Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and end-stage renal failure: Analysis of 83 limbs

Hakaim, Albert G.; Gordon, Jonathan K.; Scott, Thayer E.

doi:10.1016/s0741-5214(98)70008-4

Cited by 40 publications

(32 citation statements)

References 21 publications

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“…1 Some prognostic factors for CLI have been suggested during the past 15 years. [2][3][4][5][6][7][8][9][10][11][12][13] Meanwhile, several recent studies have suggested that sarcopenia, a reduction in skeletal muscle, is a prognostic factor for several diseases. [14][15][16][17][18][19][20][21] However, no studies have assessed whether sarcopenia is a prognostic factor for CLI patients.…”

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confidence: 99%

Sarcopenia is a prognostic factor for overall survival in patients with critical limb ischemia

Matsubara

Matsumoto

Aoyagi

et al. 2015

Journal of Vascular Surgery

114

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Background: Sarcopenia has been proposed as a prognostic factor for various diseases. Patients with critical limb ischemia (CLI) have a very poor prognosis, but sarcopenia has not been reported as a prognostic factor for CLI patients. If sarcopenia is associated with the prognosis of CLI patients, it could help select the treatment plan. Therefore, we examined whether sarcopenia is a prognostic factor for CLI patients. Methods: We performed a retrospective study of CLI patients diagnosed with Fontaine III or IV peripheral artery disease who underwent preoperative computed tomography imaging and revascularization between January 2002 and December 2009. The presence of sarcopenia was defined as skeletal muscle area of <114.0 cm 2 for men or <89.8 cm 2 for women using transverse computed tomography scans at the third lumbar vertebra. We compared the 5-year survival rate and clinical characteristics between patients with or without sarcopenia. We also screened possible prognostic factors for overall survival using hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Of 64 eligible patients, 28 patients had sarcopenia and 36 did not. There were significant differences in age, skeletal muscle area, body mass index, and the presence of smoking, cerebrovascular disease, and hemodialysis between patients with and without sarcopenia (all P < .05). The 5-year survival rate was significantly lower in patients with sarcopenia (23.5% vs 77.5%, P [ .001). Prognostic factors for overall survival were the presence of sarcopenia (HR, 3.22; 95% CI, 1.24-9.11; P [ .02), requirement for hemodialysis (HR, 4.30; 95% CI, 1.60-12.2; P [ .004), and postoperative complications (HR, 5.02; 95% CI, 1.90-13.7; P [ .001). Conclusions: Our results suggest that sarcopenia is a prognostic factor for CLI patients. Exercise and nutritional interventions focusing on improving sarcopenia might be useful treatment options for CLI patients.

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confidence: 99%

Sarcopenia is a prognostic factor for overall survival in patients with critical limb ischemia

Matsubara

Matsumoto

Aoyagi

et al. 2015

Journal of Vascular Surgery

114

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“…amputation or revascularization) is more prevalent among patients with renal insufficiency than in those with normal renal function (1)(2)(3). High serum creatinine is associated with poor long-term outcomes after lower extremity revascularization (4) and numerous small retrospective surgical series of revascularization in patients with advanced renal insufficiency have now shown that these patients are at increased risk for short-and long-term post-operative mortality and graft failure compared to patients with normal renal function (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

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confidence: 99%

Impact of Renal Insufficiency on Short-Term Morbidity and Mortality after Lower Extremity Revascularization

O’Hare¹,

Feinglass

Sidawy³

et al. 2003

Journal of the American Society of Nephrology

108

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Abstract. Few data are available on the impact of renal insufficiency on short-term operative outcomes after lower extremity surgical revascularization. We used prospectively collected data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to explore the association with renal dysfunction of adverse outcomes occurring within 30 d of lower extremity surgical revascularization in a cohort of all patients undergoing at least one lower extremity surgical revascularization from 1/1/94 to 9/30/01 (n ϭ 18,217). Even moderate renal insufficiency (estimated GFR 30-59cc/min/1.73m2 ) was associated with an increased incidence of postoperative death (adjusted odds ratio (OR) 1.44, 95% confidence interval (CI), 1.17 to 1.77, P ϭ 0.001), cardiac arrest (OR 1.43, CI 1.09 to 1.88, P ϭ 0.011), myocardial infarction (OR 1.68, 1.39 to 2.16, P Ͻ 0.001), unplanned intubation (OR 1.69, CI 1.39 to 2.07, P Ͻ 0.001) and prolonged intubation (OR 1.57, CI 1.28 to 1.94, P Ͻ 0.001) within 30 d of lower extremity revascularization. However, the incidence of wound infection and graft failure requiring return to the operating room did not appear to be substantially higher in this group. Our data also show that patients with renal insufficiency undergoing revascularization were more likely to require distal procedures and to present with limb-threatening infection compared to those with normal renal function. Efforts to improve pre-and post-operative care in patients with renal insufficiency undergoing lower extremity revascularization should take into account the increased incidence of postoperative death and cardiopulmonary complications in this group in addition to more traditional concerns about operative site complications. Further studies are needed to explore reasons for the higher rate of limb-threatening infection in patients with renal insufficiency undergoing revascularization.Peripheral vascular disease requiring operative intervention (i.e. amputation or revascularization) is more prevalent among patients with renal insufficiency than in those with normal renal function (1-3). High serum creatinine is associated with poor long-term outcomes after lower extremity revascularization (4) and numerous small retrospective surgical series of revascularization in patients with advanced renal insufficiency have now shown that these patients are at increased risk for short-and long-term post-operative mortality and graft failure compared to patients with normal renal function (5-23).However, few data are available to patients, families and health care providers regarding the association of specific adverse outcomes for patients with renal insufficiency after lower extremity revascularization surgery. Large variations in patient characteristics (such as inclusion of patients not yet requiring dialysis or renal transplant patients), indications for surgery and nature of surgery performed exist between retrospective surgical series. Therefore, it has proven difficult to

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“…Baele et al 18 , however, concluded that an acceptable level of limb salvage may be achieved in properly selected patients. Hakaim et al 19 reported no difference in perioperative mortality rate between patients with endstage renal disease and diabetes and patients with diabetes alone. Leers et al 21 described 34 patients with end-stage renal disease who had pedal bypass with a survival rate of 64 per cent at 1 year and 52 per cent at 2 years.…”

Section: Discussionmentioning

confidence: 98%

Effect of chronic renal failure on mortality rate following arterial reconstruction

Gerrard

Ray

Barrio

et al. 2002

British Journal of Surgery

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Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and end-stage renal failure: Analysis of 83 limbs

Abstract: Despite the use of the optimal autogenous conduit, the combination of diabetes and end-stage renal disease can be expected to significantly decrease primary graft patency without affecting limb salvage. The greatest effect of these comorbid factors is on patient survival.

Cited by 40 publications

References 21 publications

Sarcopenia is a prognostic factor for overall survival in patients with critical limb ischemia

Sarcopenia is a prognostic factor for overall survival in patients with critical limb ischemia

Impact of Renal Insufficiency on Short-Term Morbidity and Mortality after Lower Extremity Revascularization

Effect of chronic renal failure on mortality rate following arterial reconstruction

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