scholarly journals Comparison of Percutaneous Transluminal Angiography With or Without Catheter-Directed Thrombolysis for Chronic Femoropopliteal Occlusive Disease

2021 ◽  
Vol 27 ◽  
pp. 107602962110050
Author(s):  
Mengfei Yi ◽  
Jianjun Guo ◽  
Yanxia Gao ◽  
Jianzhuang Ren ◽  
Yonghua Bi ◽  
...  
Keyword(s):  
Survival Rate ◽  
Limb Salvage ◽  
Perioperative Complications ◽  
Balloon Catheter ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Limb Salvage Rate ◽  
Catheter Directed Thrombolysis ◽  
Long Term Effect ◽  
Salvage Rate

Background: Catheter-directed thrombolysis (CDT) is seldom used for chronic femoropopliteal occlusive disease. Methods: Patients with chronic femoropopliteal occlusive disease enrolled between January, 2011 and April, 2017. Hospitalization expense, limb salvage rate and survival rate were calculated. Results: Twenty-nine patients were treated with CDT (CDT group) and 31 patients without CDT (Non-CDT group).The mean hospitalization expense (5.2 ± 0.5), balloon catheter (1.0 ± 0.2) and stents number (0.8 ± 0.2) in CDT group were significantly less compared to Non-CDT group ( P < 0.05). The short-term and long-term effect scales showed similar in both groups. The incidences of perioperative complications (10.3% vs. 19.4%), primary patency and second patency rate, limb salvage rate (14.8% vs. 16.1%) and survival rate were also similar ( P > 0.05). Six patients died in each group and only 2 disease related deaths were found in Non-CDT group. Conclusion: CDT is a safe and economic strategy for patients with chronic femoropopliteal occlusive disease, and should be served as blanket treatment for every patient without thrombolytic contradictions or a remedy for failure PTA to achieve a comparable clinical effect.

scholarly journals Long term clinical outcome after self-expandable nitinol stent implantation for femoropopliteal occlusive disease in hemodialysis patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Ito ◽  
S Oshima ◽  
H Ishii ◽  
H Takahashi ◽  
N Umemoto ◽  
...  
Keyword(s):  
Survival Rate ◽  
Propensity Score ◽  
Clinical Outcome ◽  
Limb Salvage ◽  
Occlusive Disease ◽  
Control Group ◽  
Limb Salvage Rate ◽  
Nitinol Stent ◽  
The Impact ◽  
Salvage Rate

Abstract Background Endovascular therapy (EVT) using self-expandable bare nitinol stent (BNS) has been commonly accepted in patients with symptomatic femoropopliteal (FP) occlusive disease. However, poor clinical outcomes in hemodialysis (HD) patients are major problems. We investigated the impact of HD on clinical outcome after EVT in patients with FP disease. Methods A total of 427 consecutive HD patients undergoing successful EVT with BNS for FP disease were enrolled with 157 non-HD patients as a control group. They were followed-up for 5 years. We collected data on target lesion revascularization (TLR) rate, and limb salvage rate as well as survival rate. Propensity-score matching analysis was performed to investigate the true impact of HD on the outcome. Results Critical limb ischemia was observed in 44.0% of overall population (43.0% in HD group vs. 46.8% in non-HD group, p=0.42). Rates of diabetes (67.1% vs. 58.1%, p=0.045) and coronary artery disease (73.5% vs. 58.3%, p=0.0008) were higher, while age (70±10 years old vs. 76±10 years old, p&lt;0.0001) and TASC2 C/D lesion (27.9% vs. 44.6%, p=0.0002) were lower in HD group compared to non-HD group. Pre-procedural C-reactive protein level (0.4mg/l vs. 0.3mg/l, p=0.045) was higher and serum albumin level (3.6g/dl vs. 3.8g/dl, p=0.0045) was lower in HD group than those in non-HD group. The freedom rate from TLR at 5 years was significantly lower in HD group than in non-HD group [47.2% vs. 65.2%, hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.23–2.64, p=0.0017]. The limb salvage rate was comparable between the groups (93.3% vs. 97.1%, HR 1.57, 95% CI 0.58–5.47, p=0.41), while the survival rate was significantly lower in HD group compared to non-HD group (60.6% vs. 86.0%, HR 2.53, 95% CI 1.56–4.36, p=0.0002). After propensity-score analysis, 250 patients (125 in each group) were matched without any difference of clinical characteristics in both groups. In the matched cohort, the freedom rate from TLR was still lower in HD group compared to non-HD group (46.7% vs. 66.6%, HR 2.25, 95% CI 1.35–3.87, p=0.0019). The adjusted limb salvage rate was consistently similar between the groups (95.4% vs. 97.3%, HR 1.10, 95% CI 0.20–5.94, p=0.91). Also, the adjusted survival rate was lower in HD group than in non-HD group (47.6% vs. 89.9%, HR 3.60, 95% CI 1.89–7.44, p&lt;0.0001). Conclusion The freedom rate from TLR at 5 years after BNS implantation for FP disease were significantly lower in HD group than in non-HD group, though the limb salvage rate was similar between the groups. The survival rate was consistently lower in HD group compared to non-HD group. HD status had a great impact on TLR and mortality after EVT with BNS in patients with FP disease. Funding Acknowledgement Type of funding source: None

scholarly journals P1280IMPACT OF HAEMODIALYSIS IN PATIENTS UNDERGOING BYPASS SURGERY FOR PERIPHERAL ARTERY DISEASE WITH CRITICAL LIMB ISCHEMIA - 10-YEAR FOLLOW-UP STUDY -

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yoshitaka Kumada ◽  
Hideki Ishii ◽  
Norio Umemoto ◽  
Ryuta Ito ◽  
Hiroshi Takahashi
Keyword(s):  
Survival Rate ◽  
Limb Salvage ◽  
Bypass Surgery ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Limb Salvage Rate ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Salvage Rate

Abstract Background and Aims Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease with critical limb ischemia (CLI) even in patients on haemodialysis (HD) as well as general population, higher amputation and/or mortality rates still remains major clinical problems after bypass surgery in this population. In this 10-year follow-up study, we investigated the impact of HD on outcomes after surgical revascularization in patients with CLI. Method A total of 464 patients undergoing successfully elective bypass surgery were enrolled. We compared 304 HD patients with 335 limbs and 160 non-HD (NHD) patients with 183 limbs during 10 years follow-up period. Primary outcome was amputation-free survival (AFS) rate defined as freedom rate from composited endpoint with major amputation (limb amputation above ankle level) or all-cause mortality. To minimize the differences of clinical characteristics between the two groups, propensity score-matching with all baseline variables was performed. Results Prevalence of diabetes (55.6% vs. 33.8%), ulcer/gangrene (99.1% vs. 63.5%) and infra-popliteal artery disease (58.9% vs. 32.5%) were significantly higher in HD group compared to NHD group (p&lt;0.0001 in all). Pre-procedural C-reactive protein (CRP) levels was also higher in HD group [14.0 (4.0-51.5) mg/l vs. 7.0 (2.0-34.0) mg/l, p=0.0015]. Inversely, age was younger in HD group than in NHD group (67±9 years vs. 72±8 years, p&lt;0.0001). The 30-day mortality rate was comparable (3.3% in HD group vs. 1.3% in NHD group, p=0.16). During follow-up period (median of 48 months), 53 amputation (17.4%) and 102 death (33.6%) in HD group, and 17 amputation (10.6%) and 23 death (14.4%) in NHD group occurred, respectively. The 10-year AFS rate was significantly lower in HD group compared to NHD group [41.3% vs. 71.3%, hazard ratio (HR) 2.33, 95% confidence interval (CI) 1.64-3.41, p&lt;0.0001). Similarly, limb salvage rate and survival rate was also lower in HD group than in NHD group (72.1% vs. 87.5%, HR 1.90, 95%CI 1.12-3.39, p=0.016, and 51.8% vs. 80.4%, HR 2.78, 95%CI 1.80-4.48, p&lt;0.0001, respectively). In the propensity score-matched cohort, having no significant differences of all baseline characteristics between HD and NHD group (n=125 in each), the 10-year AFS rate and survival rate was still lower in HD group compared to NHD group (53.1% vs. 72.8%, HR 2.11, 95% CI 1.34-3.39, p=0.0012 and 58.6% vs. 84.9%, HR 3.72, 95% CI 2.09-7.06, p&lt;0.0001, respectively). However, the limb salvage rate was statistically comparable between the two group (81.9% vs. 84.2%, HR 1.13, 95%CI 0.55-2.38, p=0.74). In addition, pre-procedural CRP levels could predict major amputation in HD patients (HR 1.06, 95%CI 1.01-1.10, p=0.024) but not NHD patients (HR 1.09, 95%CI 0.93-1.25, p=0.27). Conclusion The long-term AFS rate and survival rate were markedly lower in HD patients compared to NHD patients. However, the limb salvage rate was even between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcome. Pre-procedural inflammation status may also specifically affects the poor outcome in HD group.

Can concomitant above-knee femoropopliteal bypass with artificial graft affect the outcome of femorofemoral bypass with artificial graft?

Vascular ◽  
2021 ◽  
pp. 170853812110421
Author(s):  
In-Sub Kim ◽  
Jaehyung Cha ◽  
Won-Min Jo
Keyword(s):  
Limb Salvage ◽  
Bypass Surgery ◽  
Primary Patency ◽  
Limb Salvage Rate ◽  
Group 4 ◽  
Bypass Patency ◽  
Artificial Graft ◽  
Group 2 ◽  
Salvage Rate ◽  
Group 1

Objectives Few have studied the effect of concomitant femoropopliteal (FEM-POP) bypass surgery on the outcome of femorofemoral (FEM-FEM) bypass in patients with peripheral arterial disease (PAD). This study was aimed to analyze the risk relationship of concomitant FEM-POP bypass on the patency of FEM-FEM bypass. Methods From March 2009 to April 2020, a total of 27 patients who underwent FEM-FEM bypass surgery using polytetrafluoroethylene grafts were retrospectively analyzed according to concomitant FEM-POP bypass surgery. The mean follow-up duration was 38.20 ± 34.56 months. Results The overall primary patency of the FEM-FEM bypass grafts in all 27 patients was 83.7, 78.5, and 72.0 at one, two, and 3 years, respectively. The overall limb salvage rate was 100, 94.1, and 86.9 at one, two, 3 years, respectively. Among them, ten patients underwent FEM-FEM bypass only (group 1). The other 17 patients needed a concomitant FEM-POP bypass and these patients were classified into three groups (group 2, ipsilateral FEM-POP, n = 5; group 3, crossover FEM-POP, n = 6; and group 4, bilateral FEM-POP, n = 6) The comparison of the primary patency of group 1 with the concomitant FEM-POP groups (sum of groups 2, 3, and 4, that is, group 5, n = 17) revealed a statistically significant improved patency for FEM-FEM bypasses not requiring concomitant infra-inguinal bypass ( p = .036). Among the concomitant FEM-POP groups, group 2 had the lowest primary patency of the FEM-FEM bypass significantly ( p = 0.07). The limb salvage rate of group 4 was significantly low. Conclusions A concomitant FEM-POP bypass influenced the outcome of FEM-FEM bypass surgery. In conclusion, compromised infra-inguinal runoff at either extremity requiring concomitant FEM-POP bypass significantly worsens long-term FEM-FEM bypass patency. In addition, a concomitant bilateral FEM-POP bypass is a risk factor affecting the limb salvage rate in FEM-FEM bypass.

scholarly journals Are femorodistal bypass grafts for acute limb ischemia worthwhile?

2009 ◽  
Vol 8 (4) ◽  
pp. 294-300
Author(s):  
Nader Khandanpour ◽  
Felicity J. Meyer ◽  
Lily Choy ◽  
Jane Skinner ◽  
Matthew P. Armon
Keyword(s):  
Limb Salvage ◽  
Bypass Surgery ◽  
Limb Ischemia ◽  
Primary Patency ◽  
Acute Limb Ischemia ◽  
Limb Salvage Rate ◽  
Bypass Grafts ◽  
Time Points ◽  
Vein Grafts ◽  
Salvage Rate

Background: It has been shown that autogenous veins are associated with the best limb salvage rates for femorodistal bypass surgery. However, in emergency settings, when an autogenous vein is unavailable, use of synthetic graft material or amputation is a critical decision to make. Objective: To assess the appropriateness of femorodistal bypass grafts for acute limb ischemia in emergency settings. Methods: Patients who underwent emergent bypass and elective femorodistal bypass surgery between 1996 and 2006 were reviewed retrospectively in a single center. Results: There were 147 patients of which 84 had elective and 63 had emergent bypass. The graft patency rates for elective admissions were 44 and 25% vs. 25 and 23% for admissions for acute femorodistal graft surgery at 2 and 4 years, respectively (p < 0.004). Admissions for acute ischemia who were treated with prosthetic grafts had a primary patency of 24 vs. 27% for vein grafts at 2 years and 24 vs. 23% at 4 years (p = 0.33). In the acute femorodistal grafts group, primary patency at 2 years for vein and prosthetic grafts was 27 and 24% as compared to 42 and 32% for electives. These values for cumulative limb salvage rates for elective bypasses were 73 and 63% as compared to 52% at both time points in the acute femorodistal graft group (p < 0.004). In emergency settings, the limb salvage rate for acute femorodistal bypass with prosthetic grafts was 38%, and for vein grafts it was 62% at both time points (p = 0.08). Conclusion: The long term limb salvage rate of 38% suggests that emergent femorodistal revascularization is worthwhile.

Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Anouk Grandjean ◽  
Katia Iglesias ◽  
Céline Dubuis ◽  
Sébastien Déglise ◽  
Jean-Marc Corpataux ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Hybrid Approach ◽  
Arterial Disease ◽  
Early Mortality ◽  
Secondary Patency ◽  
Limb Salvage Rate ◽  
Peripheral Arterial ◽  
Salvage Rate

Abstract. Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

The Results of Superficial Femoral, Popliteal, and Tibial Artery Stenting for Peripheral Vascular Occlusive Disease

2005 ◽  
Vol 71 (11) ◽  
pp. 905-910 ◽  
Author(s):  
Joe H. Morgan ◽  
Charles E. Wall ◽  
D. Benjamin Christie ◽  
Richard L. Harvey ◽  
Maurice M. Solis
Keyword(s):  
Limb Salvage ◽  
Ankle Brachial Index ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Primary Therapy ◽  
Peripheral Vascular Occlusive Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Angioplasty And Stenting ◽  
Vascular Occlusive Disease

The purpose of this study was to evaluate the patentcy rates and physiological effectiveness of angioplasty and stenting as a primary therapy for superficial femoral (SFA), popliteal (POP), and tibial (TIB) arterial occlusive disease. Seventy-eight patients had stents placed in the infra-inguinal vessels between January 1, 2001, and July 31, 2004. We collected data on patient demographics, symptoms, as well as pre- and postprocedure ankle-brachial index (ABI) and angio-graphic findings. Patency rates at 6 months, 12 months, and 24 months were analyzed by life table methods. Thirty-one men and 47 women had a mean age of 68 years (range 36–94 years). Risk factors included diabetes in 50 per cent, hypertension in 79 per cent, smoking in 41 per cent, and end-stage renal disease in 10 per cent. The indications for intervention were claudication in 52 per cent and limb salvage in 48 per cent of patients. Stents were placed in the SFA in 54 patients (69%), in the POP in 15 patients (18%), and in the TIB artery in 6 patients (8%). Average follow-up was 11.2 months. The mean postprocedural increase in ABI was 0.29. The 6-month, 1-year, and 2-year primary patency rates were 83 per cent, 58 per cent, and 47 per cent, respectively. Limb salvage was achieved in 66 per cent of patients treated for limb-threatening ischemia. There was one major and three minor complications. Stenting of the infra-inguinal vessels has a low morbidity, high success rate, and acceptable patency and limb-salvage rates.

Isolated limb perfusion for soft-tissue sarcoma and regional melanoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10579-10579
Author(s):  
Olfa Derbel ◽  
Eve-Marie Neidhardt ◽  
Adeline Stoltz ◽  
Pierre Meeus ◽  
Aurelien Dupre ◽  
...  
Keyword(s):  
Partial Response ◽  
Limb Salvage ◽  
Response Rate ◽  
Complete Response ◽  
Isolated Limb Perfusion ◽  
High Dose ◽  
Limb Salvage Rate ◽  
Limb Perfusion ◽  
Melanoma Patients ◽  
Salvage Rate

10579 Background: Isolated limb perfusion (ILP) represents a treatment option for locally advanced melanoma and sarcoma confined to a limb. The advantage of this approach is to deliver high-dose regional chemotherapy without serious systemic effects. However, the ILP technique involves a complex and invasive operative procedure, requiring accurate monitoring to avoid major local toxicity. Methods: From November 2004 to December 2011, 58 patients underwent IPL for unresectable soft tissu sarcoma (STS= 34) and advanced in-transit melanoma (n=24). IPLs were performed at mild hyperthermic conditions with 1-2 mg of TNF and 40-80 mg of melphalan (M) for arm and leg perfusions, respectively. The response rate, disease free intervals, overall survival, toxicity and limb salvage rate were evaluated. Results: Median age was 68 years (range: 29-91 years), with 58% of women. For sarcoma patients, median tumor size was 60 mm, 16 patients (47%) had a high grade STS. Twenty-one patients (61%) received IPL before definitive surgery. Eight patients finally underwent amputation, giving a long-term limb salvage of 77%. The overall response rate was 73.5% (Complete response rate 14.7%, partial response rate 58.8 %). For melanoma patients, 9 (38%) had an AJCC stage III disease, the median thickness of the primary tumor was 3.5 mm. A complete response was obtained in 21% of patients while 54% exhibited a partial response. The local and metastatic recurrence rates were similar between sarcoma and melanoma patients (41% and 33% respectively). All but one of the patients with non-operated sarcoma presented a local or metastatic relapse.There was no mortality and no systemic toxicity. Regional toxicity (Wieberdink scale) was: grade I (no reaction) 53 %, II (erythema, oedema) 34%, III (blistering) 8% and IV 3%. The median local relapse-free survival was 40 months in sarcoma group (26.6 months for non operated patients) and 10 months in melanoma one. The overall 3-years survival rate was 44% for sarcoma and 25% for melanoma patients. Conclusions: ILP induces a high tumour response rate, leads to a high limb salvage rate but is associated with an important recurrence rate. It provides a limb salvage alternative to amputation when local control is necessary.

scholarly journals Clinical Factors Determining Limb-salvage Rate of Osteosarcoma Patients

2011 ◽  
Vol 60 (4) ◽  
pp. 689-691
Author(s):  
Satoshi Nagano ◽  
Masahiro Yokouchi ◽  
Mitsuhiro Kaieda ◽  
Arisa Tsuru ◽  
Michihisa Zenmyo ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Limb Salvage Rate ◽  
Clinical Factors ◽  
Salvage Rate

Reconstructive Surgery in Gangrene

1976 ◽  
Vol 21 (4) ◽  
pp. 194-196 ◽  
Author(s):  
J. O'Connor ◽  
W. Reid ◽  
J. K. Watt ◽  
J. G. Pollock
Keyword(s):  
Limb Salvage ◽  
Reconstructive Surgery ◽  
Limb Salvage Rate ◽  
Reconstructive Arterial Surgery ◽  
Salvage Rate

The results of reconstructive arterial surgery in 113 critically ischaemic limbs during 1958 to 1972 are presented. There were 61 aorto-iliac reconstructions with 4 operative deaths (6.5%), resulting in a limb salvage rate of 75.4 per cent and 49 femoro-popliteal operations with 3 deaths (6.1%) and a limb salvage rate of 73.5 per cent.

Sign in / Sign up

Export Citation Format

Share Document