Epidemiological Analysis of Lower Limb Revascularization for Peripheral Arterial Disease over 12 years in the Public Health System in Brazil

Objectives: Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people. Our objective was to analyse the surgical treatment for PAD performed in the Unified Health System of Brazil over 12 years based on publicly available data. Methods: The study was conducted with data analysis available on the DATASUS platform of the Brazilian Health Ministry, assessing procedure technique distribution throughout the years, mortality and cost. Results: A total of 129,424 procedures were analysed (either for claudicants or critical ischemia, proportion unknown). The vast majority of procedures were Endovascular (65.49%), with a tendency for increase in this disproportion (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the Endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental investment for these procedures was U$ 238,010,096.51, and Endovascular Procedures were on average significantly more expensive than Open Surgery (U$ 1,932.27 v. U$ 1,517.32; p=0.016). Conclusions: In the Brazilian Public Health System, lower limb revascularizations occurred with gradual growing frequency between 2008 and 2019. Endovascular procedures were vastly more common, and related to lower in-hospital mortality rates, but higher procedural costs.

Download Full-text

Lower Limb Revascularization for Peripheral Arterial Disease in 10,951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.07.026 ◽

2021 ◽

Vol 70 ◽

pp. 223-229

Author(s):

Nelson Wolosker ◽

Marcelo Fiorelli Alexandrino da Silva ◽

Dafne Braga Diamante Leiderman ◽

Nickolas Stabellini ◽

Wellington Araujo Nogueira ◽

...

Keyword(s):

Public Health ◽

Peripheral Arterial Disease ◽

Health System ◽

Lower Limb ◽

Public Health System ◽

Descriptive Analysis ◽

Arterial Disease ◽

System A ◽

Peripheral Arterial

Download Full-text

Is There a Risk Factor More Responsible for Disaster?

Acta Medica Marisiensis ◽

10.1515/amma-2015-0054 ◽

2015 ◽

Vol 61 (3) ◽

pp. 245-247

Author(s):

Carasca Cosmin ◽

Muresan Vasile Adrian ◽

Tilea Ioan ◽

Magdas Annamaria ◽

Carasca Emilian ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Peripheral Arterial Disease ◽

Lower Limb ◽

Limb Ischemia ◽

Arterial Disease ◽

Risk Level ◽

Critical Ischemia ◽

Medium Risk ◽

Peripheral Arterial

Abstract Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension. Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking. Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation. Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

Download Full-text

Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

International Journal of Angiology ◽

10.1055/s-0040-1709504 ◽

2020 ◽

Vol 29 (03) ◽

pp. 143-148

Author(s):

Ranjit Kumar Nath ◽

Siva Subramaniyan ◽

Neeraj Pandit ◽

Deepankar Vatsa

Keyword(s):

High Risk ◽

Peripheral Arterial Disease ◽

Femoral Artery ◽

Lower Limb ◽

Treatment Strategies ◽

Arterial Disease ◽

Retrograde Approach ◽

Femoral Access ◽

Antegrade Approach ◽

Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

Download Full-text

The Role of Circulating Biomarkers in Peripheral Arterial Disease

International Journal of Molecular Sciences ◽

10.3390/ijms22073601 ◽

2021 ◽

Vol 22 (7) ◽

pp. 3601

Author(s):

Goren Saenz-Pipaon ◽

Esther Martinez-Aguilar ◽

Josune Orbe ◽

Arantxa González Miqueo ◽

Leopoldo Fernandez-Alonso ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Lower Limb ◽

Prediction Models ◽

Arterial Disease ◽

Cardiac Damage ◽

Thrombotic Occlusion ◽

Medical Treatments ◽

Peripheral Arterial ◽

Inflammatory Molecules

Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.

Download Full-text