Extra Anatomic Peripheral Vein Bypass for Acute Limb Ischemia in Trauma and Critical Limb Ischemia

Purpose Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. Materials and methods We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Results Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. Conclusion CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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Abstract 275: Angioscore Balloon in the Treatment of Collagen Plug Occlusion and Acute Limb Ischemia: Case Report

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a275 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Pooja M Swamy ◽

Abeer Berry ◽

Mahir D Elder

Keyword(s):

Case Report ◽

Lower Extremity ◽

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Closure Device ◽

Acute Limb Ischemia ◽

Access Site ◽

Left Lower Extremity

BACKGROUND: Complications of the vascular access-site (VAS) are not uncommon. With the evolution of hemostatic techniques used in the access site closure, in the last two decades, the rate of VAS related complications has significantly reduced from 6% to 2%. However, they still remain to be an important cause of morbidity following catheterization procedures. The most common complications encountered with closure of VAS are hematoma formation, arterio-venous fistula, dissection, pseudo -aneurysm and limb ischemia. According to two meta-analyses, the incidences of these complications were very low. The incidence of collagen plug from an Angioseal(™) device causing acute leg ischemia is low and upon occurrence, the use of an Angioscore(™) balloon in successful revascularization has never been reported. CASE PRESENTATION: A 62-year-old male with known severe peripheral artery disease, diabetes mellitus, hypertension and hypercholesterolemia had a successful angioplasty of a 100% chronically occluded right superficial femoral artery (SFA) via the left common femoral artery. An Angioseal (™) closure device was used to achieve hemostasis. The patient was discharged home after an uneventful post procedural course. Two days later, he presented to the ER with a cold and numb left lower extremity. On exam, the left lower extremity had no palpable pulse from below right femoral artery, confirmed by Doppler. The extremity was cold to touch with decreased sensory perception. Patient was found to have critical left lower extremity ischemia. He was emergently taken for a selective left lower extremity angiogram using the right common femoral artery for access. Fragments of the closure device and a collagen plug causing a total occlusion of the left common femoral artery were found. After a pre-dilatation with a 4.0x 40 balloon under prolonged inflations, a lesion reduction from 100 % to 30% with a TIMI 0 to TIMI 3 flow was achieved using an Angioscore (™) 5.0x 40 balloon inflated at 10 atmospheres. Subsequently, using laser 2.0 atherectomy of the left common femoral artery was performed. Flow in the dorsalis pedis artery was confirmed with Doppler. DISCUSSION: The Angio-Seal(™) device has a polylactide and polyglycolide polymer anchor, a collagen plug and a suture contained within a carrier system. Hemostasis is achieved by compressing the arterial puncture site between the anchor and the collagen plug. With newer studies, it appears that the occurrence of critical limb ischemia from collagen plug is under recognized. We therefore, with this case report urge the physicians to be aware of this serious though rare complication of closure devise and also highlight the successful use of Angioscore (™) balloon in the emergent treatment of non-athermatous vascular occlusion causing critical limb ischemia.

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Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia

Yearbook of Surgery ◽

10.1016/s0090-3671(08)79280-2 ◽

2008 ◽

Vol 2008 ◽

pp. 395-396

Author(s):

J.M. Seeger

Keyword(s):

Quality Of Life ◽

Lower Extremity ◽

Multicenter Study ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Prospective Multicenter Study ◽

Before And After ◽

Vein Bypass

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Splice Vein Bypass for Critical Limb Ischemia In Renal Failure Patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.08.088 ◽

2020 ◽

Vol 72 (5) ◽

pp. e367

Author(s):

R. Clement Darling ◽

Nicholas Russo ◽

Tigran Divanyan ◽

Neil Patel ◽

Jeffrey Hnath

Keyword(s):

Renal Failure ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Vein Bypass

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Tibiodistal vein bypass in critical limb ischemia and its role after unsuccessful tibial angioplasty

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.07.127 ◽

2018 ◽

Vol 67 (4) ◽

pp. 1191-1198 ◽

Cited By ~ 2

Author(s):

Florian K. Enzmann ◽

Sebastian K. Eder ◽

Thomas Aschacher ◽

Manuela Aspalter ◽

Patrick Nierlich ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Vein Bypass

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Neutrophil-to-lymphocyte Ratio Associated With an Increased Risk of Mortality in Patients With Critical Limb Ischemia

10.21203/rs.3.rs-243462/v1 ◽

2021 ◽

Author(s):

Min-I Su ◽

Cheng-Wei Liu

Keyword(s):

Critical Limb Ischemia ◽

Characteristic Curve ◽

Limb Ischemia ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Acute Limb Ischemia ◽

Lymphocyte Ratio ◽

Increased Risk ◽

Prognostic Prediction ◽

Related Mortality

Abstract Purpose: Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI.Materials and methods: We retrospectively enrolled consecutive CLI patients during 1/1/2013–12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality, and major adverse cardiovascular events (MACEs) and limb events (MALEs).Results: Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; BMI, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with an NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P=0.008), and MALE (28.1% vs. 13.0%, P=0.021) rates than those with an NLR<8. In multivariate logistic regression, an NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075-13.47, P<0.001) mortality, and an NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292-6.088, P=0.009).Conclusion: CLI patients with high NLRs had higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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