The impact of statin after endovascular treatment or surgical reconstruction for infrainguinal disease in patients with critical limb ischemia

Purpose: Revascularization of both endovascular therapy (EVT) and surgical reconstruction improve clinical outcomes of patients with critical limb ischemia (CLI); however, treatment of dialysis-dependent patients with CLI is still challenging. This study aimed to investigate the impact of dialysis-related parameters on the risk of mortality in dialysis-dependent patients undergoing revascularization for CLI. Materials and Methods: We retrospectively identified 274 dialysis-dependent patients with CLI (196 males; mean age 71 years), who underwent revascularization, from the clinical database of the surgical reconstruction vs peripheral intervention in patients with critical limb ischemia (SPINACH) study, which was a prospective, multicenter, observational study. Of these patients, 175 patients underwent EVT and 99 patients received surgical reconstruction. The current study evaluated the impact of dialysis vintage and renal biomarkers on the mortality rate of dialysis-dependent patients with CLI undergoing revascularization. Results: During a mean follow-up period of 1.7 ± 1.1 years, 147 deaths were observed. The 3-year overall survival rate and its standard error were estimated to be 40.5% ± 8.1% using the Kaplan-Meier method. A Cox proportional hazard analysis revealed that dialysis vintage ≥4 years, serum creatinine levels <4.7 mg/dL, serum urea nitrogen ≥88 mg/dL, and calcium-phosphate product ≥62.6 mg2/dL2 were independent risk factors for mortality after adjustment for the detailed mortality risk score developed in the SPINACH study. Adding these parameters to the original mortality risk score slightly, but not significantly, increased the area under the time-dependent receiver operating characteristics curve from 0.74 (95% CI, 0.67 to 0.81) to 0.77 (0.71 to 0.84) (p=0.084), whereas continuous net reclassification improvement reached 0.75 (0.12 to 0.90) (p=0.027). Conclusion: We found that long dialysis vintage, low serum creatinine, high serum urea nitrogen, and high calcium-phosphate product were independently associated with the increased risk of mortality in dialysis-dependent patients with CLI undergoing revascularization.

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

Vascular ◽

10.1177/1708538113518204 ◽

2014 ◽

Vol 22 (6) ◽

pp. 411-420 ◽

Cited By ~ 16

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).

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The Impact of Decline in Activities of Daily Living (ADL) of Patients With Critical Limb Ischemia (CLI) After Endovascular Treatment

Vascular and Endovascular Surgery ◽

10.1177/1538574418770849 ◽

2018 ◽

Vol 52 (6) ◽

pp. 411-417 ◽

Cited By ~ 1

Author(s):

Takahiro Tokuda ◽

Keisuke Hirano ◽

Masahiro Yamawaki ◽

Motoharu Araki ◽

Norihiro Kobayashi ◽

...

Keyword(s):

Wound Healing ◽

Activities Of Daily Living ◽

Endovascular Treatment ◽

Clinical Outcomes ◽

Critical Limb Ischemia ◽

Daily Living ◽

Independent Predictor ◽

Limb Ischemia ◽

Free Survival ◽

The Impact

Background: Certain patients with critical limb ischemia (CLI) experience significant decline in activities of daily living (ADL) during hospitalization. The prognosis of decline in ADL during hospitalization remains unknown. Methods: A retrospective analysis was performed on collected data of patients with CLI treated by endovascular treatment between April 2007 and December 2015. We evaluated CLI in patients ADL at the time of hospitalization and after discharge using the Barthel index. We classified all patients into patients with decline in ADL and stable in ADL and compared clinical outcomes (cumulative incidence of wound healing, amputation-free survival at 1 year) between the 2 groups. Results: Two hundred and fifty-five consecutive patients with CLI (221 limbs), who underwent successful endovascular intervention, were enrolled in this study. Of all patients, 22 patients were classified into the decline group. The prevalence of wound, Ischemia, foot infection (WIfI) classification high grade was higher in the decline group (30.7% vs 63.6%; P < .01). The wound healing rates were worse in the decline group than in the stable group (40% vs 78% at 1 year; P < .01). The same trends were observed in the amputation-free survival (37% vs 78%; P < .01). After multivariate analysis, decline in ADL was an independent predictor of wound healing and amputation-free survival (odds ratio [OR]: 2.85, 95% confidence interval [CI]: 1.61-3.35, P < .01; OR: 2.46, 95% CI: 1.26-4.53, P = .01). Conclusions: Patients with CLI with decline in ADL during hospitalization were found to have a poor prognosis suggesting that a decline in ADL may affect the clinical outcomes.

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THE IMPACT OF DECLINE IN ACTIVITIES OF DAILY LIVING (ADL) OF CRITICAL LIMB ISCHEMIA (CLI) PATIENTS AFTER ENDOVASCULAR TREATMENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)32592-0 ◽

2018 ◽

Vol 71 (11) ◽

pp. A2051

Author(s):

Takahiro Tokuda ◽

Keisuke Hirano ◽

Masahiro Yamawaki ◽

Motoharu Araki ◽

Norihiro Kobayashi ◽

...

Keyword(s):

Activities Of Daily Living ◽

Endovascular Treatment ◽

Critical Limb Ischemia ◽

Daily Living ◽

Limb Ischemia ◽

The Impact

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Health-related quality of life after vascular surgery and endovascular treatment in subjects with critical limb ischemia

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.5.2680 ◽

2020 ◽

Vol 36 (5) ◽

Author(s):

Emced Khalil ◽

Sedat Ozcan

Keyword(s):

Quality Of Life ◽

Endovascular Treatment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Health Related Quality ◽

Surgical Revascularization ◽

Related Quality ◽

Health Related ◽

The Impact

Background & Objective: Revascularization of the target vessel and restoration of distal flow is critical not only to reduce mortality and morbidity but also improve health-related quality of life (HRQoL) in patients with critical limb ischemia. However, data concerning the impact of surgical bypass and percutaneous transluminal angioplasty (PTA) on HRQoL is limited. This study aimed to compare the impact of surgical bypass and PTA on HRQoL in subjects undergoing superficial femoral artery (SFA) or popliteal artery revascularization. Methods: Seventy-one subjects who underwent successful revascularization of the SFA or popliteal artery either with surgical revascularization or PTA were enrolled in this study. Three months after revascularization, all subjects underwent ankle-brachial index (ABI) measurement, 6-minute walking test and completed the Nottingham Health Profile (NHP) questionnaire. The NHP score differences (measured at the post-procedural 3rd month) between subjects undergoing surgical or endovascular (PTA) revascularization subjects was the primary outcome measure of the study. Results: Both groups experienced significant improvements in ABI and 6-minute walking distance at post-procedure three months. NHP total scores of Part I and Part II at post-procedural six months were similar in the two groups. However, social isolation [77.98 (0 - 85) vs. 22.53 (0 - 100), p=0.002] and physical abilities [78.7 (30.31 - 87.7) vs. 54.47 (0 - 100), P=0.014] domain scores of the surgical revascularization group were significantly higher than that of the endovascular treatment group. Conclusion: This study shows that total scores obtained from the NHP questionnaire applied three months after revascularization of SFA stenosis are similar in subjects undergoing surgical revascularization or PTA. However, the social isolation and physical abilities domains of the NHP are significantly higher in subjects receiving surgical revascularization compared to those receiving PTA. doi: https://doi.org/10.12669/pjms.36.5.2680 How to cite this:Khalil E, Ozcan S. Health-related quality of life after vascular surgery and endovascular treatment in subjects with critical limb ischemia. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2680 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Impact of Functional Status on the Outcomes of Endovascular Lower Extremity Revascularization for Critical Limb Ischemia in the Elderly

Annals of Vascular Surgery ◽

10.1016/j.avsg.2017.06.047 ◽

2017 ◽

Vol 45 ◽

pp. 42-48 ◽

Cited By ~ 5

Author(s):

Isidore Dinga Madou ◽

Martin D. Slade ◽

Kristine C. Orion ◽

Timur Sarac ◽

Cassius Iyad Ochoa Chaar

Keyword(s):

Lower Extremity ◽

Functional Status ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

The Elderly ◽

The Impact ◽

Lower Extremity Revascularization

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Evaluating Clinical Outcomes of Performing Endovascular Treatment for Patients Presenting with Severe Intermittent Claudication or Critical Limb Ischemia Due to TASC D Lesions

Suez Canal University Medical Journal ◽

10.21608/scumj.2015.45647 ◽

2015 ◽

Vol 18 (2) ◽

pp. 149-158

Author(s):

Hatem Hussain ◽

Mamdouh Al mezaien ◽

Shrief Reffat ◽

Mohammed Ghweeba

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Intermittent Claudication ◽

Critical Limb Ischemia ◽

Limb Ischemia

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Safety and Effectiveness of Retrograde Arterial Access for Endovascular Treatment of Critical Limb Ischemia

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.08.072 ◽

2019 ◽

Vol 55 ◽

pp. 131-137 ◽

Cited By ~ 1

Author(s):

Jordan R. Stern ◽

Danielle E. Cafasso ◽

Peter H. Connolly ◽

Sharif H. Ellozy ◽

Darren B. Schneider ◽

...

Keyword(s):

Endovascular Treatment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Arterial Access

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Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/1526602817701251 ◽

2017 ◽

Vol 24 (3) ◽

pp. 331-336 ◽

Cited By ~ 3

Author(s):

Yukun Li ◽

Ali Esmail ◽

Konstantinos P. Donas ◽

Georgios Pitoulias ◽

Giovanni Torsello ◽

...

Keyword(s):

Endovascular Treatment ◽

Success Rate ◽

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Technical Success ◽

Femoral Access ◽

Technical Success Rate ◽

Below The Knee ◽

Antegrade Approach

Purpose: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI). Methods: Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups. Results: Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047). Conclusion: The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.

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