Mortality after major amputation in diabetic patients with critical limb ischemia who did and did not undergo previous peripheral revascularization

2010 ◽  
Vol 24 (4) ◽  
pp. 265-269 ◽  
Author(s):  
Ezio Faglia ◽  
Giacomo Clerici ◽  
Maurizio Caminiti ◽  
Vincenzo Curci ◽  
Jacques Clerissi ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients

scholarly journals Procalcitonin Is a Prognostic Marker of Hospital Outcomes in Patients with Critical Limb Ischemia and Diabetic Foot Infection

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Laura Giurato ◽  
Enrico Brocco ◽  
Michele Ferrannini ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Hospital Outcomes ◽  
Diabetic Foot Infection ◽  
The Mean

Aim. To evaluate the prognostic role of procalcitonin (PCT) in patients with diabetic foot infection (DFI) and critical limb ischemia (CLI). Materials and Methods. The study group was composed of diabetic patients with DFI and CLI. All patients were treated according to a preset limb salvage protocol which includes revascularization, wound debridement, antibiotic therapy, and offloading. Inflammatory markers, including PCT, were evaluated at admission. Only positive values of PCT, greater than 0.5 ng/ml, were considered. Hospital outcomes were categorized as limb salvage (discharge with preserved limb), major amputation (amputation above the ankle), and mortality. Results. Eighty-six patients were included. The mean age was 67.3±11.4 years, 80.7% were male, 95.1% had type 2 diabetes, and the mean diabetes duration was 20.5±11.1 with a mean HbA1c of 67±16 mmol/mol. 66/86 (76.8%) of patients had limb salvage, 7/86 (8.1%) had major amputation, and 13/86 (15.1%) died. Patients with positive PCT baseline values in comparison to those with normal values showed a lower rate of limb salvage (30.4 versus 93.6%, p=0.0001), a higher rate of major amputation (13 versus 6.3%, p=0.3), and a higher rate of hospital mortality (56.5 versus 0%, p<0.0001). At the multivariate analysis of independent predictors found at univariate analysis, positive PCT was an independent predictor of major amputation [OR 3.3 (CI 95% 2.0-5.3), p=0.0001] and mortality [OR 4.1 (CI 95% 2.2-8.3), p<0.0001]. Discussion. Positive PCT at admission increased the risk of major amputation and mortality in hospital patients with DFI and CLI.

Intermittent intravenous urokinase for critical limb ischemia in diabetic foot ulceration

2008 ◽  
Vol 100 (09) ◽  
pp. 475-482 ◽  
Author(s):  
Matthias Weck ◽  
Hannes Rietzsch ◽  
Holger Lawall ◽  
Uwe Pichlmeier ◽  
Peter Bramlage ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Phase Ii ◽  
Critical Limb Ischemia ◽  
Ulcer Healing ◽  
Diabetic Foot ◽  
Controlled Trial ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Foot Ulceration

SummaryPatients with diabetic foot ulceration and critical limb ischemia have a high risk of major amputation, especially if limbs can not be revascularized. Urokinase is effective in improving microcirculation in critical limb ischemia and might improve outcomes. There are no data on the efficacy and safety of urokinase treatment (survival free of major amputation, ulcer healing and the rate of minor and major bleeding). Therefore, we aimed to investigate the effect of urokinase treatment in a phase II clinical trial. We performed an open, prospective, non-controlled, multi-center phase II cohort study in 77 type-2 diabetic patients with critical limb ischemia and diabetic foot ulceration. Patients had no surgical or endovascular treatment option based on interdisciplinary consensus. Urokinase (1 Mio IU if plasma fibrinogen ≥2.5 g/l, 0.5 Mio IU if fibrinogen < 2.5 g/l) was administered for 21 days as an intravenous infusion over 30 minutes. Each patient was followed up for 12 months. Treatment for a median of 21 days resulted in 33% of patients being alive, having no major amputation and completely healed ulcers after 12 months. Total survival rate was 84.6%,amputation-free survival 69.2% and rate of major amputation 21.1%.Eighty-two percent of patients experienced at least once a complete ulcer healing within the course of study. Three serious adverse events were urokinase-related. Urokinase treatment in diabetic patients with critical limb ischemia appears to be effective, feasible and safe. Although this calls for a larger, randomized and controlled trial, the results are highly relevant for clinical practice to prevent these patients from receiving major amputation due to diabetic foot syndrome.Clinical Trial Registration No.: NCT00537498

Direct Endovascular Revascularization Based on the Angiosome Model Reduces Risk of Major Amputations and Increases Life Expectancy in Type 2 Diabetic Patients with Critical Limb Ischemia and Foot Ulceration

2021 ◽  
Author(s):  
Elisabetta Iacopi ◽  
Alberto Coppelli ◽  
Chiara Goretti ◽  
Irene Bargellini ◽  
Antonello Cicorelli ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Group Versus ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Endovascular Revascularization ◽  
Indirect Revascularization ◽  
Type 2 Diabetic

Background: We evaluated whether direct or indirect endovascular revascularization, based on angiosome model (AM), affects outcomes in type 2 diabetes (T2DM) and critical limb ischemia (CLI). Methods: From 2010 to 2015, 603 T2DM were admitted for CLI and submitted to endovascular revascularization. Among these, 314 (52%) underwent a direct and 123 (20%) an indirect revascularization, depending on whether the flow to the artery directly feeding the site of ulceration, according to the AM, whereas 166 patients (28%) were judged not revascularizable. Outcomes were: healing (HR), major amputation (MA) and mortality rates (MR), respectively. Results: An overall HR of 62.5% was observed: patients who did not receive PTA presented a HR of 58.4% (p&lt; 0.02 vs revascularized patients). An higher HR was observed in the direct group versus indirect one (82.4% vs 50.4%. p&lt;0.001). MA rate was significantly higher in indirect group than in direct one (9.2% vs 3.2%. p&lt;0.05). MR was 21.6% and higher in indirect revascularization (24% vs 14% in direct group. p&lt;0.05). Conclusions: Our data show that direct revascularization of arteries supplying the diabetic foot ulcers site by means of AM is associated with higher healing rate and lower risk of amputation and death as compared to indirect procedure. These results support use of AM in T2DM with CLI.

Long-Term Clinical Outcomes of Infrapopliteal Drug-Eluting Stent Placement for Critical Limb Ischemia in Diabetic Patients

2015 ◽  
Vol 26 (10) ◽  
pp. 1423-1430 ◽  
Author(s):  
Stavros Spiliopoulos ◽  
Vasiliki Theodosiadou ◽  
Konstantinos Katsanos ◽  
Panagiotis Kitrou ◽  
George C. Kagadis ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critical Limb Ischemia ◽  
Stent Placement ◽  
Limb Ischemia ◽  
Drug Eluting Stent ◽  
Diabetic Patients ◽  
Drug Eluting

Use of Tapered Balloons to Recanalize Occluded Below-the-Knee Arteries in Diabetic Patients with Critical Limb Ischemia

2016 ◽  
Vol 31 ◽  
pp. 105-110
Author(s):  
Nicola Troisi ◽  
Leonardo Ercolini ◽  
Emiliano Chisci ◽  
Piefrancesco Frosini ◽  
Clara Pigozzi ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Below The Knee

Isolated femoral artery revascularisation with or without iliac inflow improvement – a less invasive surgical option in critical limb ischemia

VASA ◽  
2021 ◽  
pp. 1-7
Author(s):  
Andreas S. Peters ◽  
Katrin Meisenbacher ◽  
Dorothea Weber ◽  
Theodosios Bisdas ◽  
Giovanni Torsello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Negative Impact ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lesion Length ◽  
Vascular Intervention ◽  
Selection Of Variables ◽  
Surgical Option

Summary: Background: Isolated femoral artery revascularisation (iFAR) represents a well-established surgical method in the treatment of peripheral arterial disease (PAD) involving common femoral artery disease. Data for iFAR in multilevel PAD are inconsistent, particularly in patients with critical limb ischemia (CLI). The aim of the study was to evaluate the outcome of iFAR in CLI regarding major amputation and reintervention and to identify associated risk factors for this outcome. Patients and methods: The data used have been derived from the German Registry of Firstline Treatment in Critical Limb Ischemia (CRITISCH). A total of 1200 patients were enrolled in 27 vascular centres. This sub-analysis included patients, which were treated with iFAR with/without concomitant iliac intervention. For detection of risk factors for the combined endpoint of major amputation and/or reintervention, selection of variables for multiple regression was conducted using stepwise forward/backward selection by Akaike’s information criterion. Results: 95 patients were included (mean age: 72 years ± 10.82; 64.2% male). Of those, 32 (33.7%) participants reached the combined endpoint. Risk factor analysis revealed continued tobacco use (odds ratio [OR] 2.316, confidence interval [CI] 0.832–6.674), TASC D-lesion (OR: 2.293, CI: 0.869–6.261) and previous vascular intervention in the trial leg (OR: 2.720, CI: 1.037–7.381) to be associated with reaching the combined endpoint. Conclusions: iFAR provides a reasonable, surgical option to treat CLI. Lesion length (TASC D) seems to have a negative impact on outcome. Further research is required to better define the future role of iFAR for combined femoro-popliteal lesions in CLI – best in terms of a randomised controlled trial.

Abstract P380: The Cardiovascular Fate in Patients with Amputation or Revascularization for Critical Limb Ischemia

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Paola De Rango ◽  
Massimo Lenti ◽  
Enrico Cieri ◽  
Alessandro Marucchini ◽  
Luca Farchioni ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Critical Limb Ischemia ◽  
Strong Predictor ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Mortality And Morbidity ◽  
Primary Amputation ◽  
All Cause Mortality ◽  
And Gender ◽  
Cox Analysis

Background: Critical limb ischemia (CLI) continues to be a significantly morbid disease for the aging population with high likelihood of cardiovascular mortality and morbidity. Objective: To analyze incidence and timing of all cause and cardiovascular mortality (CM) in patients who survived after intervention for CLI. Methods: Patients consecutively discharged with diagnosis of CLI during the period 2006-2008 were re-evaluated for cardiovascular morbidity after 2 years. Patients receiving revascularization either open or endovascular and those with primary major amputation were compared with Kaplan-Meier analyses. The effect of treatment on outcome was analyzed with Cox analysis. Results: There were 257 patients (171 men, aged 74.12y), 39 treated by primary major amputation and 218 by revascularization. During a mean follow-up of 37months, 81 patients died for all cause mortality and 35 for CM. Mean survival time was 57.4months. More than half deaths (n=44) occurred by 15 months with 21 patients dying in the first 6 months and 33 within the first 12 months. Thirty-five myocardial infarctions and 15 strokes occurred. Cumulative survival rate at 60 months was 54% for all cause mortality and 79% for CM. There was significantly worse survival in patients with primary amputation when compared to those receiving revascularization: rates for all cause mortality were 45% vs. 75% (p=0.001) and rates for CM were 68% vs. 90% (p<0.0001), in primary amputation and revascularization group respectively at 42 months. Unadjusted odd ratios for all cause and cardiovascular mortality in patients with primary amputation vs. revascularization were 3.07 (95%CI 1.5-6.1, p=0.002) and 5.25 (95%CI 2.3-11.6, p<0.0001), respectively. After adjusting for age and gender, primary amputation persisted as independent predictor of all cause (HR 2.76, p<0.0001) and cardiovascular mortality (HR 5.11; p<0.0001). Conclusion: Mortality and CM after 2 years in patients surviving from CLI procedures are high. Primary amputation is a strong predictor of poor prognosis in the mid-long term for patients with CLI. Most deaths occur in the first 15 months after treatment. This data may question the benefits of revascularization.

scholarly journals Myocardial revascularization in diabetic patients presenting with critical limbischemia

2010 ◽  
Vol 13 (4) ◽  
pp. 25-29
Author(s):  
Ivan Ivanovich Dedov ◽  
Victor Yur'evich Kalashnikov ◽  
Konstantin Vladimirovich Melkozerov
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Critical Limb Ischemia ◽  
Myocardial Revascularization ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Preoperative Risk Assessment ◽  
Therapeutic Modalities ◽  
Optimal Drug ◽  
Patients With Diabetes

The frequency of diabetic complications remains high despite the development of improved therapeutic modalities. Macroangiopathy continues to bethe predominant complication while coronary heart disease is the main cause of mortality.This paper considers clinical features of diabetic patientswith coronary heart disease and critical limb ischemia; various aspects of optimal drug therapy, preoperative examination and diagnostics precedingvascular non-cardiac surgery; preoperative risk assessment; indications for coronary angiography and myocardial revascularization. The authors emphasizethe importance of development of algorithms for the treatment of patients with diabetes, critical limb ischemia, and coronary heart disease.

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