scholarly journals Clinical outcomes of surgical embolectomy versus catheter-directed thrombolysis for acute limb ischemia: a nationwide cohort study

2021 ◽  
Author(s):  
Po-Kai Yang ◽  
Chien-Chou Su ◽  
Chih-Hsin Hsu
Keyword(s):  
Rate Ratio ◽  
Surgical Intervention ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Antithrombotic Agent ◽  
Catheter Directed Thrombolysis ◽  
Significant Difference ◽  
Surgical Embolectomy ◽  
Adjusted Rate ◽  
Adjusted Rate Ratio

AbstractIn Taiwan, the outcomes of acute limb ischemia have yet to be investigated in a standardized manner. In this study, we compared the safety, feasibility and outcomes of acute limb ischemia after surgical embolectomy or catheter-directed therapy in Taiwan. This study used data collected from the Taiwan’s National Health Insurance Database (NHID) and Cause of Death Data between the years 2000 and 2015. The rate ratio of all-cause in-hospital mortality and risk of amputation during the same period of hospital stay were estimated using Generalized linear models (GLM). There was no significant difference in mortality risk between CDT and surgical intervention (9.5% vs. 10.68%, adjusted rate ratio (95% CI): regression 1.0 [0.79–1.27], PS matching 0.92 [0.69–1.23]). The risk of amputation was also comparable between the two groups. (13.59% vs. 14.81%, adjusted rate ratio (95% CI): regression 0.84 [0.68–1.02], PS matching 0.92 [0.72–1.17]). Age (p < 0.001) and liver disease (p = 0.01) were associated with higher mortality risks. Heart failure (p = 0.03) and chronic or end-stage renal disease (p = 0.03) were associated with higher amputation risks. Prior antithrombotic agent use (p = 0.03) was associated with a reduced risk of amputation. Both surgical intervention and CDT are effective and feasible procedures for patients with ALI in Taiwan.

scholarly journals The Role of Catheter Directed Thrombolysis on Acute Limb Ischemia (an Evidence-Based Case Report)

2021 ◽  
Vol 49 (1) ◽  
pp. 3-24
Author(s):  
Ali Farhan Fathoni ◽  
Raden Suhartono
Keyword(s):  
Case Report ◽  
Adult Patient ◽  
Controlled Trial ◽  
Limb Ischemia ◽  
Evidence Based ◽  
Acute Limb Ischemia ◽  
First Line ◽  
Bleeding Events ◽  
Catheter Directed Thrombolysis ◽  
Significant Difference

Introduction. Acute limb ischemia can be managed both with surgery and thrombolysis, especially catheter-directed thrombolysis. The risk, benefit and indication of thrombolysis is already well known. However, as a first line therapy, it is unclear which intervention is more beneficial; the catheter directed thrombolysis or surgery. This report aims to elucidate which technique is more effective and safer. Method. This is an Evidence-Based Case Report based on a case of a geriatric, diabetic patient whom suffered acute limb ischemia. The report systematically search for meta-analysis, systematic review, randomized controlled trial and cohort studies from Cochrane central and PubMed for all adult patient suffering from acute limb ischemia whose are treated with catheter-directed thrombolysis or surgery as first-line intervention and comparing the outcome in terms of efficacy (clinical outcome such as patency and amputation-free rates) and safety (mortality and morbidity). Results. Subjects’ characteristics should be placed first to draw the demography. Put the study finding(s) here with no interpretation. For all adult patient regardless of their diabetic status and age there is no statistically significant difference for limb salvage, amputation, and mortality between two technique, however catheter directed thrombolysis showed reduced need for additional intervention whilst increasing risk of bleeding events. Conclusion. Neither techniques are more superior than the other but catheter-directed thrombolysis can be considered given that it reduce the need for further intervention, less invasive and even though it has risks for bleeding complication it is still lower compared to systemic thrombolysis. The selection of which technique can be up to clinician’s discretion in consideration of risk and benefit for each patient.

scholarly journals Sex Differences in Management and Outcomes of Critical Limb Ischemia in the Medicare Population

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Amgad Mentias ◽  
Mary Vaughan-Sarrazin ◽  
Marwan Saad ◽  
Saket Girotra
Keyword(s):  
Sex Differences ◽  
Critical Limb Ischemia ◽  
Rate Ratio ◽  
Hospital Admissions ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Fee For Service ◽  
Adjusted Risk ◽  
Adjusted Rate ◽  
Adjusted Rate Ratio

Background: Evidence about sex differences in management and outcomes of critical limb ischemia (CLI) is conflicting. Methods: We identified Fee-For-Service Medicare patients within the 5% enhanced sample file who were diagnosed with new incident CLI between 2015 and 2017. For each beneficiary, we identified all hospital admissions, outpatient encounters and procedures, and pharmacy prescriptions. Outcomes included 90-day mortality and major amputation. Results: Incidence of CLI declined from 2.80 (95% CI, 2.72–2.88) to 2.47 (95% CI, 2.40–2.54) per 1000 person from 2015 to 2017, P <0.01. Incidence was lower in women compared with men (2.19 versus 3.11 per 1000) but declined in both groups. Women had a lower prevalence of prescription of any statin (48.4% versus 52.9%, P <0.001) or high-intensity statins (15.3% versus 19.8%, P <0.01) compared with men. Overall, 90-day revascularization rate was 52%, and women were less likely to undergo revascularization (50.1% versus 53.6%, P <0.01) compared with men. Women had a similar unadjusted (9.9% versus 10.3%, P =0.5) and adjusted 90-day mortality (adjusted rate ratio, 0.98 [95% CI, 0.85–1.12], P =0.7) compared with men. Over the study period, unadjusted 90-day mortality remained unchanged for men (10.4% in 2015 to 9.9% in 2017, P for trend =0.3), and women (9.5% in 2015 to 10.6% in 2017, P for trend =0.2). Men had higher unadjusted (12.9% versus 8.9%, P <0.001) and adjusted risk of 90-day major amputation (adjusted rate ratio, 1.30 [95% CI, 1.14–1.48], P <0.001). One-third of patients with CLI underwent major amputation without a diagnostic angiogram or trial of revascularization in the preceding 90 days regardless of the sex. Conclusions: Women with new incident CLI are less likely to receive statin or undergo revascularization at 90 days compared with men. However, the differences were small. There was no difference in risk of 90-day mortality between both sexes. Graphic Abstract: A graphic abstract is available for this article.

scholarly journals RR20. Ultrasound-Accelerated Thrombolysis is Superior to Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

2011 ◽  
Vol 53 (6) ◽  
pp. 106S-107S
Author(s):  
Maria E. Litzendorf ◽  
Jean E. Starr ◽  
Bhagwan Satiani ◽  
Katherine E. Notter
Keyword(s):  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Catheter Directed Thrombolysis

scholarly journals Catheter directed thrombolysis for acute limb ischemia: eight cases in two years

2014 ◽  
Vol 9 (5-6) ◽  
pp. 185-185
Author(s):  
Majda Vrkic Kirhmajer ◽  
Ljiljana Banfic ◽  
Kresimir Putarek ◽  
Miroslav Krpan ◽  
Savko Dobrota ◽  
...  
Keyword(s):  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Catheter Directed Thrombolysis

scholarly journals Prevalence and Incidence of Statin Use and 3-Year Adherence and Discontinuation Rates Among Older Adults With Dementia

2018 ◽  
Vol 33 (8) ◽  
pp. 527-534 ◽  
Author(s):  
Richard Ofori-Asenso ◽  
Jenni Ilomaki ◽  
Mark Tacey ◽  
Andrea J. Curtis ◽  
Ella Zomer ◽  
...  
Keyword(s):  
Older Adults ◽  
Poisson Regression ◽  
Rate Ratio ◽  
Annual Prevalence ◽  
People With Dementia ◽  
Proportion Of Days Covered ◽  
Adjusted Rate ◽  
Adjusted Rate Ratio ◽  
Statin Use

Objective: To examine the patterns of statin use and determine the 3-year adherence and discontinuation rates among a cohort of Australians aged ≥65 years with dementia. Methods: The yearly prevalence and incidence of statin use were compared via Poisson regression modeling using 2007 as the reference year. People with dementia were identified according to dispensing of antidementia medications. A cohort of 589 new statin users was followed longitudinally. Adherence was estimated via the proportion of days covered (PDC). Discontinuation was defined as ≥90 days without statin coverage. Results: The annual prevalence of statin use among older Australians with dementia increased from 20.6% in 2007 to 31.7% in 2016 (aged-sex adjusted rate ratio: 1.51, 95% confidence interval: 1.35-1.69). Among the new users, the proportion adherent (PDC ≥ 0.80) decreased from 60.3% at 6 months to 31.0% at 3 years. During the 3-year follow-up, 58.7% discontinued their statin. Conclusions: Despite increased use of statins among older Australians with dementia, adherence is low and discontinuation is high, which may point to intentional cessation.

Analysis of the Safety and Efficacy of the Endovascular Treatment for Acute Limb Ischemia with Percutaneous Pharmacomechanical Thrombectomy Compared with Catheter-Directed Thrombolysis

2020 ◽  
Vol 66 ◽  
pp. 470-478
Author(s):  
Rafael de Athayde Soares ◽  
Marcelo Fernando Matielo ◽  
Francisco Cardoso Brochado Neto ◽  
Bruno Vinícius Pereira de Carvalho ◽  
Roberto Sacilotto
Keyword(s):  
Endovascular Treatment ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Safety And Efficacy ◽  
Catheter Directed Thrombolysis

scholarly journals Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden

BMJ ◽  
2020 ◽  
pp. m853 ◽  
Author(s):  
Alicia Nevriana ◽  
Matthias Pierce ◽  
Christina Dalman ◽  
Susanne Wicks ◽  
Marie Hasselberg ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Rate Ratio ◽  
Parental Mental Illness ◽  
Affective Psychosis ◽  
Fall Injuries ◽  
Increased Risk ◽  
Adjusted Rate ◽  
Adjusted Rate Ratio ◽  
Parents With Mental Illness

Abstract Objective To determine the association between parental mental illness and the risk of injuries among offspring. Design Retrospective cohort study. Setting Swedish population based registers. Participants 1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers. Exposures Maternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers. Main outcome measures Risk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders. Results Children with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders. Conclusions Parental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child’s life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.

scholarly journals Efficacy of intra-arterial catheter-directed thrombolysis for popliteal and infrapopliteal acute limb ischemia

2020 ◽  
Vol 71 (1) ◽  
pp. 141-148
Author(s):  
Wei Shuai Lian ◽  
Sushant Kumar Das ◽  
Xiao Xiao Hu ◽  
Xiao Jun Zhang ◽  
Xiao Yun Xie ◽  
...  
Keyword(s):  
Limb Ischemia ◽  
Arterial Catheter ◽  
Acute Limb Ischemia ◽  
Catheter Directed Thrombolysis
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