Outcome of Femoral Angioplasty/Stenting Procedures in Different Ethnic Groups in England: A Retrospective Analysis of Hospital Episode Statistics and Review of Literature

Purpose Various studies, mainly from North America, report worse outcomes in ethnic minority populations submitted to revascularization for peripheral arterial disease (PAD). Limited nationwide data in relation to ethnicity are available from Europe. Objective The objective of the study is to compare the outcomes of femoral angioplasty/stenting procedures among different ethnic groups in England during the 10-year period from 2006 to 2015. Materials and Methods The “Hospital Episode Statistics” database has been searched using International Classification of Diseases, Tenth Revision ( ICD-10) codes to identify all cases of femoral angioplasty or stenting from English NHS Hospitals between January 1, 2006, and December 31, 2015. Subsequent mortality, second open or endovascular infrainguinal procedures, and major amputations on the same side within 2 years after the first procedure have been recorded. Patients were broadly categorized according to ethnicity as whites, Asians, and blacks. Chi-square test was used to demonstrate significant differences among ethnic groups and odds ratios (ORs) were calculated using white ethnic group as reference. Results A total number of 70 887 femoral endovascular procedures were recorded in patients from the 3 ethnic groups. Two-year mortality in whites, Asians, and blacks was 18.3%, 22.1%, and 19.5% (p<0.001); rates of second endovascular procedure were 12.1%, 13.1%, and 13.5% (p=0.24); rates of open infrainguinal procedure were 5.6%, 4.5%, and 8.0% (p<0.001); and rates of major amputation were 4.8%, 4.1%, and 7.0% (p<0.001), respectively. Mortality was higher in Asians (OR=1.26, 95% confidence interval [CI]=1.10-1.45, p<0.01) compared with whites. On the contrary, blacks underwent more open arterial operations (OR=1.48, 95% CI=1.19-1.83, p<0.01) and more amputations (OR=1.49, 95% CI=1.18-1.87, p<0.01). There were no significant differences in the rates of second endovascular procedures. Conclusion Two-year mortality after femoral angioplasty/stenting is higher in Asians, whereas risk of limb loss is higher in blacks compared with whites. Reasons of these ethnic differences in outcomes following femoral endovascular procedures for PAD merit further study.

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Hubungan Indeks Massa Tubuh (IMT) dengan Ankle Brachial Index (ABI) pada Pasien Diabetes Mellitus Tipe 2 Etnis Jawa

Jurnal Kesehatan ◽

10.26630/jk.v11i2.1992 ◽

2020 ◽

Vol 11 (2) ◽

pp. 197

Author(s):

Yanuarita Tursinawati ◽

Arum Kartikadewi ◽

Kamala Nuriyah ◽

Setyoko Setyoko ◽

Ari Yuniastuti

Keyword(s):

Diabetes Mellitus ◽

Ankle Brachial Index ◽

Sampling Technique ◽

Arterial Disease ◽

P Value ◽

Chi Square ◽

Chi Square Test ◽

Peripheral Arterial ◽

Relationship Of

<p>Diabetes mellitus (DM) often give a macrovascular complication such as Peripheral arterial disease (PAD). Ankle-brachial index (ABI) is a sensitive and specific examination for PAD. Obesity can be a risk factor of PAD. Obesity can be classified by the BMI (Body Mass Index) classification. The purpose of this research is to analyze the relationship of BMI with ABI in Type 2 DM (T2DM) patients of Javanese ethnicity. This study was an observational analytic research with case-control design and used a purposive sampling technique. There were 40 case samples and 40 control samples. Data analysis used the Independent T-test and Chi-square test. There was a significant differences on age (p=0,000), METs (p-value=0,003), and ABI (p-value=0,002) between the two groups. In the DM group was found that most abnormal ABIs were found in the higher BMI, even though there was no significant correlation by the statistic (p-value=0,255). BMI contributed less to the ABI value of Javanese ethnic T2DM patients.</p>

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

Journal of Clinical Medicine ◽

10.3390/jcm10071413 ◽

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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Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1322-4811 ◽

2020 ◽

Author(s):

Erika Vainieri ◽

Raju Ahluwalia ◽

Hani Slim ◽

Daina Walton ◽

Chris Manu ◽

...

Keyword(s):

Limb Salvage ◽

Diabetic Foot ◽

Emergency Admission ◽

Arterial Disease ◽

Major Amputation ◽

Outcome Data ◽

High Rate ◽

Free Survival ◽

Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

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Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

Vascular and Endovascular Surgery ◽

10.1177/15385744211022598 ◽

2021 ◽

pp. 153857442110225

Author(s):

Joel Mathew John ◽

Vimalin Samuel ◽

Dheepak Selvaraj ◽

Prabhu Premkumar ◽

Albert A Kota ◽

...

Keyword(s):

Clinical Outcomes ◽

Interventional Procedure ◽

Tertiary Care ◽

Arterial Disease ◽

Multivariable Logistic Regression Analysis ◽

Tertiary Care Centre ◽

Chi Square ◽

Exact Test ◽

Institutional Review ◽

Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

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Variation in lip print pattern between two ethnic groups, Oraon tribals and Bengalee Hindus, residing in West Bengal, India

Anthropological Review ◽

10.2478/anre-2019-0031 ◽

2019 ◽

Vol 82 (4) ◽

pp. 405-415

Author(s):

Archita Dey ◽

Mahua Chanak ◽

Kaustav Das ◽

Koel Mukherjee ◽

Kaushik Bose

Keyword(s):

Ethnic Groups ◽

West Bengal ◽

Personal Identification ◽

P Value ◽

Type Ii ◽

Ethnic Variation ◽

Criminal Cases ◽

Chi Square ◽

Significant Difference ◽

Chi Square Test

Abstract Lip print pattern (LPP) is unique to each individual. For decades, forensic experts have used LPP for personal identification to solve criminal cases. However, studies investigating ethnic variation in LPP are scanty. Our study wanted to investigate variation in LPP between two ethnic groups, Oraon tribals and Bengalee Hindus, residing in West Bengal, India. A total of 280 participants included 112 Oraons and168 Bengalee Hindus of both. Prints were taken using dark shaded lipstick and transparent cellophane tape and recorded into white A4 sheet. Prints were divided into four quadrants and examined by magnifying glass. For analysis of results, classification of Suzuki and Tsuchihashi was followed. A p value of 0.05 was considered to be statistically significant. It was observed that Type II pattern was dominant in first and second quadrants in both ethnic groups, irrespective of sex. Combination of Type II+III was found to be the most common pattern in males among both Oraons (16.2%) and Bengalee Hindus (12.2%) whereas in females Type II pattern (25.0%) among Oraons and Type III pattern among Bengalee Hindus (11.4%) was the most common. Chi square test showed statistically significant difference among females (p<0.05) and in third and fourth quadrants among males (p<0.01) of both ethnic groups. Our investigation clearly demonstrated sex and ethnic variations in LPP. Further studies are required to investigate ethnic variation in LPP among the various populations groups, both tribal as well as non-tribal, from different regions of India.

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Norwegian trends in numbers of lower extremity revascularisations and amputations including regional trends in endovascular treatments for peripheral arterial disease: a retrospective cross-sectional registry study from 2001 to 2014

BMJ Open ◽

10.1136/bmjopen-2017-016210 ◽

2017 ◽

Vol 7 (11) ◽

pp. e016210 ◽

Cited By ~ 9

Author(s):

Kjersti Wendt ◽

Ronny Kristiansen ◽

Kirsten Krohg-Sørensen ◽

Fredrik Alexander Gregersen ◽

Erik Fosse

Keyword(s):

Lower Extremity ◽

Arterial Disease ◽

Major Amputation ◽

Cross Sectional Study ◽

Incidence Rates ◽

Cross Sectional ◽

Regional Trends ◽

Treatment Knowledge ◽

Patients With Diabetes ◽

Peripheral Arterial

ObjectiveThe numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important.MethodsThis retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. The revascularisation treatments were categorised in multilevel, aortoiliac, femoral to popliteal and popliteal to foot levels and sorted as open, endovascular and hybrid. The sessions in amputations were divided in major (thigh and below knee) and minor (ankle, foot or digit). Incidence rates were assessed per 100 000 for patients in the age group>60 years. The diabetic prevalence was calculated and the endovascular numbers at the South-Eastern, Western, Central and Northern Norway Regional Health Authority were compared.ResultsThe overall revascularisation rates increased from 308.7 to 366.8 (p=0.02). Open revascularisations decreased from 158.9 to 98.7 (p<0.01) while endovascular revascularisations increased from 142.2 to 243.4 (p<0.01). Hybrid revascularisations increased from 7.4 to 24.8 (p<0.01). Major amputation rates decreased from 87.8 to 48.7 (p<0.01) while minor amputations increased from 12.3 to 19.6 (p=0.01). The diabetic percentages increased from 12.2 to 22.3 (p<0.01) in revascularisations, from 26.5 to 30.8 (p=0.02) in major amputations and from 43.0 to 49.3 (p=0.13) in minor. (p values refer to average annual changes.) The regional trends in endovascular treatments varied within and between the vascular groups.ConclusionFrom 2001 to 2014, the revascularisation rates increased due to the rise in endovascular procedures. Open revascularisations and major amputation rates decreased, minor increased. The regional variances in endovascular treatments indicate that the availability of this technology differed between the health regions of Norway. The increase in patients with diabetes requires continued awareness of diabetes and its complications.

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Abstract 13923: Incidence and Outcomes of Infective Endocarditis After 180 Days in Transcatheter Aortic Valve Replacement and Mitraclip

Circulation ◽

10.1161/circ.142.suppl_3.13923 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Manpreet Kaur ◽

Anas M Saad ◽

Keerat Ahuja ◽

Simrat Kaur ◽

Toshiaki Isogai ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

International Classification Of Diseases ◽

Chi Square ◽

Transcatheter Aortic Valve ◽

Classification Of Diseases ◽

Chi Square Test

Background: Infective endocarditis (IE) after Transcatheter aortic valve replacement (TAVR) and Mitra Clip (MC) occurs less commonly but is associated with grave complications. We aim to report the incidence and outcomes of IE within 180 days of TAVR and MC. Methods: We used the Nationwide Readmissions Database (NRD) between 2014 and 2017 to select patients who underwent either TAVR or MC between January and June every year (to allow for at least 180 days of follow up in the NRD) using the appropriate International Classification of Diseases-9 th and 10 th revision (ICD) codes. We performed a chi-square test to compare baseline characteristics and rates of IE after TAVR and MC procedures. All statistical analyses were performed the using SPSS version 26. Results: We included 68,270 and 7,080 patients who underwent TAVR and MC respectively, of which 0.68% vs. 0.94% (P=.012), developed IE respectively within 180 days of procedure. During that index hospitalization, in-hospital mortality rates did not differ between the two groups (15.08% in TAVR vs. 17.91%, in MC P=.587). Other outcomes are presented in table 1. Conclusion: Our study suggests that the overall incidence of IE following TAVR and MC is relatively low but appropriate preventive measures should be taken after the procedures to reduce the morbidity and mortality. Further studies and analysis are required in modern MC and TAVR techniques to circumvent this critical complication.

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Lower Limb Amputation Rates in Patients With Diabetes and an Infected Foot Ulcer: A Prospective Observational Study

Wound Management & Prevention ◽

10.25270/wmp.2021.7.2230 ◽

2021 ◽

Vol 67 (7) ◽

pp. 22-30

Author(s):

Natasha Chaudhary ◽

Farhanul Huda ◽

Ravi Roshan ◽

Somprakas Basu ◽

Deepak Rajput ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Clinical Signs ◽

Foot Ulcer ◽

Arterial Disease ◽

Major Amputation ◽

Lower Extremity Amputation ◽

Patients With Diabetes ◽

Peripheral Arterial ◽

Extremity Amputation

BACKGROUND: Lower extremity amputation is a serious complication of diabetes mellitus and occurs most commonly in persons who have a foot ulcer. PURPOSE: To examine variables that affect the rate of lower extremity amputation in patients with diabetes and infected foot ulcers. METHODS: A prospective observational study was performed including all consecutive patients who were 18 to 65 years, had a diagnosis of diabetes, and a foot ulcer showing clinical signs of infection. Patients were followed for 6 months or until ulcer healing, minor, or major amputation. A total of 81 persons were enrolled. Demographic variables were obtained, and clinical assessments, blood tests, and radiological investigations were performed. Ulcers were categorized using the Perfusion, Extent, Depth, Infection and Sensation classification system. Differences between variables and outcomes were assessed using the Wilcoxon test, Fisher’s exact test, Chi-square test, and t-test. RESULTS: Mean patient age was 54.58 ± 9.04 years, and the majority (61, 75%) were male. After 6 months, 33 (41%) were healed, 2 patients died, and 17 (21%) underwent major and 24 (30%) minor amputations. Major amputation rates were significantly higher in patients with a high Perfusion, Extent, Depth, Infection and Sensation score (6.92 ± 1.36; P = .005), elevated HbA1c (%) (9.43 ± 2.19; P = .049), presence of growth on wound culture (41 [64.1%]; P = .016), culture sensitivity to beta lactam (20 [31.2%]; P = .012), and presence of peripheral arterial disease seen on arterial Doppler ultrasound (P < .001). Minor amputation rates were higher in men (P = .02) and in the presence of peripheral arterial disease (P = .01). CONCLUSION: The presence of the above factors in persons with diabetes and foot ulcer with clinical signs of infection should alert the clinician to the need for focused and individualized treatment to attempt to prevent amputation.

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

American Journal of Nephrology ◽

10.1159/000508575 ◽

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.

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