Contemporary Management of Acute Limb Ischemia: Factors Associated with Amputation and In-Hospital Mortality

Abstract Background Arterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI). Objectives To analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019. Methods An ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant. Results From 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories. Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased. Conclusions There was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged.

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Neutrophil-to-lymphocyte ratio associated with an increased risk of mortality in patients with critical limb ischemia

PLoS ONE ◽

10.1371/journal.pone.0252030 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252030

Author(s):

Min-I. Su ◽

Cheng-Wei Liu

Keyword(s):

Hospital Mortality ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Acute Limb Ischemia ◽

Male Body ◽

Lymphocyte Ratio ◽

Increased Risk ◽

Related Mortality

Purpose Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. Materials and methods We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Results Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. Conclusion CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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Effect of Acute Limb Ischemia on the Mortality of Patients with Extracorporeal Membrane Oxygenation Established by Femoral Vein-Arterial Catheterization and Analysis of Related Risk Factors

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/3471764 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Xiang Li ◽

Guang Chen ◽

Sheng Zhang ◽

Xinting Zheng ◽

Wenjun Zhao ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Arrest ◽

Risk Factor ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Cardiopulmonary Failure ◽

Va Ecmo ◽

Associated Risk Factors

Extracorporeal membrane oxygenation (ECMO) is a common treatment for cardiopulmonary failure. Although it can effectively reduce the mortality of patients with cardiopulmonary failure, it still has a high mortality rate, such as acute limb ischemia (ALI), stroke, liver and kidney failure, and other related complications and related causes of death. This study aims to explore the impact of ALI on the mortality of VA-ECMO patients in hospital and 6 months after discharge and analyze the occurrence of ALI and related factors that affect the mortality of VA-ECMO in hospital and 6 months after discharge. The results showed that the smoking history was an independent risk factor for ALI, and age, diabetes, cardiac arrest, first time of ECMO, and hyperbilirubinemia were associated risk factors for in-hospital mortality. Cardiac arrest and ALI were associated risk factors for mortality at 6 months after discharge. Although ALI is not significantly associated with VA-ECMO in-hospital mortality, it is a risk factor for mortality at 6 months after discharge, and medical personnel should therefore strive to reduce and avoid ALI.

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Predictors of In-hospital Mortality in Patients with Acute Limb Ischemia – Lesson Learnt from A Tertiary Hospital in Jakarta

10.21203/rs.3.rs-104591/v1 ◽

2020 ◽

Author(s):

Suci Indriani ◽

Suko Adiarto ◽

Hananto Andriantoro ◽

Ismoyo Sunu ◽

Taofan Siddiq ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Vitamin E ◽

Hospital Mortality ◽

Independent Predictor ◽

Limb Ischemia ◽

Clinical History ◽

Tertiary Hospital ◽

Acute Limb Ischemia ◽

History Of

Abstract Background This study aims to identify risk factors associated with in-hospital and 30-days mortality in patients with acute limb ischemia (ALI). Methods This study was a single-centered cohort enrolling a total of 160 consecutive patients with a diagnosis of ALI. The ALI diagnosis was based on clinical history, physical examination, and Doppler studies of the extremities. The main outcome of this study is in-hospital and 30-days mortality. Results There were a total of 170 patients involving 192 limbs with the diagnosis of ALI. Intra-aortic balloon pump (IABP) insertion (HR 3.4; 95% CI 1.0-11.3, p = 0.042), no vitamin E treatment (HR 5.6; CI 1.7–18.3, 0.004), arrhythmia (HR 12.00; CI 3.8–37.7, p < 0.001), and acute renal failure (HR 6.70; CI 1.88–24.3, p = 0.003) were an independent predictor of intra-hospital mortality. For 30-days mortality, the independent predictors were menopause (HR 3.2; CI 1.16–8.85, p = 0.02); IABP insertion (HR 4.51; CI 1.14–17.92, p = 0.03); arrhythmia (HR 0.11; CI 0.04–0.32, p < 0.001); bleeding requiring transfusion (HR 3.77; CI 0.10-14.28, p = 0.05); and acute renal failure (HR 5.5; CI 1.79–16.95, p = 0.003). Conclusion In-hospital mortality in patients with ALI remains high in our center. Several factors contributing to mortality were arrhythmia, renal failure, no vitamin E supplementation, and a history of recent cardiac operation.

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The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients

Indonesian Journal of Cardiology ◽

10.30701/ijc.1114 ◽

2021 ◽

Author(s):

Suci Indriani ◽

Suko Adiarto ◽

Hananto Andriantoro ◽

Ismoyo Sunu ◽

Taofan Siddiq ◽

...

Keyword(s):

Vitamin E ◽

Hospital Mortality ◽

Reperfusion Injury ◽

Univariate Analysis ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Logistic Regression Models ◽

Cardiovascular Center ◽

Huge Challenge

Background Management of acute limb ischemia (ALI) is still a huge challenge. Current advances of endovascular therapeutic approach in management of ALI have decreased the overall amputation rate, nevertheless, mortality rate remains high which may be caused by metabolic consequences of reperfusion injury. Aim To understand the role of vitamin E to intra-hospital and 30-day mortality among acute limb ischemia patients. Methods This retrospective cohort study included all patients with ALI between 2015 to 2018. Vitamin E 2x400 mg orally for seven days was given based on physician preference after ALI diagnosis was confirmed. Data were collected from Vascular Registries of National Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Univariate analysis and logistic regression models were used to explore factors that contribute to intra-hospital and 30-day mortality. Results A total of 160 patients with ALI involving 192 limbs were admitted to our hospital. Mostly were male (63.1%) and mean age were 56±13 years old. Majority of the patients had unilateral lesion (80%), and were diagnosed with Rutherford stage IIA (36.3%), followed by stage IIB (33.8%), stage I (20%), and stage III (10%) respectively. Intra-hospital and 30-day mortality were 28.1% and 36.9%, respectively. Low treatment of vitamin E increased intra-hospital mortality (HR 5,6 95%CI 1.7-18.3), however, it did not affect 30-day mortality. Other factors including IABP insertion, arrhythmia, bleeding requiring transfusion and acute renal failure were associated with higher intra-hospital and 30-day mortality. In addition, menopause (HR 3.2; CI 1.16-8.85) was also a predictor of 30-day mortality. Conclusion Vitamin E administration reduced intra-hospital mortality but not on 30-day mortality in acute limb ischemia patients. Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injury

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The Diagnosis, Evaluation and Contemporary Management of Acute Limb Ischemia

Endovascular Interventions ◽

10.1002/9781119283539.ch17 ◽

2018 ◽

pp. 207-219

Author(s):

Michael N. Young ◽

Douglas E. Drachman

Keyword(s):

Limb Ischemia ◽

Acute Limb Ischemia ◽

Contemporary Management

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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