Comparison of the Incidence of Complications and Secondary Surgical Interventions Necessary in Patients with Chronic Lower Limb Ischemia Treated by Both Open and Endovascular Surgeries

Janczak, Dariusz; Malinowski, Maciej; Bąkowski, Wojciech; Krakowska, Katarzyna; Marschollek, Karol; Marschollek, Paweł; Chabowski, Mariusz

doi:10.5761/atcs.oa.16-00282

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…Subgroup analysis of three studies with only lower limb revascularization procedures also showed a significant reduction in SSI in the incisional NPWT group. The rate of SSI was higher in the studies of lower limb revascularization procedures only, and lower in the studies that included EVAR procedures as well, in agreement with previous studies.…”

Section: Discussionsupporting

confidence: 91%

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Svensson‐Björk

Zarrouk

Asciutto

et al. 2019

British Journal of Surgery

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Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery.Methods: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool.Results: Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0⋅35, 95 per cent c.i. 0⋅24 to 0⋅50; P < 0⋅001). The heterogeneity between the included studies was low (I 2 = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0⋅37, 0⋅22 to 0⋅63; P < 0⋅001; I 2 = 0 per cent).Conclusion: Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.

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Section: Discussionsupporting

confidence: 91%

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Svensson‐Björk

Zarrouk

Asciutto

et al. 2019

British Journal of Surgery

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“…In particular, several studies have reported initial success and patency rates with PTA/stent similar to surgery stirred inclination to PTA/stent. [9][10][11] The treatment of total occlusions, thought to be a limitation of percutaneous treatment due to more technically adversity than subtotal occlusion, is currently possible owing to the advancement of catheter, stent, and DCBs. Due to facilitating access to the most tortuous anatomy, various levels of tip stiffness provide excellent visibility.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transluminal angioplasty/stent treatment of totally occlusive iliofemoral artery with limb ischemia: Experience of surgical team

Ata

Şenel

2018

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada, merkezimizin perkütan translüminal anjiyoplasti/stentleme deneyimi sunuldu.Ça lış mapla nı:Ocak 2015 -Mart 2017 tarihleri arasında iliofemoral total oklüzyon hastalığı nedeniyle kliniğimizde tedavi edilen toplam 40 hasta (34 erkek, 6 kadın; ort. yaş 64.5±8.7 yıl; dağılım, 49-85 yıl) çalışmaya alındı. Kırk beş bacak ve 51 hedef damar vardı. İliofemoral veya femoropopliteal baypas greftli olan bu hastalara hibrid işlem yapıldı. Bul gu lar:İlk girişimde 48 hedef damara (%94.1) 55 stent yerleştirildi. Başarısız üç hedef damar (%5.9), daha sonra cerrahi revaskülarizasyon ile tedavi edildi. İşleme bağlı mortalite görülmedi. Bir hastaya 70 gün sonra diz altı ampütasyon yapıldı. İki hastaya tek parmak ampütasyonu yapıldı. Bir hastada kontrast nefropati gelişti ve bu hasta tıbbi olarak tedavi edildi. Ortalama takip süresi 16.7±5 (dağılım, 8-29) ay idi. Takip sonrasında, 41 stent müdahale olmaksızın açık olarak tespit edildi ve primer açıklık oranı %74.5 idi. Beş stent trombozu hastası (%12.5) farklı zamanlarda tedavi edildi.So nuç: Çalışma sonuçlarımız, ciddi komorbiditeli hastalara perkütan translüminal anjiyoplasti/stent tedavisinin önerilebileceğini göstermektedir. Stent serilerindeki nispeten düşük komplikasyon oranları, deneyimli ellerde perkütan translüminal anjiyoplasti/stentin, cerrahi revaskülarizasyona kıyasla, işleme bağlı riskinin daha düşük olduğuna işaret etmektedir. Hibrid işlem, daha önce girişimde bulunulan komorbiditeli hastalarda bacak kurtarma amacıyla uygun bir işlem olarak görülmektedir.Anah tar söz cük ler: Klodikasyon; hibrid revaskülarizasyon; perkütan translüminal anjiyoplasti/stent; total oklüzyon. ABSTRACT Background:In this study, we present our center's experience on percutaneous transluminal angioplasty/stenting.

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“…Revascularization, however, has a number of deficiencies, including a risk of perioperative complications, failure to successfully heal the ulcer and lack of suitability for some patients. 8 9 There is therefore a need for alternative and adjunctive therapies. 10 11 …”

Section: Introductionmentioning

confidence: 99%

Animal models of ischemic limb ulcers: a systematic review and meta-analysis

Thanigaimani

Phie

Golledge

2020

BMJ Open Diab Res Care

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The aims of this systematic review were to assess the clinical relevance and quality of previously published animal models of ischemic ulceration and examine the available evidence for interventions improving ulcer healing in these models. Publicly available databases were searched for original studies investigating the effect of limb ischemia on wound healing in animal models. The quality of studies was assessed using two tools based on the Animal research: Reporting of In Vivo Experiments (ARRIVE) guidelines and the clinical relevance of the models. A total of 640 wounds (ischemic=314; non-ischemic=326) were assessed in 252 animals (92 mice, 140 rats, 20 rabbits) from 7 studies. Meta-analyses showed that wound healing was consistently delayed by ischemia at all time-points examined (day-7 standard median difference (SMD) 5.36, 95% CI 3.67 to 7.05; day-14 SMD 4.50, 95% CI 2.90 to 6.10 and day-21 SMD 2.53, 95% CI 1.25 to 3.80). No significant difference in wound healing was observed between 32 diabetic and 32 non-diabetic animals with ischemic wounds. Many studies lacked methods to reduce bias, such as outcome assessors blinded to group allocation and sample size calculations and clinically relevant model characteristics, such as use of older animals and a peripheral location of the wound. Five different interventions were reported to improve wound healing in these models. The impaired wound healing associated with limb ischemia can be modeled in a variety of different animals. Improvements in study design could increase clinical relevance, reduce bias and aid the discovery of translatable therapies.

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Comparison of the Incidence of Complications and Secondary Surgical Interventions Necessary in Patients with Chronic Lower Limb Ischemia Treated by Both Open and Endovascular Surgeries

Cited by 6 publications

References 18 publications

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Percutaneous transluminal angioplasty/stent treatment of totally occlusive iliofemoral artery with limb ischemia: Experience of surgical team

Animal models of ischemic limb ulcers: a systematic review and meta-analysis

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