scholarly journals Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 38-45
Author(s):  
Tadashi Furuyama ◽  
Toshihiro Onohara ◽  
Ryosuke Yoshiga ◽  
Keiji Yoshiya ◽  
Yutaka Matsubara ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Ulcer Healing ◽  
Therapy Group ◽  
Limb Ischemia ◽  
Direct Flow ◽  
Free Survival ◽  
Ambulatory Status ◽  
Bypass Group ◽  
One Year

Objective Patients with critical limb ischemia have serious systemic comorbidities and are at high risk of impairment of limb function. In this study, we assessed the prognostic factors of limbs after revascularization. Methods In this retrospective single-center cohort study, from April 2008 to December 2012, we treated 154 limbs of 121 patients with critical limb ischemia by the endovascular therapy-first approach based on the patients’ characteristics. The primary end point was amputation-free survival. Secondary end points were patency of a revascularized artery, major adverse limb events, or death. Furthermore, we investigated the ambulatory status one year after revascularization as prognosis of limb function. Results Endovascular therapy was performed in 85 limbs in 65 patients as the initial therapy (endovascular therapy group) and surgical reconstructive procedures (bypass group) were performed in 69 limbs in 56 patients. Early mortality within 30 days was not observed in either group. The primary patency rate was significantly better in the bypass group than in the endovascular therapy group ( p < 0.0001). Furthermore, the secondary patency rate was similar between the two groups ( p = 0.0096). There were no significant differences in amputation-free survival and major adverse limb event between the two groups. Univariate analysis showed that ulcer healing ( p < 0.0001), no hypoalbuminemia ( p = 0.0019), restoration of direct flow below the ankle ( p = 0.0219), no previous cerebrovascular disease ( p = 0.0389), and Rutherford 4 ( p = 0.0469) were predictive factors for preservation of ambulatory status one year after revascularization. In multivariate analysis, ulcer healing ( p < 0.0001) and restoration of direct flow below the ankle ( p = 0.0060) were significant predictors. Conclusions Ulcer healing and restoration of direct flow below the ankle are independently associated with prognosis of limb functions in patients who undergo infrainguinal arterial reconstruction.

Prognostic factors of ulcer healing and amputation-free survival in patients with critical limb ischemia

Vascular ◽  
2018 ◽  
Vol 26 (6) ◽  
pp. 626-633 ◽  
Author(s):  
Tadashi Furuyama ◽  
Toshihiro Onohara ◽  
Sho Yamashita ◽  
Ryosuke Yoshiga ◽  
Keiji Yoshiya ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Ulcer Healing ◽  
Limb Ischemia ◽  
Healing Time ◽  
Free Survival ◽  
Arterial Revascularization ◽  
Major Defect

Objective A multidisciplinary approach is required to treat critical limb ischemia. We determined the poor prognostic factors of ischemic ulcer healing after optimal arterial revascularization, and assessed the efficacy of the medication therapy using cilostazol, which is a selective inhibitor of phosphodiesterase 3. Methods In this retrospective, single-center, cohort study, 129 limbs that underwent infrainguinal arterial revascularization for Rutherford class 5 critical limb ischemia were reviewed. The primary end point was the ulcer healing time after arterial revascularization. The secondary end point was the amputation-free survival rate. Results Of the 129 limbs, endovascular therapy was performed in 69 limbs, and surgical reconstructive procedures were performed in 60 limbs for initial therapy. Complete ulcer healing was achieved in 95 limbs (74%). The median ulcer healing time was 90 days. In multivariate analysis, no cilostazol use significantly inhibited ulcer healing ( p = 0.0114). A white blood cell count >10,000 ( p = 0.0185), a major defect after debridement ( p = 0.0215), and endovascular therapy ( p = 0.0308) were significant poor prognostic factors for ulcer healing. Additionally, ischemic heart disease ( p < 0.0001), albumin levels <3 g/dl ( p = 0.0016), no cilostazol use ( p = 0.0078), and a major defect after debridement ( p = 0.0208) were significant poor prognostic factors for amputation-free survival rate. Conclusions Ulcer healing within 90 days after arterial revascularization is impaired by no cilostazol use, a white blood cell count >10,000, a major defect after debridement, and endovascular therapy. Furthermore, cilostazol improves amputation-free survival rate in patients with critical limb ischemia.

scholarly journals Validation of ERICVA Risk Score as a Predictor of One Year Amputation-Free Survival of Patients with Critical Limb Ischemia

2021 ◽  
Author(s):  
Sara-Azhari Mohamed ◽  
Navian Lee Viknaswaran ◽  
Jonathan Doran ◽  
Clara Sanz-Nogués ◽  
Khalid Ahmed ◽  
...  
Keyword(s):  
Risk Score ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Free Survival ◽  
One Year

Predictors of non-healing in patients with critical limb ischemia and tissue loss following successful endovascular therapy

2014 ◽  
Vol 85 (5) ◽  
pp. 850-858 ◽  
Author(s):  
Norihiro Kobayashi ◽  
Keisuke Hirano ◽  
Masatsugu Nakano ◽  
Toshiya Muramatsu ◽  
Reiko Tsukahara ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Tissue Loss

scholarly journals No Association of Diabetic Duration or Insulin Use with the Prognosis of Critical Limb Ischemia after Endovascular Therapy

2011 ◽  
Vol 18 (12) ◽  
pp. 1102-1109 ◽  
Author(s):  
Mitsuyoshi Takahara ◽  
Hideaki Kaneto ◽  
Osamu Iida ◽  
Naoto Katakami ◽  
Fumie Sakamoto ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Insulin Use

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.

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