DM. We also evaluated potential relationships between diabetic control and outcomes in patients with DM. Methods: Nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Registry. Propensity score adjusted comparison of total and CV mortality, MACE, AMI, stroke, and major amputation after elective infrainguinal endovascular surgery for IC in 626 patients with and 1112 without DM at 30 postoperative days and after median 5.2 [interquartile range (IQR) 4.2–6.3] years of follow-up for patients with DM, and 5.4 (IQR 4.3–6.5) years for those without. Results: In propensity score adjusted Cox regression after 30 postoperative days, there were no differences between groups in morbidity or mortality. At last follow-up, patients with DM showed higher rates of MACE [hazard ratio (HR) 1.26, confidence interval (CI) 1.07–1.48; p < 0.01], AMI (HR 1.48, CI 1.09–2.00; p = 0.01), and major amputation (HR 2.31, CI 1.24–4.32; p < 0.01). Among patients with DM, higher HbA1c was associated with higher total mortality during follow-up (HR 1.01, CI 1.00–1.03; p = 0.045). Conclusion: Patients with DM have higher rates of MACE, AMI, and major amputation in propensity score adjusted analysis during 5 years of follow-up after infrainguinal endovascular surgery for IC. Furthermore, HbA1c is associated with total mortality in patients with DM. Prevention and treatment of DM is important to improve cardiovascular and limb outcomes.

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Section: Discussionmentioning

confidence: 89%

Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Dakhel

Zarrouk

Ekelund³

et al. 2020

Therapeutic Advances in Endocrinology

View full text Add to dashboard Cite

show abstract

“…Endovascular surgery, a minimally invasive approach, is mostly conducted under local anaesthesia in an angio suite. A majority of the procedures performed for IC in Sweden are undertaken via the endovascular route 2 . The approach is percutaneous, and by using the Seldinger technique an introducer is inserted into the vessel either with or without ultrasound guidance.…”

Section: 2b Invasive Treatment: General Considerationsmentioning

confidence: 99%

“…In open surgery, the arteries explored are fully visible in the operational field by incision of the skin and by dissecting the target arteries free from the surrounding tissues. A minority of the IC procedures are performed by open surgery 2 .…”

Section: 2b Invasive Treatment: General Considerationsmentioning

confidence: 99%

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Absence of Long-Term Benefit of Revascularization in Patients With Intermittent Claudication

Djerf

Millinger

Falkenberg

et al. 2020

Circ: Cardiovascular Interventions

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“…Hence, amputation risk is inherently increased in diabetes, and a history of DFD and amputation are risk factors for CV events, including re-amputation, and poorer prognosis [ 15 , 16 ]. Results of a population-based cohort study showed that the risk of amputation was particularly high during the first 6 months following revascularization for critical limb ischemia [ 17 ]. Actually, a history of amputation and DFD were also strong and independent risk factors for amputation in the CANVAS program [ 3 ].…”

mentioning

confidence: 99%

Increased amputation risk with canagliflozin treatment: behind the large cardiovascular benefit?

Tanaka

Node

2017

Cardiovasc Diabetol

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A growing body of evidence suggests that sodium-glucose cotransporter 2 (SGLT2) inhibitors appear to be a powerful option to improve the cardiovascular (CV) prognosis in high CV-risk patients with type 2 diabetes. Despite a significant reduction in major adverse CV events with SGLT2 inhibitor treatment, however, an unexpected increased risk of amputation was observed in the CANVAS program and the subsequent pharmacovigilance analysis. Although the underlying mechanisms are currently unknown, because amputation has a large negative impact on patient clinical course, clinicians want to know the exact reason for the increased amputation in the canagliflozin treatment. We herein discuss a need to elucidate the actual reasons with more appropriate statistical consideration, taking into account individual clinical course potentially involved in the diabetes-related amputation. Decreases in the hardendpoints by canagliflozin might result in an alternate increase in the other diabetes-related complications, including amputation. In addition, if amputation occurred after stopping canagliflozin, the incidence might be caused by worsened glycemic control and a decrease in hematocrit, accompanied by a subsequent worsening of diabetic foot disease. More detailed approach considering individual clinical course potentially involved in the amputation, would help to further unravel the cause for suspected risk of amputation with canagliflozin.

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Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study

Cited by 148 publications

References 18 publications

Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Absence of Long-Term Benefit of Revascularization in Patients With Intermittent Claudication

Increased amputation risk with canagliflozin treatment: behind the large cardiovascular benefit?

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