Regarding “Perioperative outcomes and amputation-free survival after lower extremity bypass surgery in California hospitals”

In this study, we determined the reamputation-free survival to both limbs and to the contralateral limb only following an index amputation of any-level and assessed whether reamputation rates have changed over time. We completed a systematic search using PubMed and screened a total of 205 articles for data on reamputation rates. We reported qualitative characteristics of 56 studies that included data on reamputation rates and completed a meta-analysis on 22 of the studies which enrolled exclusively participants with diabetes. The random-effects meta-analysis fit a parametric survival distribution to the data for reamputations to both limbs and to the contralateral limb only. We assessed whether there was a temporal trend in the reamputation rate using the Mann-Kendall test. Incidence rates were high for reamputation to both limbs and to the contralateral limb only. At 1 year, the reamputation rate for all contralateral and ipsilateral reamputations was found to be 19% (IQR=5.1%–31.6%), and at 5 years, it was found to be 37.1% (IQR=27.0%–47.2%). The contralateral reamputation rate at 5 years was found to be 20.5% (IQR=13.3%–27.2%). We found no evidence of a trend in the reamputation rates over more than two decades of literature analyzed. The incidence of lower extremity reamputation is high among patients with diabetes who have undergone initial amputations secondary to diabetes, and rates of reamputation have not changed over at least two decades.

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Lower Extremity Bypass Surgery on Patients Transferred from Other Hospitals is Associated with Increased Morbidity and Mortality

Annals of Vascular Surgery ◽

10.1016/j.avsg.2016.09.019 ◽

2017 ◽

Vol 41 ◽

pp. 205-213.e2

Author(s):

Faisal Aziz ◽

Youngmin Chu ◽

Erik B. Lehman

Keyword(s):

Lower Extremity ◽

Bypass Surgery ◽

Morbidity And Mortality

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Catastrophic Antiphospholipid Syndrome Following Lower Extremity Arterial Bypass Surgery: Case Report and Evidence Review

Vascular and Endovascular Surgery ◽

10.1177/15385744211046245 ◽

2021 ◽

pp. 153857442110462

Author(s):

Ahmed A. Sorour ◽

Levester Kirksey ◽

Sarah Keller ◽

Michael S. O’Connor ◽

Sean P. Lyden

Keyword(s):

Case Report ◽

Lower Extremity ◽

Antiphospholipid Syndrome ◽

Current Literature ◽

Bypass Surgery ◽

Multidisciplinary Approach ◽

Catastrophic Antiphospholipid Syndrome ◽

Diagnosis And Management ◽

Life Threatening ◽

Evidence Review

Catastrophic antiphospholipid syndrome (CAPS) is a rare life threatening presentation of antiphospholipid syndrome. Surgery has been proposed as one of the triggering factors for this life threatening entity. There are no detailed published reports in the current literature describing CAPS as a complication after surgery. We report a case of a 21 year old that developed CAPS postoperatively and discuss the multidisciplinary approach for diagnosis and management.

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Guideline-Oriented Therapy of Lower Extremity Peripheral Artery Disease (PAD) – Current Data and Perspectives

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-0690-9365 ◽

2019 ◽

Vol 191 (04) ◽

pp. 311-322 ◽

Cited By ~ 3

Author(s):

Jonas Kersting ◽

Lars Kamper ◽

Marco Das ◽

Patrick Haage

Keyword(s):

Lower Extremity ◽

Peripheral Artery Disease ◽

Bypass Surgery ◽

Interdisciplinary Approach ◽

Current Data ◽

Arterial System ◽

Peripheral Artery ◽

Vascular Surgeon ◽

Technical Developments ◽

Artery Disease

Background Because of the demographic change, lower extremity peripheral artery disease (PAD) is becoming increasingly relevant with respect to health economics. PAD patients often suffer from multiple diseases. Consequently, therapy is commonly complex and requires an interdisciplinary approach. Because of rapid technical developments, interventional endovascular therapy regimens play an increasingly important role. Method Review and literature search on the basis of the current German S3 guidelines on the therapy of PAD as well as international guidelines. In terms of state-of-the-art therapies, relevant current studies were considered. Results Knowledge of existing guidelines and recommendations as well as new therapeutic approaches is essential for the adequate therapy of PAD patients. A close cooperation between the interventional radiologist and the vascular surgeon is the key to success. In addition to established conservative approaches and invasive bypass surgery, the endovascular approach has been a mainstay in the TASC A and B environment for years. It has recently shown promising results in advanced PAD conditions, such as TASC C and D. An endovascular-first strategy is defined in most guidelines. Conclusion A primarily endovascular-first strategy has become the standard in the majority of even complex lesions of the lower extremity arterial system. Regarding the crural segment, a decrease in mortality compared to bypass surgery has been demonstrated. Further evidence can be expected from ongoing randomized multicenter trials. Key Points: Citation Format

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Perioperative and Oncological Outcomes of 1,002 Consecutive Patients With Localized Renal Cell Carcinoma Treated by Robotic Partial Nephrectomy at a Single Center

The Korean Journal of Urological Oncology ◽

10.22465/kjuo.2021.19.3.183 ◽

2021 ◽

Vol 19 (3) ◽

pp. 183-192

Author(s):

Taejin Kim ◽

Jae Hoon Chung ◽

Hyun Hwan Sung ◽

Hwang Gyun Jeon ◽

Byong Chang Jeong ◽

...

Keyword(s):

Survival Rate ◽

Partial Nephrectomy ◽

Death Rate ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Recurrence Free Survival ◽

Single Center ◽

Free Survival ◽

Oncological Outcomes

Purpose: To analyze and compare the results of robotic partial nephrectomy (RPN) at a single center with the previous large-scale studies in terms of perioperative and oncological outcomes.Materials and Methods: We retrospectively evaluated 1,013 cases of RPN in our center database from December 2008 to August 2018. Total 11 cases were excluded in final analysis. We evaluated perioperative outcomes as the Trifecta achievement, which is defined as no positive surgical margin (PSM), no perioperative complications greater than Clavien-Dindo classification I and a warm ischemia time of <25 minutes. In addition, we analyzed pathological and oncological outcomes; recurrence, metastasis, all-cause deaths, cancer-specific deaths, and 5-year survival rates.Results: In 1,002 cases, the Trifecta achievement was 61.1% (n=612). The postoperative complication was 18.4% (n=184) but most were grade 2 or less (14.9%, n=145). Ninety-three cases (9.28%) had benign and 907 cases (90.5%) had malignant pathologies. A local recurrence were 14 cases (1.54%) and distant metastasis were 20 cases (2.2%) during follow-up periods. Allcause death rate was 1.2% (n=11) and cancer-specific death rate was 0.2% (n=2). The median follow-up period was 39 months. A 5-year recurrence-free survival rate, cancer-specific survival rate, and overall survival rate were 95.2%, 99.7%, and 98.4%.Conclusions: In summary, our data shows comparable perioperative outcomes to other largescale studies of RPN in terms of the Trifecta achievement with similar baseline characteristics. In terms of oncological outcomes, there was lower rate of PSM and similar recurrence free survival rate.

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