Six-Month Freedom From Amputation Rates and Quality of Life Following Tibial and Pedal Endovascular Revascularization for Critical Limb Ischemia

2019 ◽  
Vol 53 (3) ◽  
pp. 212-215 ◽  
Author(s):  
Anahita Dua ◽  
Kara A. Rothenberg ◽  
Jisun J. Lee ◽  
Rebecca Gologorsky ◽  
Sapan S. Desai
Keyword(s):  
Quality Of Life ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Technical Success ◽  
Single Institution ◽  
Disease Pattern ◽  
Angioplasty And Stenting

Objective: Patients with critical limb ischemia (CLI) and gangrene have a 10% to 38% rate of major amputation at 6 months. The purpose of this study is to report short- and mid-term major and minor amputation rates for patients who underwent tibial and pedal revascularization in addition to quality-of-life (QoL) scores. Methods: All patients who presented to a single institution with CLI (defined as rest pain or nonhealing wounds) and underwent antegrade or retrograde tibial access, atherectomy and angioplasty of the tibial circulation, and angioplasty of pedal circulation (antegrade or retrograde) from June 2016 to September 2017 were included. The Stark QoL questionnaire was used at each visit. Patients were scored at 1, 3, and 6 months postprocedure. Amputation rates were recorded. Results: Forty-two patients with CLI and gangrene underwent 57 peripheral interventions for limb salvage between June 2016 and September 2017. Thirty-two limbs had dry gangrene along the dorsalis pedis angiosome, 14 limbs had dry gangrene along the posterior tibial angiogram, and 11 limbs had a combined disease pattern. Twelve limbs underwent angioplasty of the superficial femoral artery (SFA), 18 limbs underwent angioplasty and stenting of the SFA, and 14 limbs underwent atherectomy, angioplasty, and stenting of the SFA. All patients had 1 or 2 tibial vessel runoff and high-grade stenosis of the pedal circulation. Immediate technical success defined as 3-vessel outflow to the foot occurred in 49 limbs (86%) with zero 30-day complications (30-day readmission, major amputation, or sepsis). Major amputation rate at 1, 3, and 6 months was 0%, 2%, and 4%, respectively. Patient satisfaction in terms of QoL increased over the 6-month follow-up period. Conclusion: Aggressive tibial and pedal revascularization may improve freedom from minor and major amputation at 6 months and may be associated with a short- and mid-term higher QoL.

scholarly journals RETRACTED ARTICLE: Stromal vascular fraction cells for the treatment of critical limb ischemia: a pilot study

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Adas Darinskas ◽  
Mindaugas Paskevicius ◽  
Gintaras Apanavicius ◽  
Gintaris Vilkevicius ◽  
Liutauras Labanauskas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Cell Therapy ◽  
Critical Limb Ischemia ◽  
Stromal Vascular Fraction ◽  
Limb Ischemia ◽  
Digital Subtraction ◽  
Before And After

Abstract Background Cell-based therapy is being explored as an alternative treatment option for critical limb ischemia (CLI), a disease associated with high amputation and mortality rates and poor quality of life. However, therapeutic potential of uncultured adipose-derived stromal vascular fraction (SVF) cells has not been evaluated as a possible treatment. In this pilot study, we investigated the efficacy of multiple injections of autologous uncultured adipose-derived SVF cells to treat patients with CLI. Methods This study included 15 patients, from 35 to 77 years old, with rest pain and ulceration. SVF cells were injected once or twice in the ischemic limb along the arteries. Digital subtraction angiography was performed before and after cell therapy. The clinical follow up was carried out for the subsequent 12 months after the beginning of the treatment. Results Multiple intramuscular SVF cell injections caused no complications during the follow-up period. Clinical improvement occurred in 86.7% of patients. Two patients required major amputation, and the amputation sites healed completely. The rest of patients achieved a complete ulcer healing, pain relief, improved ankle-brachial pressure index and claudication walking distance, and had ameliorated their quality of life. Digital subtraction angiography performed before and after SVF cell therapy showed formation of numerous vascular collateral networks across affected arteries. Conclusion Results of this pilot study demonstrate that the multiple intramuscular SVF cell injections stimulate regeneration of injured tissue and are effective alternative to achieve therapeutic angiogenesis in CLI patients who are not eligible for conventional treatment. Trial registration number at ISRCTN registry, ISRCTN13001382. Retrospectively registered at 26/04/2017.

scholarly journals Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischemia Patient

2019 ◽  
Vol 58 (6) ◽  
pp. e325
Author(s):  
Chloé Peters ◽  
Jolanda de Vries ◽  
Paul Lodder ◽  
Stijn Steunenberg ◽  
Eelco Veen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
The Elderly ◽  
Major Amputation

scholarly journals Critical Limb Ischemia and Its Impact on Patient Health Preferences and Quality of Life—An International Study

2012 ◽  
Vol 21 (03) ◽  
pp. 139-146 ◽  
Author(s):  
Giovanni Pisa ◽  
Thomas Reinhold ◽  
Eliot Obi-Tabot ◽  
Maria Bodoria ◽  
Bernd Brüggenjürgen
Keyword(s):  
Quality Of Life ◽  
Critical Limb Ischemia ◽  
International Study ◽  
Limb Ischemia ◽  
Patient Health

scholarly journals Quality of life in patients with no-option critical limb ischemia underlines the need for new effective treatment

2010 ◽  
Vol 52 (4) ◽  
pp. 843-849.e1 ◽  
Author(s):  
Ralf W. Sprengers ◽  
Martin Teraa ◽  
Frans L. Moll ◽  
G. Ardine de Wit ◽  
Yolanda van der Graaf ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Effective Treatment ◽  
Critical Limb Ischemia ◽  
Limb Ischemia

Cumulative Number of Treatment Interventions Predicts Health-Related Quality of Life In Patients With Critical Limb Ischemia

2016 ◽  
Vol 34 ◽  
pp. 14
Author(s):  
Matthew P. Goldman ◽  
Ryan Barnard ◽  
Santiago Saldana ◽  
Jeanette M. Stafford ◽  
Douglas Easterling ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Cumulative Number ◽  
Health Related Quality ◽  
Treatment Interventions ◽  
Related Quality ◽  
Health Related ◽  
Number Of Treatment

Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Grant W Reed ◽  
Negar Salehi ◽  
Pejman Raeisi-Giglou ◽  
Umair Malik ◽  
Rami Kafa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Proportional Hazards ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Kaplan Meier

Introduction: There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy. Methods: In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis. Results: A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005). Conclusions: A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.

Health related quality of life in patients with critical limb ischemia

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 78-88 ◽  
Author(s):  
Lawall ◽  
Zemmrich ◽  
Bramlage ◽  
Amann
Keyword(s):  
Quality Of Life ◽  
Critical Limb Ischemia ◽  
Treatment Options ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Peripheral Arterial

Critical limb ischemia (CLI) is the terminal stage of peripheral artery disease. Research in recent years has been largely focussed on treatment options such as bypass surgery / endovascular treatment, surgery / primary amputation and additional benefits of supportive pharmacotherapy. Despite this plethora of treatment options, however, patients continue to have a reduced health related quality of life (HRQoL). Aim of the present work was to review the available evidence of improvement of HRQoL with regard to different treatment options. We found that a number of clinical studies have been conducted using HRQoL measures mostly as secondary outcomes in patients with CLI and other less severe forms of peripheral arterial disease. The studies demonstrate a consistent improvement of HRQoL over baseline within the first few months after the intervention. Prostaglandins, but no other pharmacotherapies, appear to be effective in patients without an option for revascularization. Due to a largely differing patient population under investigation and the different degrees of disease progression it appears difficult however to compare different treatment options with respect to their impact on HRQoL. HRQoL improvement as a predefined endpoint of novel therapeutic approach studies should be considered more consequently.

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