A National and Single Institutional Experience in the Contemporary Treatment of Acute Lower Extremity Ischemia

Eliason, Jonathan L.; Wainess, Reid M.; Proctor, Mary C.; Dimick, Justin B.; Cowan, John A.; Upchurch, Gilbert R.; Stanley, James C.; Henke, Peter K.

doi:10.1097/01.sla.0000086663.49670.d1

Cited by 166 publications

(124 citation statements)

References 22 publications

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“…The absolute in-hospital mortality during the first study decade of 8.3% is comparable to the mortality rate of 9.3% reported previously for patients presenting with ALI between 1992 and 2000 using the Nationwide Inpatient Sample hospital database. 17 The high-risk clinical profile of patients with LET alludes not only to the high rates of all-cause and cardiovascular mortality that generally characterize these individuals with polyvascular atherosclerosis 18 but also to the high operative mortality that characterizes some of the invasive treatments for LET. 3 In fact, more than one quarter of the patients admitted with LET in the present study were not considered candidates for any revascularization procedure, likely because of the presence of severe comorbidities or presentation with severe, prolonged ischemic time, making revascularization options prohibitive.…”

Section: Discussionmentioning

confidence: 99%

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

et al. 2013

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Background-Epidemiology data for lower-extremity arterial thromboembolism (LET) are limited and may result from either acute limb ischemia or an acute exacerbation of critical limb ischemia. Given marked changes in both diagnosis and therapy over the last 2 decades, we hypothesized that this time period would have witnessed reductions in both the incidence and in-hospital mortality of LET. Methods and Results-Data from 1988 through 2007 from the National Hospital Discharge Survey were analyzed. All admissions for patients with LET were extracted, and the respective International Classification of Diseases, Ninth Revision, Clinical Modification codes were internally validated for both LET and acute limb ischemia. Descriptive statistics were used. The validity of the codes was good for identifying LET cases but poor for identifying acute limb ischemia cases because many of these acute presentations were attributable to critical limb ischemia. Over the 20-year span, there were 1.76 million cases of LET. The incidence of LET decreased significantly from 42.4 per 100 000 persons between 1988 and 1997 to 23.3 per 100 000 persons between 1998 and 2007. The in-hospital mortality for LET decreased significantly from 8.28% between 1988 and 1997 to 6.34% between 1998 and 2007, and male patients achieved greater mortality reduction compared with female patients. Treatments for acute limb ischemia showed decreasing use of surgical bypass and amputation and increasing rates of catheter-based thrombolysis. Conclusions-Over the 20-year study period, there have been significant reductions in both LET incidence and in-hospital mortality. Unfortunately, LET admissions extracted from an administrative database comprise a diverse group of individuals, including those with acute and chronic forms of limb ischemia and iatrogenic arterial injury, limiting the true assessment of ALI incidence. .).The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

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Section: Discussionmentioning

confidence: 99%

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

et al. 2013

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“…This condition is associated with high morbidity and mortality as prolonged ischemia can threaten tissue viability and potentially result in a loss of limb or life 2, 3. Thus, prompt diagnosis followed by rapid restoration of blood flow to the ischemic extremity are paramount in the management of ALI 4…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

Inagaki

Farber

Kalish

et al. 2018

JAHA

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BackgroundContemporary data on patients presenting with acute limb ischemia (ALI), who are selected for treatment with endovascular peripheral vascular interventions (PVI), are limited. Our study examined outcomes following endovascular PVI in patients with ALI by comparing with patients treated for chronic critical limb ischemia using a regional quality improvement registry.Methods and ResultsOf the 11 035 patients in the Vascular Study Group of New England PVI database (2010–2014), we identified 365 patients treated for lower extremity ALI who were 5:1 frequency matched (by procedure year and arterial segments treated) to 1808 patients treated for critical limb ischemia. ALI patients treated with PVI had high burden of atherosclerotic risk factors and were more likely to have had prior ipsilateral revascularizations. ALI patients were less likely to be treated with self‐expanding stents and more likely to undergo thrombolysis than patients with critical limb ischemia. In multivariable analysis, ALI was associated with higher technical failure (odds ratio 1.7, 95% confidence interval, 1.1%–2.5%), increased rate of distal embolization (odds ratio 2.7, 95% confidence interval, 1.5%–4.9%), longer length of stay (means ratio 1.6, 95% confidence interval, 1.4%–1.8%), and higher in‐hospital mortality (odds ratio 2.8, 95% confidence interval, 1.3%–5.9%). ALI was not associated with risk of major amputation or mortality at 1 year.ConclusionsIn a multicenter cohort of patients treated with PVI, we found that ALI patients selected for treatment with endovascular techniques experienced greater short‐term adverse events but similar long‐term outcomes as their critical limb ischemia counterparts. Further studies are needed to refine the selection of ALI patients who are best served by PVI.

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“…Unlike acute myocardial ischemia, which when due to coronary arterial insufficiency is most often due to in situ thrombosis over unstable plaque, acute lower extremity ischemia may be caused by either one of the afore-mentioned mechanisms (Eliason et al, 2003).…”

Section: Extremity Arterial Insufficiencymentioning

confidence: 99%

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

Mohan

Rajagopal

2003

Computational and Mathematical Methods in Medicine

140

121

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Multiple interacting mechanisms control the formation and dissolution of clots to maintain blood in a state of delicate balance. In addition to a myriad of biochemical reactions, rheological factors also play a crucial role in modulating the response of blood to external stimuli. To date, a comprehensive model for clot formation and dissolution, that takes into account the biochemical, medical and rheological factors, has not been put into place, the existing models emphasizing either one or the other of the factors. In this paper, after discussing the various biochemical, physiologic and rheological factors at some length, we develop a model for clot formation and dissolution that incorporates many of the relevant crucial factors that have a bearing on the problem. The model, though just a first step towards understanding a complex phenomenon, goes further than previous models in integrating the biochemical, physiologic and rheological factors that come into play.

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A National and Single Institutional Experience in the Contemporary Treatment of Acute Lower Extremity Ischemia

Abstract: In patients with acute limb ischemia, the more widespread use of heparin anticoagulation and, in select patients, performance of embolectomy rather than pursuing thrombolysis may improve patient outcomes.

Cited by 166 publications

References 22 publications

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

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