scholarly journals NATIONWIDE TRENDS OF SURGICAL AND ENDOVASCULAR REVASCULARIZATION PROCEDURES FOR HOSPITAL ADMISSION, COST UTILIZATION, ALL-CAUSE MORTALITY, AND MAJOR AMPUTATION AMONG ADULTS WITH CRITICAL LIMB ISCHEMIA FROM 2003-2012

2016 ◽  
Vol 67 (13) ◽  
pp. 2261
Author(s):  
Shikhar Agarwal ◽  
Karan Sud ◽  
Mehdi Shishehbor
Keyword(s):  
Hospital Admission ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Endovascular Revascularization ◽  
All Cause Mortality ◽  
Cost Utilization ◽  
Revascularization Procedures

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 Endovascular revascularization of multilevel arterial disease in patients with critical limb ischemia

2018 ◽  
Vol 5 (6) ◽  
pp. 2039
Author(s):  
Asser Abd El Hamid Goda
Keyword(s):  
Wound Healing ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Healing Rate ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Endovascular Revascularization ◽  
The Mean ◽  
Revascularization Procedures ◽  
Salvage Rate

Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease.  Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim this study is evaluation of the efficacy of endovascular intervention for multilevel arterial disease in patients with critical limb ischemia.Methods: This prospective study was included CLI patients due to multilevel arterial disease who underwent endovascular revascularization between January 2016 and January 2017 in our institution. Study end points were limb salvage and wound healing. Results: The mean age of patients was (61.7±7.47) years, with 13 (61.9%) men. Eight limbs were identified as Rutherford category 4 (38.1%), ten limbs as Rutherford category 5 (47.6%), and three limbs as Rutherford category 6 (14.3%). Limb salvage rate was (90.5%) at 1 year. Wound healing rate was 80.9%.Conclusions: This study proved that endovascular revascularization of multilevel arterial disease for patients with critical limb ischemia is effective.

Surgical reconstruction versus peripheral intervention in patients with critical limb ischemia – a prospective multicenter registry in Japan: The SPINACH study design and rationale

Vascular ◽  
2014 ◽  
Vol 22 (6) ◽  
pp. 411-420 ◽  
Author(s):  
Nobuyoshi Azuma ◽  
Osamu Iida ◽  
Mitsuyoshi Takahara ◽  
Yoshimitsu Soga ◽  
Akio Kodama
Keyword(s):  
Endovascular Treatment ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Current Treatment ◽  
Surgical Reconstruction ◽  
Clinical Trial Registration ◽  
Patient Model ◽  
Secondary Endpoints ◽  
Revascularization Procedures

Clinical evidence reflecting the recent development of treatments for patients with critical limb ischemia is mandatory to guide the decision-making process for the selection of revascularization procedures, including bypass or endovascular treatment. This paper describes the protocol for a clinical study that is designed and carried out by both vascular surgeons and interventional cardiologists collaboratively, and will investigate current treatment for critical limb ischemia in Japan. The registry aimed to recruit approximately 450 patients with critical limb ischemia, including approximately 150 patients who underwent bypass surgery and approximately 300 patients who underwent endovascular treatment in 23 institutions. The primary endpoint of this study is amputation-free survival at 36 months, and the secondary endpoints include major amputation, cardiovascular events, re-intervention, death, ulcer healing, and their composite outcomes. The SPINACH study aims to provide a suitable patient model for each revascularization procedure, bypass and endovascular treatment, and will expound on the role of each approach for critical limb ischemia treatment (Clinical trial registration UMIN000007050).

Cell Therapy for Critical Limb Ischemia

Angiology ◽  
2015 ◽  
Vol 67 (5) ◽  
pp. 444-455 ◽  
Author(s):  
Aaron Liew ◽  
Vish Bhattacharya ◽  
James Shaw ◽  
Gerard Stansby
Keyword(s):  
Cell Therapy ◽  
Critical Limb Ischemia ◽  
Ulcer Healing ◽  
Mononuclear Cells ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Cochrane Library ◽  
Mortality Data ◽  
All Cause Mortality

Early-phase trials showed the feasibility and potential efficacy of cell therapy in patients with critical limb ischemia (CLI). For systematic review, randomized controlled trials (RCTs) of cell therapy versus no cell therapy in CLI were searched from PubMed and the Cochrane library databases. Outcome measures included major amputation, complete ulcer healing, ankle–brachial index (ABI), and all-cause mortality. Data were pooled using 16 RCTs, involving 774 patients. Compared with no cell therapy, cell therapy significantly reduced major amputation (odds ratio [OR]: 0.54; 95% CI: 0.34-0.87: P = .01) and improved ulcer healing (OR: 2.90; 95% confidence interval [CI]: 1.44-5.82; P < .01) and ABI (OR: 5.91; 95% CI: 1.85-18.86: P < .01). Peripheral blood-derived mononuclear cells (PB-MNCs; OR: 0.29; 95% CI: 0.12-0.72; P < .01) and bone marrow concentrate (OR: 0.44; 95% CI: 0.21-0.93; P = .03) significantly lowered the risk of major amputation. The PB-MNCs also significantly increased ulcer healing (OR: 5.77; 95% CI: 1.77-18.87; P < .01). All-cause mortality was similar in both groups (OR: 0.78; 95% CI: 0.44-1.40; P = .41). However, all estimates were nonsignificant following reanalysis using placebo-controlled RCTs only. Cell therapy remains a potential therapeutic option in CLI, but further larger placebo-controlled RCTs are needed.

Abstract 16656: Drug Eluting Balloon Versus Percutaneous Transluminal Angioplasty Below the Knee Intervention for Critical Limb Ischemia: A Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muhammad Khalid ◽  
Mahmoud El Iskandarani ◽  
Vijay Ramu ◽  
Michael Donovan ◽  
Terry Forrest ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Meta Analysis ◽  
Limb Ischemia ◽  
Target Lesion ◽  
Major Amputation ◽  
Transluminal Angioplasty ◽  
Below The Knee ◽  
All Cause Mortality ◽  
Drug Eluting ◽  
Drug Eluting Balloon

Introduction: Studies have shown decrease rates of restenosis and target lesion revascularization (TLR) with drug eluting balloon (DEB) in diabetic patients with critical limb ischemia (CLI). Hypothesis: The aim of this meta-analysis to compare the efficacy of DEB versus Percutaneous transluminal angioplasty (PTA) below the knee peripheral intervention. Methods: Electronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all randomized controlled trials (RCTs) published until April 2020 comparing outcomes of DEB vs PTA in patients with CLI below the knee. End points were major amputation, major adverse events (MAEs), all-cause mortality, target lesion revascularization (TLR), myocardial infarction, and cerebrovascular accidents (CVA). The risk ratio (RR) with 95% confidence interval (CI) were computed and p <0.05 was considered as a level of significance. Results: A total of 4 RCTs (n=655) were included in the final analysis. There were no differences of major amputation (RR: 1.30; CI: 0.68-2.46; p=0.43), MAEs (RR: 0.86; CI: 0.60-1.23; p=0.41), all-cause mortality (RR: 0.91; CI: 0.69-1.19; p=0.48), TLR (RR: 0.65; CI: 0.30-1.44; p=0.29), MI (RR: 1.71; CI: 0.57-5.14; p=0.34) and CVA (RR: 0.66; CI: 0.19-2.26; p=0.50) between the 2 groups [Figure 1]. Conclusions: There were no significant differences of major amputation and TLR for DEB versus PTA . Major adverse cardiac, cerebrovascular events and all-cause mortality were not statistically different for drug coated balloon versus PTA in the management of below knee critical limb ischemia. Further studies needed to confirm these findings.

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.

Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios

Vascular ◽  
2021 ◽  
pp. 170853812098629
Author(s):  
Sevinç B Erdoğan ◽  
Ümmühan N Selçuk ◽  
Murat Baştopçu ◽  
Gökhan Arslanhan ◽  
Arif Y Çakmak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Treatment ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Response To Treatment ◽  
Standard Regimen ◽  
Markers Of Inflammation ◽  
Endovascular Revascularization ◽  
Cardiovascular Center ◽  
Associated Risk Factors

Objectives Inflammation is a component in the pathogenesis of critical limb ischemia. We aimed to assess how inflammation affects response to treatment in patients treated for critical limb ischemia using neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocytes ratios (PLR) as markers of inflammation. Methods Patients in a single tertiary cardiovascular center with critical limb ischemia unsuitable for surgical or interventional revascularization were retrospectively identified. Data were collected on medical history for risk factors, previous surgical or endovascular revascularization, and outcome. A standard regimen of low molecular weight heparin, aspirin, statins, iloprost infusions, and a standard pain medication protocol were applied to each patient per hospital protocol. Patients with improvement in ischemic pain and healed ulcers made up the responders group and cases with no worsening pain or ulcer size or progression to minor or major amputations made up the non-responders group. Responders and Non-responders were compared for risk factors including pretreatment NLR and PLR. Results 268 included patients who were not candidates for surgical or endovascular revascularization were identified. Responders had significantly lower pretreatment NLR (4.48 vs 8.47, p < 0.001) and PLR (162.19 vs 225.43, p = 0.001) values. After controlling for associated risk factors NLR ≥ 4.63 (p < 0.001) and PLR ≥ 151.24 (p = 0.016) were independently associated with no response to treatment. Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocytes ratio are markers of inflammation that are reduced in patients improving with medical treatment suggesting a decreased state of inflammation before treatment in responding patients.

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

2021 ◽  
pp. 153857442110264
Author(s):  
Hee Korleski ◽  
Laura DiChiacchio ◽  
Luiz Araujo ◽  
Michael R. Hall
Keyword(s):  
Case Report ◽  
General Anesthesia ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Treatment Modality ◽  
Conventional Treatment ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

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