Predictors of limb loss despite a patent endovascular-treated arterial segment

Khan, Mohammad Usman; Lall, Purandath; Harris, Linda M.; Dryjski, Maciej L.; Dosluoglu, Hasan H.

doi:10.1016/j.jvs.2009.02.226

Cited by 51 publications

(60 citation statements)

References 23 publications

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“…The long-term outcomes of the current report confirm previous short-term results that the peroneal artery is equivalent to single-vessel tibial runoff in a patent an endovascularly treated arterial segment. 30 Furthermore, the long-term LS presented here is similar to the 68% to 93% LS rates for open peroneal artery bypass reported in the literature. [31][32][33] This study is a single-center, retrospective analysis and is therefore limited by the potential for referral and selection bias.…”

Section: Discussionsupporting

confidence: 87%

Long-term outcomes of patients undergoing endovascular infrainguinal interventions with single-vessel peroneal artery runoff

Abularrage

Conrad

Haurani

et al. 2011

Journal of Vascular Surgery

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Section: Discussionsupporting

confidence: 87%

Long-term outcomes of patients undergoing endovascular infrainguinal interventions with single-vessel peroneal artery runoff

Abularrage

Conrad

Haurani

et al. 2011

Journal of Vascular Surgery

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“…The results of this study were generally in agreement with those of previous reports. [23][24][25][26] TASC II recommends that factors that can negatively affect wound healing, such as cardiac failure or poor nutritional status, should be evaluated and treated appropriately.…”

Section: Discussion What Difference Does This Study Make?mentioning

confidence: 99%

“…23,24 A high incidence of infrapopliteal lesions, 32 neurological disorders, increased susceptibility to infection, lower limb deformity, and renal impairment are considered contributing factors in patients with diabetes. 33,34 In fact, even when a venous graft remains patent, the risk of lower limb amputation is reported to be high in patients with diabetes.…”

Section: Discussion What Difference Does This Study Make?mentioning

confidence: 99%

Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia

Iida

Nakamura²,

Yamauchi³

et al. 2013

Circ: Cardiovascular Interventions

141

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Background— Recent technical advances have made endovascular treatment (EVT) an alternative first-line treatment for critical limb ischemia. Methods and Results— A prospective multicenter study was conducted to evaluate the clinical outcomes of 314 Japanese critical limb ischemia patients (mean age, 73±10 years) with infrainguinal arterial lesions who underwent EVT. Patients were enrolled from December 2009 to July 2011 and were followed-up for 12 months. The primary end point was amputation-free survival (AFS) at 12 months. Secondary end points were anatomic, clinical, and hemodynamic measures, including 12-month freedom from major adverse limb events. The 12-month AFS rate was 74%, with body mass index <18.5 (hazard ratio [HR], 2.22; P =0.008), heart failure (HR, 1.73; P =0.04), and wound infection (HR, 1.89; P =0.03) associated with a poor prognosis for AFS. The 12-month major adverse limb event-free rate was 88%, with hemodialysis (HR, 1.98; P =0.005), heart failure (HR, 1.69; P =0.02), and Rutherford classification 6 (HR, 2.25; P =0.002) associated with a poor prognosis for major adverse limb events. The median time for wound healing was 97 days, with body mass index <18.5 (HR, 0.54; P =0.03) and wound infection (HR, 0.60; P =0.04) being significant risk factors for unhealed wounds after EVT. At 12 months, 34% had undergone reintervention (bypass surgery, 2.6%; repeat EVT, 31.7%), and 73% were major adverse event–free. Conclusions— The high reintervention rate notwithstanding, EVT was an effective treatment for Japanese critical limb ischemia patients with infrainguinal disease, with satisfactory AFS and major adverse limb event-free rates. The results of this study will be helpful for the future evaluation of critical limb ischemia therapy. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr . Unique identifier: UMIN000002830.

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“…Therefore diabetes is a determinant of poor outcome after revascularisation for critical lower limb ischaemia (CLI) [3]. It is associated with a significant number of postoperative systemic and lower limb adverse events [4], and, quite commonly, major limb amputation is required in diabetic patients despite a patent bypass graft [5] or patent endovascularly treated artery [6]. Estimation of the risk of adverse outcome in this high-risk patient population would enable clinicians to better understand the determinants of an unfavourable course of events after lower limb revascularisation, to direct resources to those patients with a potentially favourable outcome, and to focus research on those with poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

The role of chronic kidney disease as a predictor of outcome after revascularisation of the ulcerated diabetic foot

et al. 2011

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Aims/hypothesis The aim of the study was to stratify the risk of diabetic patients with leg ulcer or gangrene undergoing infrainguinal revascularisation for critical limb ischaemia. Methods The study cohort included 732 revascularisation procedures performed in 597 diabetic patients with ulcer or gangrene. Logistic regression and CART analysis were used for identification of predictors of 1-year outcome. Results Logistic regression showed that chronic kidney disease (CKD) class (OR 1.38, 95% CI 1.16, 1.65) was an independent predictor of 1-year leg salvage (area under the receiver operating characteristic [ROC] curve 0.60, 95% CI 0.54, 0.65). The terminal nodes of the CART for 1-year leg salvage were CKD classes 4-5, the level (infrapopliteal vs femoropopliteal revascularisation), type of revascularisation (bypass surgery vs percutaneous transluminal angioplasty) and gangrene (area under the ROC curve 0.62, 95% CI 0.57, 0.68). Logistic regression showed that pulmonary disease (OR 1.76, 95% CI 1.11, 2.78), CKD class (OR 1.43, 95% CI 1.24, 1.65), foot gangrene (OR 1.76, 95% CI 1.21, 2.60) and patient age (OR 1.02, 95% CI 1.01, 1.04) were independent predictors of 1-year amputation-free survival (area under the ROC curve 0.65, 95% CI 0.60, 0.69). The terminal nodes of the CART for 1-year amputation-free survival were CKD classes 3-5, patient's age of ≥75 years and foot gangrene (area under the ROC curve 0.64, 95% CI 0.60, 0.68). Conclusions/interpretation CKD is a formidable risk factor for poor intermediate outcome after infrainguinal revascularisation in diabetic patients with foot ulcer or gangrene. CART analysis indicates that foot gangrene is also a significant risk factor for adverse outcome.

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Predictors of limb loss despite a patent endovascular-treated arterial segment

Abstract: Amputation despite PETAS is the most common means of limb loss in patients undergoing endovascular revascularization for limb salvage. It is likely the result of aggressive attempts at limb salvage and usually occurs Show more

Cited by 51 publications

References 23 publications

Long-term outcomes of patients undergoing endovascular infrainguinal interventions with single-vessel peroneal artery runoff

Long-term outcomes of patients undergoing endovascular infrainguinal interventions with single-vessel peroneal artery runoff

Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia

The role of chronic kidney disease as a predictor of outcome after revascularisation of the ulcerated diabetic foot

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