Clinical success using patient-oriented outcome measures after lower extremity bypass and endovascular intervention for ischemic tissue loss

Despite aggressive limb salvage techniques, lower extremity amputation (LEA) is frequently performed. Major indications for LEA include ischemia and uncontrolled infection (UI). A review of the national Vascular Quality Initiative amputation registry was performed to analyze the influence of indication on outcomes after LEA. Retrospective review of the Vascular Quality Initiative LEA registry (2012–2017) identified all above- and below-knee amputations. Outcome measures included 30-day mortality, return to operating room (OR), postoperative myocardial infarctions, and postoperative SSI. Indications for surgery included ischemic rest pain, ischemic tissue loss (TL), acute limb ischemia (ALI), UI, and neuropathic TL. A total of 6701 patients met the inclusion criteria. The indications for surgery included TL (49.0%), UI (31.7%), ALI (8.0%), rest pain (6.6%), and neuropathic TL (2.3%). Patients with ALI had the highest 30-day mortality (12.0%) compared with TL (6.6%) and UI (6.4%) [ P < 0.001]. The highest rate of return to OR occurred in the UI group (12.6%) [ P < 0.001]. Multivariate analysis demonstrated that patients with UI have significantly higher rates of return to OR, whereas those with ALI have a 30-day mortality twice as high as other indications (both P < 0.001). These data can inform expectations after LEA based on the indications for surgery.

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Open Surgical Secondary Interventions are More Durable than Endovascular Interventions for Lower Extremity Bypass Stenosis or Occlusion

Vascular and Endovascular Surgery ◽

10.1177/15385744211028749 ◽

2021 ◽

pp. 153857442110287

Author(s):

Abhisekh Mohapatra ◽

Mikayla N. Lowenkamp ◽

Efthymios D. Avgerinos ◽

Eric S. Hager ◽

Michael C. Madigan

Keyword(s):

Lower Extremity ◽

Bypass Graft ◽

Primary Patency ◽

Endovascular Intervention ◽

Tissue Loss ◽

Secondary Patency ◽

Graft Occlusion ◽

Secondary Interventions ◽

Endovascular Interventions ◽

Bypass Patency

Objectives: Lower extremity bypasses often require secondary interventions to maintain patency. Our objectives were to characterize effectiveness of secondary interventions to maintain or restore bypass graft patency, and to compare outcomes of open and endovascular interventions. Methods: We reviewed patients who underwent lower extremity bypass at our institution from 2007 to 2010. We recorded the index bypass and subsequent ipsilateral interventions performed through 2018 or until loss of secondary patency. Patient, procedure, and anatomic data were collected. Endovascular intervention was compared with open/hybrid intervention. For outcome analysis, patency measures were defined relative to the time of the secondary intervention rather than the time of the index bypass. Results: 174 secondary interventions (56 open/hybrid, 118 endovascular; 42 for graft occlusion, and 132 for stenosis) treating 228 lesions in 97 bypasses were available for study. The index bypass was most commonly performed for tissue loss (71.1%), utilized a tibial artery target (57.7%), and used single-segment great saphenous vein (59.8%) rather than alternative vein (32.0%) or prosthetic (8.2%). A higher portion of open/hybrid interventions (51.8%) were done for graft occlusion than endovascular interventions (11.0%, P < .001). Mean follow-up for secondary interventions was 3.5 years. A multivariate Cox proportional hazards model identified female gender, prior MI, anticoagulation, occlusion, and endovascular intervention as predictors of loss of primary patency. Intervention for occlusion predicted poorer primary and secondary patency. Endovascular intervention was associated with poorer primary patency as compared to open intervention and a trend toward poorer secondary patency. Conclusions: Both open and endovascular secondary interventions on lower extremity bypasses are low-risk procedures that offer acceptable patency. Although more commonly performed in the setting of graft occlusion, open surgical interventions show improved durability compared to endovascular interventions. Some patients, including those with occluded grafts, may benefit from more liberal use of open surgical intervention to restore bypass patency.

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Lower-Extremity Muscle Activity During Aquatic and Land Treadmill Running at the Same Speeds

Journal of Sport Rehabilitation ◽

10.1123/jsr.2013-0003 ◽

2014 ◽

Vol 23 (2) ◽

pp. 107-122 ◽

Cited By ~ 5

Author(s):

W. Matthew Silvers ◽

Eadric Bressel ◽

D. Clark Dickin ◽

Garry Killgore ◽

Dennis G. Dolny

Keyword(s):

Lower Extremity ◽

Outcome Measures ◽

Muscle Activity ◽

Tibialis Anterior ◽

Rectus Femoris ◽

Biceps Femoris ◽

Swing Phase ◽

Treadmill Running ◽

Vastus Medialis ◽

Lower Extremity Muscle

Context:Muscle activation during aquatic treadmill (ATM) running has not been examined, despite similar investigations for other modes of aquatic locomotion and increased interest in ATM running.Objectives:The objectives of this study were to compare normalized (percentage of maximal voluntary contraction; %MVC), absolute duration (aDUR), and total (tACT) lower-extremity muscle activity during land treadmill (TM) and ATM running at the same speeds.Design:Exploratory, quasi-experimental, crossover design.Setting:Athletic training facility.Participants:12 healthy recreational runners (age = 25.8 ± 5 y, height = 178.4 ± 8.2 cm, mass = 71.5 ± 11.5 kg, running experience = 8.2 ± 5.3 y) volunteered for participation.Intervention:All participants performed TM and ATM running at 174.4, 201.2, and 228.0 m/min while surface electromyographic data were collected from the vastus medialis, rectus femoris, gastrocnemius, tibialis anterior, and biceps femoris.Main Outcome Measures:For each muscle, a 2 × 3 repeated-measures ANOVA was used to analyze the main effects and environment–speed interaction (P ≤ .05) of each dependent variable: %MVC, aDUR, and tACT.Results:Compared with TM, ATM elicited significantly reduced %MVC (−44.0%) but increased aDUR (+213.1%) and tACT (+41.9%) in the vastus medialis, increased %MVC (+48.7%) and aDUR (+128.1%) in the rectus femoris during swing phase, reduced %MVC (−26.9%) and tACT (−40.1%) in the gastrocnemius, increased aDUR (+33.1%) and tACT (+35.7%) in the tibialis anterior, and increased aDUR (+41.3%) and tACT (+29.2%) in the biceps femoris. At faster running speeds, there were significant increases in tibialis anterior %MVC (+8.6−15.2%) and tACT (+12.7−17.0%) and rectus femoris %MVC (12.1−26.6%; swing phase).Conclusion:No significant environment–speed interaction effects suggested that observed muscle-activity differences between ATM and TM were due to environmental variation, ie, buoyancy (presumed to decrease %MVC) and drag forces (presumed to increase aDUR and tACT) in the water.

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Lower-Extremity Biomechanics and Maintenance of Vertical-Jump Height During Prolonged Intermittent Exercise

Journal of Sport Rehabilitation ◽

10.1123/jsr.2013-0065 ◽

2014 ◽

Vol 23 (4) ◽

pp. 319-329

Author(s):

Randy J. Schmitz ◽

John C. Cone ◽

Timothy J. Copple ◽

Robert A. Henson ◽

Sandra J. Shultz

Keyword(s):

Lower Extremity ◽

Outcome Measures ◽

Principal Components ◽

Intermittent Exercise ◽

Vertical Jump ◽

The Body ◽

Rating Of Perceived Exertion ◽

Jump Height ◽

Lower Extremity Biomechanics ◽

Biomechanical Factors

Context:Potential biomechanical compensations allowing for maintenance of maximal explosive performance during prolonged intermittent exercise, with respect to the corresponding rise in injury rates during the later stages of exercise or competition, are relatively unknown.Objective:To identify lower-extremity countermovement-jump (CMJ) biomechanical factors using a principal-components approach and then examine how these factors changed during a 90-min intermittent-exercise protocol (IEP) while maintaining maximal jump height.Design:Mixed-model design.Setting:Laboratory.Participants:Fifty-nine intermittent-sport athletes (30 male, 29 female) participated in experimental and control conditions.Interventions:Before and after a dynamic warm-up and every 15 min during the 1st and 2nd halves of an individually prescribed 90-min IEP, participants were assessed on rating of perceived exertion, sprint/cut speed, and 3-dimensional CMJ biomechanics (experimental). On a separate day, the same measures were obtained every 15 min during 90 min of quiet rest (control).Main Outcome Measures:Univariate piecewise growth models analyzed progressive changes in CMJ performance and biomechanical factors extracted from a principal-components analysis of the individual biomechanical dependent variables.Results:While CMJ height was maintained during the 1st and 2nd halves, the body descended less and knee kinetic and energetic magnitudes decreased as the IEP progressed.Conclusions:The results indicate that vertical-jump performance is maintained along with progressive biomechanical changes commonly associated with decreased performance. A better understanding of lower-extremity biomechanics during explosive actions in response to IEP allows us to further develop and individualize performance training programs.

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Lower Extremity Joint Moments of Collegiate Soccer Players Differ between Genders during a Forward Jump

Journal of Sport Rehabilitation ◽

10.1123/jsr.17.2.137 ◽

2008 ◽

Vol 17 (2) ◽

pp. 137-147 ◽

Cited By ~ 5

Author(s):

Joseph M. Hart ◽

J. Craig Garrison ◽

Riann Palmieri-Smith ◽

D. Casey Kerrigan ◽

Christopher D. Ingersoll

Keyword(s):

Lower Extremity ◽

Internal Rotation ◽

Outcome Measures ◽

Cruciate Ligament ◽

Ligament Injury ◽

Initial Contact ◽

Joint Angles ◽

Joint Moments ◽

Heel Contact ◽

Hip Internal Rotation

Context:Lower extremity kinetics while performing a single-leg forward jump landing may help explain gender biased risk for noncontact anterior cruciate ligament injury.Objective:Gender comparison of lower extremity joint angles and moments.Design:Static groups comparison.Setting:Motion analysis laboratory.Patients or Other Participants:8 male and 8 female varsity, collegiate soccer athletes.Intervention:5 single-leg landings from a 100cm forward jump.Main Outcome Measures:Peak and initial contact external joint moments and joint angles of the ankle, knee, and hip.Results:At initial heel contact, males exhibited a adduction moment whereas females exhibited a abduction moment at the hip. Females also had significantly less peak hip extension moment and significantly less peak hip internal rotation moment than males had. Females exhibited greater knee adduction and hip internal rotation angles than men did.Conclusions:When decelerating from a forward jump, gender differences exist in forces acting at the hip.

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