Trends in amputations in people with hospital admissions for peripheral arterial disease in Germany

VASA ◽  
2011 ◽  
Vol 40 (4) ◽  
pp. 289-295 ◽  
Author(s):  
Moysidis ◽  
Nowack ◽  
Eickmeyer ◽  
Waldhausen ◽  
Brunken ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Hospital Admissions ◽  
Arterial Disease ◽  
Major Amputation ◽  
Hospitalized Patients ◽  
Hospitalisation Rate ◽  
Minor Amputation ◽  
Federal Statistical ◽  
Peripheral Arterial ◽  
First Time

Background: Using the information of the federal statistics, a detailed description of the hospitalisation rate for amputation in Germany was possible for the first time, and trends since 2005 can be reported. Patients and methods: Detailed lists of all amputations coded as minor amputations (OPS 5 - 864) and major amputations (OPS 5 - 865) performed in 2005 and 2008, divided into the 4th and 5th number of the OPS-code, were provided by the Federal Statistical Office. Results: Despite an increase in total number of hospitalized patients suffering from peripheral arterial disease and neurovascular disease there is a relevant decrease in age adjusted major amputation rates per 100.000 population in Germany from 27.0 in 2005 to 25.1 in 2008 in males and from 19.7 in 2005 to 17.1 in 2008 in females. Overall minor amputation rates do not show such a decrease but increased in males (from 47.4 in 2005 to 53.7 in 2008) und remained unchanged in females (23.1 in 2005 and 23.1 in 2008). In the 6th and 7th decade of life males have approximately four times higher major and minor amputation rates than females. Conclusions: Hospitalisation rate for major amputation in Germany decreased in the recent years whereas hospitalisation rate for minor amputation did not.

Risk factors for wound complications and 30-day mortality after major lower limb amputations in patients with peripheral arterial disease

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Koichi Morisaki ◽  
Terutoshi Yamaoka ◽  
Kazuomi Iwasa
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Major Amputation ◽  
Hazard Ratio ◽  
Wound Complications ◽  
Albumin Concentration ◽  
Knee Amputation ◽  
Peripheral Arterial

Purpose Risk factors for wound complications or 30-day mortality after major amputation in patients with peripheral arterial disease remain unclear. We investigated the outcomes of major amputation in patients with peripheral arterial disease. Methods Patients who underwent major amputation from 2008 to 2015 were retrospectively analyzed. The main outcome measures were risk factors for wound complications and 30-day mortality after major lower limb amputations. Major amputation was defined as above-knee amputation or below-knee amputation. Wound complications were defined as surgical site infection or wound dehiscence. Results In total, 106 consecutive patients underwent major amputation. The average age was 77.3 ± 11.2 years, 67.9% of patients had diabetes mellitus and 35.8% were undergoing hemodialysis. Patients who underwent primary amputation constituted 61.9% of the cohort, and the proportions of above-knee amputation and below-knee amputation were 66.9% and 33.1%, respectively. The wound complication rate was 13.3% overall, 10.3% in above-knee amputation, and 19.5% in below-knee amputation. Multivariate analysis showed that the risk factors for wound complications were female sex (hazard ratio, 4.66; 95% confidence interval, 1.40–17.3; P = 0.01) and below-knee amputation (hazard ratio, 4.36; 95% confidence interval, 1.20–17.6; P = 0.03). The 30-day mortality rate was 7.6%, pneumonia comprised the most frequent cause of 30-day mortality, followed by sepsis and cardiac death. Multivariate analysis showed that a low serum albumin concentration (hazard ratio, 3.87; 95% confidence interval, 1.12–16.3; P = 0.03) was a risk factor for 30-day mortality. Conclusions Female sex and below-knee amputation were risk factors for wound complications. A low serum albumin concentration was a risk factor for 30-day mortality after major amputation in Japanese patients with peripheral arterial disease.

scholarly journals Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia

2021 ◽  
Vol 10 (13) ◽  
pp. 2865
Author(s):  
Felice Pecoraro ◽  
David Pakeliani ◽  
Salvatore Bruno ◽  
Ettore Dinoto ◽  
Francesca Ferlito ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Hybrid Approach ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Major Amputation ◽  
Primary Patency ◽  
Secondary Patency ◽  
Peripheral Arterial

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported. Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months. Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively. Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.

scholarly journals Nitric Oxide Manipulation: A Therapeutic Target for Peripheral Arterial Disease?

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Gareth Williams ◽  
Xu Shi-Wen ◽  
David Abraham ◽  
Sadasivam Selvakumar ◽  
Daryll M. Baker ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Peripheral Arterial Disease ◽  
Vascular Dysfunction ◽  
Treatment Options ◽  
Arterial Disease ◽  
Major Amputation ◽  
Western World ◽  
Risk Factor Modification ◽  
Number Of Patients ◽  
Peripheral Arterial

Peripheral Arterial Disease (PAD) is a cause of significant morbidity and mortality in the Western world. Risk factor modification and endovascular and surgical revascularisation are the main treatment options at present. However, a significant number of patients still require major amputation. There is evidence that nitric oxide (NO) and its endogenous inhibitor asymmetric dimethylarginine (ADMA) play significant roles in the pathophysiology of PAD. This paper reviews experimental work implicating the ADMA-DDAH-NO pathway in PAD, focussing on both the vascular dysfunction and effects within the ischaemic muscle, and examines the potential of manipulating this pathway as a novel adjunct therapy in PAD.

Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

2019 ◽  
Vol 39 (3) ◽  
pp. 261-267 ◽  
Author(s):  
Abyalew Sahlie ◽  
Bernard G. Jaar ◽  
Lilian Galarza Paez ◽  
Tahsin Masud ◽  
Janice P. Lea ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Length Of Stay ◽  
Peripheral Arterial Disease ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Arterial Disease ◽  
Index Admission ◽  
Peripheral Arterial

Background Hospital readmissions are common among in- center hemodialysis patients, but little is known about read-missions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. Methods Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days on dialysis) between 31 January 2011 and 30 November 2014, readmissions were defined as new hospital admissions within 30 days of index discharge. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for readmission. Results Overall, 26.8% of index admissions were followed by a readmission. Readmitted patients were more likely to have congestive heart failure (31.0% vs 25.4%; p < 0.001) and peripheral arterial disease (11.6% vs 8.6%; p < 0.001) and had longer index admission length of stay (median = 4 vs 3 days; p < 0.001) than those who were not; age, sex, and race did not differ by readmission status. After adjustment for patient and index admission characteristics, longer length of stay (≥ 4 vs < 4 days, OR = 1.48, 95% confidence interval [CI] 1.35 – 1.62), peripheral arterial disease (OR = 1.31, 95% CI 1.16 – 1.57), congestive heart failure (OR = 1.25, 95% CI 1.13 – 1.39), and ischemic heart disease (OR = 1.12, 95% CI 1.01 – 1.24) were associated with higher likelihood of readmission; index admission due to peritonitis vs other causes was associated with lower likelihood of readmission (OR = 0.80, 95% CI 0.70 – 0.92). Conclusions Our results suggest that, particularly in the absence of a PD-related cause of hospitalization such as peritonitis, PD patients may be at high risk for readmission and may benefit from closer post-discharge monitoring.

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