Long-Term Results and Costs of Muscle Flap Coverage With Ilizarov Bone Transport in Lower Limb Salvage

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

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Long term results of lower limb posttraumatic acute bone defects treated with masquelet technique

Injury ◽

10.1016/j.injury.2021.02.057 ◽

2021 ◽

Author(s):

Gonzalo Luengo-Alonso ◽

Ismael Auñon Martin ◽

Victor Rodriguez Vega ◽

Aranzazu Capel Agundez ◽

Pedro Caba Doussoux

Keyword(s):

Lower Limb ◽

Bone Defects ◽

Long Term Results ◽

Masquelet Technique

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Open Surgical versus Minimally Invasive in Situ Femorodistal Bypass: Long-term Results

Journal of Endovascular Therapy ◽

10.1177/152660280301000122 ◽

2003 ◽

Vol 10 (1) ◽

pp. 117-120 ◽

Cited By ~ 1

Author(s):

Nomdo S. Renken ◽

Cees H.A. Wittens ◽

Peter M.T. Pattynama ◽

Nico A.J.J. Du Bois ◽

Lukas C. van Dijk

Keyword(s):

Minimally Invasive ◽

Limb Salvage ◽

Long Term Results ◽

Open Technique ◽

Treatment Groups ◽

Closed Technique ◽

Open Versus

Purpose: To compare long-term patency and limb survival rates for the classical in situ surgical bypass procedure versus a minimally invasive technique for femorodistal revascularization. Methods: From May 1992 to June 1994, a prospective multicenter study was undertaken at 4 centers to evaluate the open versus closed technique for femorodistal bypass grafting. Of 97 patients enrolled in the trial, 73 patients (49 men; mean age 71 years) were assigned to the long-term follow-up protocol and prospectively randomized to the open (n = 38) or closed (n = 35) procedure. The classical open technique is characterized by a long incision over the length of the bypass graft, while the minimally invasive procedure involves only two short incisions over each anastomosis site (the side branches are closed with a coaxial embolization catheter system). Graft patency was evaluated with duplex imaging periodically throughout the 4-year observation period. Results: There was no statistically significant difference between the treatment groups with respect to age, sex, hypertension, ischemic heart disease, or smoking. However, the open group had a significantly greater incidence of diabetes (p = 0.037). Over a median 4.7-year follow-up (range 0.3–6.4), 9 (12%) patients (3 open and 6 closed) were lost to follow-up: 2 died and 7 refused the duplex examination. No significant differences in 4-year patency, limb salvage, or survival was demonstrated between the open versus closed treatment groups; 4-year secondary patency was 62% versus 64%, respectively, and limb salvage was 72% versus 86%. Conclusions: The closed technique for femorodistal in situ bypass procedures yields favorable long-term outcomes compared to the traditional open technique.

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Effective use of various minimally invasive technologies eliminating vertical reflux in the treatment of chronic diseases of the lower limb veins

Wiadomości Lekarskie ◽

10.36740/wlek202002124 ◽

2020 ◽

Vol 73 (2) ◽

pp. 329-331

Author(s):

Serhiy I. Savolyuk ◽

Valentyn A. Khodos ◽

Roman A. Herashchenko ◽

Vladyslav S. Horbovets

Keyword(s):

Lower Limb ◽

High Frequency ◽

Long Term Results ◽

Laser Coagulation ◽

Results Of Treatment ◽

Functional Classes ◽

Group 3 ◽

Group 2 ◽

Effective Use

The aim: To analyze and evaluate the efficacy of CDLLV treatment, using high-frequency endovascular welding (EVW), endovenous laser coagulation (EVLC) and catheter microfoam echosclerotherapy. Materials and methods: We have treated 329 patients with CDLLV C2-C6 functional classes according to the Clinical Etiological Anatomical Pathophysiology. Of these, 102 patients had vertical reflux eliminated by EVW, in 112 – by EVLC, and in 115 – by catheter microfoam echosclerotherapy. Results: In the EVW group 3 patients (2.94%) had a partial recanalization of coagulated veins 3 months after the procedure. In EVLC group 2 patients (1.79%) also had partial recanalization group after 6 months. In the group of catheter microfoam echosclerotherapy partial recanalization occurred in 3 patients during 3 months of observation, in the period of 6 months – in 2, in the period of 12 months – in 9, in total – in 14 patients (12.17%). The EVW and EVLC methods showed high efficacy of vertical reflux elimination on the great and small subcutaneous veins (GSV/SSV) in CDLLV and have no fundamental differences in the immediate and long-term results of treatment. Microfoam catheter echosclerotherapy leads to a greater number of recanalisations, compared with EVW and EVLC. Conclusions: High-frequency endovenous welding results in complete fibrotic GSV/SSV transformation in 97.06% of patients. Endovascular laser coagulation results in complete fibrotic GSV/SSV transformation in 98.21% of patients. Elimination of vertical reflux by microfoam echosclerotherapy results in complete fibrotic GSV/SSV transformation in 87.83% of patients.

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Long-term results by epidural spinal electrical stimulation (ESES) in patients with inoperable severe lower limb ischaemia

European Journal of Vascular Surgery ◽

10.1016/s0950-821x(87)80062-2 ◽

1987 ◽

Vol 1 (5) ◽

pp. 345-349 ◽

Cited By ~ 42

Author(s):

Lennart Jivegård ◽

Lars-Erik Augustinsson ◽

Carl-Axel Carlsson ◽

Jan Holm

Keyword(s):

Electrical Stimulation ◽

Lower Limb ◽

Long Term Results ◽

Limb Ischaemia ◽

Lower Limb Ischaemia

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Long-Term Results of Endovascular Femoropopliteal Interventions

International Journal of Angiology ◽

10.1055/s-0038-1629923 ◽

2018 ◽

Vol 27 (03) ◽

pp. 151-157 ◽

Cited By ~ 2

Author(s):

Luke Marone ◽

Robert Hacker

Keyword(s):

Limb Salvage ◽

Univariate Analysis ◽

Limb Ischemia ◽

Major Amputation ◽

Long Term Results ◽

Secondary Patency ◽

Endovascular Interventions ◽

Significant Difference ◽

Societal Consensus

Background and Objective Short-term results of endovascular intervention for femoropopliteal lesions have been extensively reported; however, there exists a paucity of long-term objective data related to outcomes of these interventions. We sought to characterize these long-term results including patency, limb salvage, and mortality. Methods From May 2003 to July 2009, all patients who underwent technically successful endovascular balloon angioplasty and/or stenting for Trans-Atlantic Inter-Societal Consensus (TASC) II B, C, and D lesions were identified in a retrospective fashion. Patient demographics, clinical characteristics, arterial noninvasive data, and angiographic anatomic data were evaluated. Results A total of 236 limbs in 186 patients (mean age 74, range 37–94) were treated. Lesion distributions by TASC II classification B, C, and D were 121 (51.3%), 37 (15.7%), and 78 (33%), respectively. Critical limb ischemia (CLI) was the indication for intervention in 42.4% of patients. Five-year primary and primary-assisted patency rates stratified by TASC II classification were B: 55.1%, 91.9%; C: 37.4%, 74.6%; D: 35.5%, 67%, respectively (p = 0.23). Secondary patency based on TASC II classification was B: 92.9%, C: 83%, and D: 75.9%, respectively. Univariate analysis identified age > 75, CLI, and cerebrovascular disease as predictors for loss of patency. Reinterventions to maintain patency were required in 26.5% of TASC II B, 43.2% of TASC II C, and 25.6% of TASCII D lesions (p = NS) and mean time to reintervention ranged from 22 to 29 months with no significant difference related to TASC II classification. A total of eight limbs (3.38%) were converted to open revascularization with two (0.85%) having a change in their initial preoperatively identified bypass target site. Three limbs (1.27%) required a major amputation during follow-up. Survival at 5 years was 44.3%; CLI and smoking were identified as risk factors for death (hazard ratio [HR] 2.6, 1.75–3.84, p < 0.001, HR 3.33, 1.70–6.52, p < 0.001), respectively. Conclusion Long-term patency of endovascular interventions for complicated femoropopliteal lesions is acceptable across TASC II classification and is associated with excellent limb salvage. Mortality in this patient cohort is significant with CLI and smoking being identified as predictors of death.

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Long-Term Results of Surgical Treatment of Popliteal Artery Aneurysms

International Surgery ◽

10.9738/intsurg-d-14-00301.1 ◽

2016 ◽

Vol 103 (5-6) ◽

pp. 315-322

Author(s):

Kimihiro Igari ◽

Toshifumi Kudo ◽

Takahiro Toyofuku ◽

Takehisa Iwai ◽

Yoshinori Inoue

Keyword(s):

Limb Salvage ◽

Popliteal Artery ◽

Surgical Repair ◽

Graft Patency ◽

Primary Patency ◽

Long Term Results ◽

Open Surgical Repair ◽

Autologous Vein ◽

Medial Approach

The aim of this study was to evaluate the long-term outcomes of the surgical repair of popliteal artery aneurysms (PAAs), and to analyze the factors associated with graft patency. Between January 1980 and December 2013, 45 limbs were subjected to open surgical repair at Tokyo Medical and Dental Hospital. We retrospectively examined the patients' clinical characteristics, clinical symptoms, and aneurysm-related anatomy. Surgical procedures were performed through a posterior or medial approach using autologous vein or prosthetic graft. Surgical outcomes were evaluated by postoperative mortality, postoperative morbidity, graft patency, and limb salvage. During the study period, 45 limbs (35 patients; mean age, 60 years) underwent open surgical repair. A total of 25 limbs were treated through a posterior approach using 23 autologous vein grafts (AVGs) and 2 expanded polytetrafluoroethylene (ePTFE) grafts. The other 20 limbs were treated through a medial approach using 13 AVGs and 7 ePTFE grafts. During the mean follow-up period of 65 months, the primary patency rates at 1, 3, and 5 years were 88.0%, 75.7%, and 75.7%, respectively, and the limb salvage rates at 1, 3, and 5 years were 97.1%, 91.4%, and 91.4%, respectively. In the univariate analysis, the ligation and bypass grafting affected the primary patency rate significantly, and the ePTFE graft was associated with a poor primary patency in the multivariate analysis (hazard ratio, 17.8). The use of resection or endoaneurysmorrhaphy for PAAs and graft interposition with an AVG might be more effective for the open repair of PAAs.

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Twenty years′ follow-up of a de-epithelialised turnover flap

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699269 ◽

2008 ◽

Vol 41 (02) ◽

pp. 211-213

Author(s):

A. Gopalakrishna ◽

T. V. Pavan Kumar

Keyword(s):

Good Alternative ◽

Plastic Surgeon ◽

Long Term Results ◽

Flap Coverage

ABSTRACTThe authors have used the de-epithelialised turnover flap (Thatte′s Flap) for covering compound defects over the tendo-achilles in 31 patients in the period covering 1980-2000. Two of these patients have come up for follow-up after 20 years. In this late follow-up, the results are good and the tendon which was bridged by the dermis of the flap is functioning to allow the patients to stand on their toes. The de-epithelialised turnover flap is a simple and easy technique giving good long-term results. In spite of all the new advances in flap coverage, the de-epithelialised turnover flap is a good alternative for the tendo-achilles area in the armamentarium of a plastic surgeon.

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