Impact of Kidney Disease on Peripheral Arterial Interventions: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 51 (7) ◽  
pp. 527-533
Author(s):  
Mahesh Anantha-Narayanan ◽  
Azfar Bilal Sheikh ◽  
Sameer Nagpal ◽  
Kim G. Smolderen ◽  
Jeffrey Turner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Meta Analysis ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Major Amputation ◽  
Early Mortality ◽  
Comorbid Condition ◽  
Increased Risk ◽  
Peripheral Arterial

Background: There are limited data on outcomes of patients undergoing peripheral arterial disease (PAD) interventions who have comorbid CKD/ESRD versus those who do not have such comorbid condition. We performed a systematic review and meta-analysis to analyze outcomes in this patient population. Methods: Five databases were searched for studies comparing outcomes of lower extremity PAD interventions for claudication and critical limb ischemia (CLI) in patients with CKD/ESRD versus non-CKD/non-ESRD from January 2000 to June 2019. Results: Our study included 16 observational studies with 44,138 patients. Mean follow-up was 48.9 ± 27.4 months. Major amputation was higher with CKD/ESRD compared with non-CKD/non-ESRD (odds ratio [OR 1.97] [95% confidence interval [CI] 1.39–2.80], p = 0.001). Higher major amputations with CKD/ESRD versus non-CKD/non-ESRD were only observed when indication for procedure was CLI (OR 2.27 [95% CI 1.53–3.36], p < 0.0001) but were similar for claudication (OR 1.15 [95% CI 0.53–2.49], p = 0.72). The risk of early mortality was high with CKD/ESRD patients undergoing PAD interventions compared with non-CKD/non-ESRD (OR 2.55 [95% CI 1.65–3.96], p < 0.0001), which when stratified based on indication, remained higher with CLI (OR 3.14 [95% CI 1.80–5.48], p < 0.0001) but was similar with claudication (OR 1.83 [95% CI 0.90–3.72], p = 0.1). Funnel plot of included studies showed moderate bias. Conclusions: Patients undergoing lower extremity PAD interventions for CLI who also have comorbid CKD/ESRD have an increased risk of experiencing major amputations and early mortality. Randomized trials to understand outcomes of PAD interventions in this at-risk population are essential.

Antiphospholipid antibodies and lower extremity peripheral arterial disease - a systematic review and meta-analysis

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Beatriz Gavier ◽  
Fernando Vazquez ◽  
Esteban Gandara
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Antiphospholipid Antibodies ◽  
Meta Analysis ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Disease Case ◽  
Peripheral Arterial

Abstract. Background: Despite being an important risk factor for venous thromboembolism and ischaemic stroke, the role of antiphospholipid antibodies in patients with peripheral arterial disease remains a matter of debate. The aim of this study was to evaluate the association of persistently elevated antiphospholipid antibodies and lower extremity peripheral arterial disease. Methods: We conducted a systematic review of electronic databases including MEDLINE, EUROPUBMED and EMBASE to assess the prevalence of antiphospholipid antibodies in patients with lower extremity peripheral arterial disease. Case-control studies were included if they reported the prevalence of antiphospholipid antibodies in patients with lower extremity peripheral arterial disease. Two reviewers (FV and EG) independently assessed the eligibility of all articles. The primary outcome measure was the odds ratio (OR) for the prevalence of antiphospholipid antibodies patients with lower extremity peripheral arterial disease, along with the corresponding 95 % confidence intervals (CIs). Results: Our initial electronic search identified 128 relevant abstracts, of which two studies were included. Antiphospholipid antibodies were found in 50/571 patients with lower extremity peripheral arterial disease and 13/490 of the controls, OR 3.32 (95 % CI = 1.49 to 7.4). In those with critical limb ischaemia, the prevalence of antiphospholipid antibodies was elevated compared to controls, pooled OR 4.78 (95 % CI = 2.37 to 9.65). Conclusions: Our systematic review and meta-analysis suggests that the prevalence of persistently elevated levels of antiphospholipid antibodies is increased in patients with lower extremity peripheral diseases when compared to healthy controls, especially in those with critical limb ischaemia.

scholarly journals Antithrombotic Treatment in Lower Extremity Peripheral Arterial Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Anders Gottsäter
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Low Dose ◽  
Combined Treatment ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Anticoagulant Treatment ◽  
Arterial Complications ◽  
Increased Risk ◽  
Peripheral Arterial

Lower extremity arteries might be affected by atherosclerotic peripheral arterial disease (PAD), or by embolization causing ischaemic symptoms. Patients with PAD often have widespread atherosclerosis, and progression of PAD is associated with increased risk for both other cardiovascular events and cardiovascular mortality. Peripheral arterial disease patients should therefore be offered both non-pharmacological and pharmacological secondary prevention to reduce the risk for future ischemic arterial complications. This review is focussed on the rationale for recommendations on antiplatelet and anticoagulant treatment in PAD. Asymptomatic PAD does not warrant either anticoagulant or antiplatelet treatment, whereas patients with ischaemic lower extremity symptoms such as intermittent claudication or critical limb ischemia caused by atherosclerosis should be offered platelet antiaggregation with either low dose aspirin or clopidogrel. Combined treatment with aspirin and low-dose of the direct oral anticoagulant (DOAC) rivaroxaban should be considered and weighed against bleeding risk in symptomatic PAD patients considered at high risk for recurrent ischaemic events and in patients having undergone endovascular or open surgical intervention for PAD. Patiens with cardiogenic embolization to lower extremity arteries should be recommended anticoagulant treatment with either one of the DOACs (apixaban, dabigatran, edoxaban, and rivaroxaban) or warfarin.

Intensive walking exercise for lower extremity peripheral arterial disease: A systematic review and meta-analysis

2015 ◽  
Vol 8 (3) ◽  
pp. 363-377 ◽  
Author(s):  
Xiafei Lyu ◽  
Sheyu Li ◽  
Shifeng Peng ◽  
Huimin Cai ◽  
Guanjian Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Meta Analysis ◽  
Arterial Disease ◽  
Walking Exercise ◽  
Peripheral Arterial

scholarly journals Differentiating Lower Extremity Wounds: Arterial, Venous, Neurotrophic

2018 ◽  
Vol 35 (05) ◽  
pp. 399-405 ◽  
Author(s):  
Ava Star
Keyword(s):  
Lower Extremity ◽  
Multidisciplinary Care ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
The United States ◽  
Major Amputation ◽  
Vascular Assessment ◽  
Improved Outcomes ◽  
Lower Extremity Wound ◽  
Peripheral Arterial

AbstractPeripheral arterial disease (PAD) is a currently underdiagnosed and underrecognized vascular disease afflicting up to 200 million people worldwide, with at least 1 million of those suffering from critical limb ischemia (CLI). The 5-year mortality after major amputation for CLI (70%) is twice the average 5-year cancer mortality in the United States, and as many as 50% of CLI patients proceed directly to amputation without preceding vascular assessment or revascularization. Each year, twice as many breast augmentations are performed as leg revascularizations. Strong evidence in the literature supports markedly improved outcomes when multidisciplinary care teams across specialties are engaged to evaluate, treat, and manage patients with lower extremity wounds. This article assists the vascular specialist in differentiating the three most common lower extremity wound types.

scholarly journals Sulodexide improves pain-free walking distance in patients with lower extremity peripheral arterial disease: A systematic review and meta-analysis

2020 ◽  
Vol 9 ◽  
pp. 204800402090700
Author(s):  
Antonio Vittorino Gaddi ◽  
Fabio Capello ◽  
Oana Florentina Gheorghe-Fronea ◽  
Simone Fadda ◽  
Roxana Oana Darabont
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Meta Analysis ◽  
Arterial Disease ◽  
Walking Distance ◽  
Peripheral Arterial

scholarly journals What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review

2021 ◽  
Vol 10 (7) ◽  
pp. 1413
Author(s):  
Judith Catella ◽  
Anne Long ◽  
Lucia Mazzolai
Keyword(s):  
Arterial Disease ◽  
Major Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Quality Of Data ◽  
Amputation Level ◽  
Increased Risk ◽  
Transcutaneous Oximetry ◽  
Peripheral Arterial

Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.

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