Is endovascular revascularisation worthwhile in diabetic patients with critical limb ischemia who also have end-stage renal disease?

Rabellino, Martín; Aragón‐Sánchez, Javier; Gonzalez, G.; Zander, Tobías; Baldi, S.; García-Nielsen, Luis; Armas-Suarez, Silvia; Barbero, Pablo Cereceda; Luis-Rodríguez, Desiré; Maynar, Manuel

doi:10.1016/j.diabres.2010.09.021

Cited by 15 publications

(17 citation statements)

References 8 publications

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“…Most patients with ESRD have multiple systemic comorbidities and their arteries are affected by severe calcification and multiple distal occlusions 3,4 that often make bypass surgery extremely challenging. In such patients, surgical arterial reconstruction has primarily been performed for limb salvage.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Revascularization for Critical Limb Ischemia in Patients with End-stage Renal Disease

Yamamoto

Hosaka

Okamoto

et al. 2014

European Journal of Vascular and Endovascular Surgery

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Section: Introductionmentioning

confidence: 99%

Efficacy of Revascularization for Critical Limb Ischemia in Patients with End-stage Renal Disease

Yamamoto

Hosaka

Okamoto

et al. 2014

European Journal of Vascular and Endovascular Surgery

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“…Patients with critical limb ischemia (CLI) are known to have a poor prognosis if they also have diabetes mellitus, and end stage renal disease. [1][2][3] Therefore, the prognosis after major amputation has been reported to be poor in patients with diabetes mellitus and end stage renal disease. 4 The indications for major amputation differ by medical institution.…”

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confidence: 99%

Prognosis of critical limb ischemia: Major vs. minor amputation comparison

Matsuzaki

Hayashi

Okabe

et al. 2015

Wound Repair Regeneration

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Healthcare providers treating wounds have difficulties assessing the prognosis of patients with critical limb ischemia who had been discharged after complete healing of major amputation wounds. The word "major" in "major amputation" gives the impression of "being more severe" than "minor amputation." Therefore, even if wounds are healed after major amputation, they imagine that prognosis after major amputation would be poorer than that after minor amputation. We investigated the prognosis of diabetic nephropathy patients 2 years after amputations. Those patients underwent dialysis as well as amputation following percutaneous transluminal angioplasty for their foot wounds. They were ambulatory prior to these surgeries. Among 56 cases of minor amputation, 45 were males and 11 were females, and mortality was 41.1%. The mortality of cases with and without a coronary intervention history was 53.1% and 25.0%, respectively (p = 0.034). Among 10 cases of major amputation, 9 were males and 1 was female, and mortality was 60%. The mortality of cases with and without a coronary intervention history was 75.0% and 0%, respectively. Although we predicted poor prognosis in cases with major amputation, there was no significant difference in mortality 2 years after amputations (p = 0.267). Thus far poor prognosis has been reported for major amputation. It might be due to inclusion of the following patients: patients with wounds proximal to ankle joints, patients with extensive gangrene spreading to the lower legs, patients with septicemia from wound infection and who died around the time of operation, and patients with malnutrition. The results of our present study showed that the outcomes at 2 years postoperatively were similar between patients with major amputations and those with minor amputations, if surgical wounds were able to heal. We should not estimate the prognosis by the level of amputation, rather we should consider the effect of coronary intervention history on prognosis.

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“…Renal failure diabetic patients are known to have poor prognosis (15–17). Attinger et al (15) examined 45 renal failure diabetic patients and reported on the postoperative prognosis in 71 wounds in 54 limbs.…”

Section: Discussionmentioning

confidence: 99%

Diabetic foot wounds in haemodialysis patients: 2‐year outcome after percutaneous transluminal angioplasty and minor amputation

Matsuzaki

Miyamoto

Naohiro

et al. 2012

International Wound Journal

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Critical limb ischaemia (CLI) is known to be associated with high mortality. In some patients, surgery cannot be performed due to high risk of perioperative death and complications. In other cases, there is only pain at rest but no wound. Therefore, it is difficult to accurately predict the prognosis of individual patients. We examined the prognosis of CLI cases in which therapeutic footwear was made for ambulation after wounds healed. The subjects were 31 haemodialysis patients with diabetic foot wounds, which were treated with percutaneous transluminal angioplasty and minor amputation. The subjects were 22 men and 9 women. Female patients were significantly older than male patients (P = 0.046). Two-year postoperative outcomes were survival in 19 patients and death in 12 patients. Eight of twelve deceased patients had a history of coronary intervention. There were 8 deaths among 13 patients with such history, indicating a marginally significant increase in the mortality rate (P = 0.060). Re-amputation was performed in 6 of 19 patients who survived. Two years postoperatively, 41.9% of patients overall survived without re-amputation. It is important to increase the number of cases for further study to improve the well-being of CLI patients and to examine medical economics.

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Is endovascular revascularisation worthwhile in diabetic patients with critical limb ischemia who also have end-stage renal disease?

Cited by 15 publications

References 8 publications

Efficacy of Revascularization for Critical Limb Ischemia in Patients with End-stage Renal Disease

Efficacy of Revascularization for Critical Limb Ischemia in Patients with End-stage Renal Disease

Prognosis of critical limb ischemia: Major vs. minor amputation comparison

Diabetic foot wounds in haemodialysis patients: 2‐year outcome after percutaneous transluminal angioplasty and minor amputation

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