scholarly journals Association of comorbid depression with inpatient outcomes in critical limb ischemia

2019 ◽  
Vol 25 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Greg J Zahner ◽  
Abigail Cortez ◽  
Erin Duralde ◽  
Joel L Ramirez ◽  
Sue Wang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Critical Limb Ischemia ◽  
Multivariable Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Comorbid Depression ◽  
Surgical Quality ◽  
Inpatient Outcomes ◽  
Artery Disease ◽  
End Stage

There is a growing body of evidence that peripheral artery disease (PAD) may be impacted by depression. The objective of this study is to determine whether outcomes, primarily major amputation, differ between patients with depression and those without who presented to hospitals with critical limb ischemia (CLI), the end-stage of PAD. A retrospective cohort of patients hospitalized for CLI during 2012 and 2013 was identified from the National Inpatient Sample (NIS) using ICD-9 codes. The primary outcome was major amputation and secondary outcomes were length of stay and other complications. The sample included 116,008 patients hospitalized for CLI, of whom 10,512 (9.1%) had comorbid depression. Patients with depression were younger (64 ± 14 vs 67 ± 14 years, p < 0.001) and more likely to be female (55% vs 41%, p < 0.001), white (73% vs 66%, p < 0.001), and tobacco users (46% vs 41%, p < 0.001). They were also more likely to have prior amputations (9.8% vs 7.9%, p < 0.001). During the hospitalization, the rate of major amputation was higher in patients with comorbid depression (11.5% vs 9.1%, p < 0.001). In multivariable analysis, excluding patients who died prior to/without receiving an amputation ( n = 2621), comorbid depression was associated with a 39% increased odds of major amputation (adjusted OR 1.39, 95% CI 1.30, 1.49; p < 0.001). Across the entire sample, comorbid depression was also independently associated with a slightly longer length of stay (β = 0.199, 95% CI 0.155, 0.244; p < 0.001). These results provide further evidence that depression is a variable of interest in PAD and surgical quality databases should include mental health variables to enable further study.

scholarly journals Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

2016 ◽  
Vol 22 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Caitlin W Hicks ◽  
Alireza Najafian ◽  
Alik Farber ◽  
Matthew T Menard ◽  
Mahmoud B Malas ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Multivariable Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Primary Patency ◽  
Tissue Loss ◽  
Vascular Intervention ◽  
Below The Knee ◽  
Endovascular Interventions ◽  
One Year

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

Balloon Angioplasty in Chronic Critical Limb Ischemia: Factors Affecting Clinical and Angiographic Outcome

2002 ◽  
Vol 9 (4) ◽  
pp. 403-410 ◽  
Author(s):  
Hannes Balmer ◽  
Felix Mahler ◽  
Dai-Do Do ◽  
Jürgen Triller ◽  
Iris Baumgartner
Keyword(s):  
Balloon Angioplasty ◽  
Critical Limb Ischemia ◽  
Duplex Ultrasound ◽  
Limb Ischemia ◽  
Target Lesion ◽  
Major Amputation ◽  
Factors Affecting ◽  
Chronic Critical Limb Ischemia ◽  
Endpoint Event ◽  
Artery Disease

Purpose: To assess factors that affect clinical and angiographic outcome in chronic critical limb ischemia (CLI) 12 months after primary, technically successful balloon angioplasty (BA) in infrainguinal arteries. Methods: Sixty consecutive patients (37 women; mean age 75 ± 10 years, range 53–99) with technically successful BA in 66 limbs were followed for 12 months or until death, for major amputation, or repeat target lesion revascularization (TLR). Assessment at baseline and 1 day and 12 months after BA or at an endpoint event, if feasible, was performed with angiography or duplex ultrasound (above-knee revascularization only). Mortality, limb prognosis, and restenosis rate were correlated with cardiovascular risk factors, hemodynamic measures, and angiographic features. Results: Mortality was 25% at 1 year; compared to survivors, nonsurvivors more often had coronary artery disease (93% versus 44% for survivors, p<0.001), bilateral CLI (60% versus 29%, p=0.033), and higher fibrinogen levels (5.1 g/L versus 4.3 g/L, p=0.049). CLI resolved in more than half (35, 53%) of the limbs without repeat TLR. The major amputation rate was 6%. Limb prognosis correlated with ankle pressures after BA. Restenosis rates were 65% at the femoropopliteal and 56% at the infrapopliteal level (NS); these correlated with the length of the treated arterial segment (8.7 cm with restenosis versus 4.0 cm without, p<0.001). Conclusions: High mortality in CLI was associated with an extensive, clinically manifest arteriosclerotic process and high fibrinogen levels. Limb prognosis and restenosis after BA were primarily influenced by local hemodynamic and technical factors. Despite considerable restenosis, more than 90% of survivors avoided major amputations.

Evolution of Major Amputation Risk in Patients Hospitalized in France for Critical Limb Ischemia: The COPART Registry

Angiology ◽  
2020 ◽  
pp. 000331972097682
Author(s):  
Alice Coudene ◽  
Francois-Xavier Lapébie ◽  
Ileana Desormais ◽  
P Lacroix ◽  
Valerie Aurillac ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Major Amputation ◽  
The Past ◽  
Significant Difference ◽  
Before And After ◽  
Secondary Outcomes ◽  
Artery Disease ◽  
Peripheral Arterial

Over the past decade, improvements in medical treatment and revascularization techniques have been beneficial for patients with peripheral artery disease in the late stage of critical limb ischemia (CLI). We evaluated the putative reduction in the number of major amputees in the Cohorte des Patients ARTeriopathes (COPART) cohort over time. Patients were selected from this multicenter cohort, from 2006 to 2016, for CLI according to Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease II criteria. Patients included before and after 2011 were compared. Patients were followed for 1 year. Primary outcome was the rate of major amputations. Secondary outcomes were minor amputations, deaths from all causes, cardiovascular deaths; 989 patients were included, 489 before 2011 and 450 after 2011. There was a significant decrease in rates of major amputation after 2011 (17% vs 25%), confirmed in multivariate analysis (odds ratio [OR]: 1.5 [1.1-2.2]), an increase in revascularization, particularly distal angioplasty (OR: 2.7 [1.7-4.4]) and increased statin intake (OR: 1.6 [1.1-2.1]). For secondary outcomes, there was no significant difference. Limb prognosis of CLI patients has improved over the past decade, possibly due to more revascularizations, particularly distal ones, and increased statin use.

Combined Superficial and Deep Venous Arterialization in No-Option Critical Limb Ischemia: Case Report

2021 ◽  
pp. 153857442198986
Author(s):  
Tammam Harfouch ◽  
Andrei Tarus ◽  
Elena-Teodora Agafitei ◽  
Raluca Ozana Chistol ◽  
Grigore Tinica
Keyword(s):  
Critical Limb Ischemia ◽  
Varicose Veins ◽  
Treatment Options ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Poor Quality ◽  
High Rate ◽  
Viable Option ◽  
Artery Disease

The management of peripheral artery disease with no revascularization options can be challenging due to the very limited treatment options available and the high rate of major amputation which is linked to increased mortality and poor quality of life. Using a distal venous bed as an alternative bypass runoff seems to be a viable option when arterial reconstruction is not feasible. We report our experience with distal venous arterialization for limb salvage in non-reconstructable critical limb ischemia and describe the configuration used to achieve venosome directed revascularization in a patient with concomitant varicose veins.

scholarly journals CURRENT TRENDS IN CRITICAL LIMB ISCHEMIA - REVIEW

2020 ◽  
pp. 1-3
Author(s):  
Puneet Kumar Agarwal ◽  
Vikram Vasuniya
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Primary Treatment ◽  
Ischemic Pain ◽  
Therapeutic Goals ◽  
Current Trends ◽  
Drug Eluting ◽  
Artery Disease

Critical limb ischemia (CLI) is considered the most severe clinical manifestation of peripheral artery disease (PAD). These patients carry high risk of amputation and mortality. CLI patientfaces may problems like restriction of movement, starvation of services and depression. Therapeutic goals in treating these patients include relieving ischemic pain, reducing cardiovascular risk factors, preventing major amputation, improving quality of life and increasing survival.Revascularization is the primary treatment strategy in critical limb ischemia patients. Many patients are not treatable by conventional techniques.This review article provides a comprehensive summary that includes current trends in the management of Critical limb ischemia like endovascular revascularization,gene and cell based therapies and drug eluting stents (DESs) etc.

Abstract 349: The Association of Comorbid Depression with Inpatient Outcomes in Patients with Critical Limb Ischemia

2018 ◽  
Vol 38 (Suppl_1) ◽  
Author(s):  
Greg J Zahner ◽  
Abigail Cortez ◽  
Erin Duralde ◽  
Joel L Ramirez ◽  
Sue Wang ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Comorbid Depression ◽  
Inpatient Outcomes

scholarly journals Coronary Artery Disease in Patients with Critical Limb Ischemia Undergoing Major Amputation or Not

2017 ◽  
Vol 5 (6) ◽  
pp. e1377 ◽  
Author(s):  
Akio Nishijima ◽  
Naoto Yamamoto ◽  
Ryuichi Yoshida ◽  
Koji Hozawa ◽  
Satoshi Yanagibayashi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Artery Disease

scholarly journals Non-compressible ABIs are associated with an increased risk of major amputation and major adverse cardiovascular events in patients with critical limb ischemia

2017 ◽  
Vol 22 (3) ◽  
pp. 210-217 ◽  
Author(s):  
Gagan D Singh ◽  
Ehrin J Armstrong ◽  
Stephen W Waldo ◽  
Bejan Alvandi ◽  
Ellen Brinza ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critical Limb Ischemia ◽  
Cardiovascular Events ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Tissue Loss ◽  
Major Adverse Cardiovascular Events ◽  
Increased Risk ◽  
Artery Disease ◽  
Stage Renal Disease

Ankle–brachial indices (ABIs) are important for the assessment of disease burden among patients with peripheral artery disease. Although low values have been associated with adverse clinical outcomes, the association between non-compressible ABI (ncABI) and clinical outcome has not been evaluated among patients with critical limb ischemia (CLI). The present study sought to compare the clinical characteristics, angiographic findings and clinical outcomes of those with compressible (cABI) and ncABI among patients with CLI. Consecutive patients undergoing endovascular evaluation for CLI between 2006 and 2013 were included in a single center cohort. Major adverse cardiovascular events (MACE) were then compared between the two groups. Among 284 patients with CLI, 68 (24%) had ncABIs. These patients were more likely to have coronary artery disease ( p=0.003), diabetes ( p<0.001), end-stage renal disease ( p<0.001) and tissue loss ( p=0.01) when compared to patients with cABI. Rates of infrapopliteal disease were similar between the two groups ( p=0.10), though patients with ncABI had lower rates of iliac ( p=0.004) or femoropopliteal stenosis ( p=0.003). Infrapopliteal vessels had smaller diameters ( p=0.01) with longer lesions ( p=0.05) among patients with ncABIs. After 3 years of follow-up, ncABIs were associated with increased rates of mortality (HR 1.75, 95% CI: 1.12–2.78), MACE (HR 2.04, 95% CI: 1.35–3.03) and major amputation (HR 1.96, 95% CI: 1.11–3.45) when compared to patients with cABIs. In conclusion, ncABIs are associated with higher rates of mortality and adverse events among those undergoing endovascular therapy for CLI.

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

2021 ◽  
pp. 153857442110264
Author(s):  
Hee Korleski ◽  
Laura DiChiacchio ◽  
Luiz Araujo ◽  
Michael R. Hall
Keyword(s):  
Case Report ◽  
General Anesthesia ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Treatment Modality ◽  
Conventional Treatment ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

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