scholarly journals Peripheral Vascular Disease is Associated with Increased Risk of Acute Postoperative Infection and Failure of Total Ankle Replacements

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0014
Author(s):  
Matthew S. Conti ◽  
Oleksandr Savenkov ◽  
Scott J. Ellis
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Lower Extremity ◽  
Vascular Disease ◽  
Preoperative Diagnosis ◽  
Postoperative Infection ◽  
Peripheral Vascular ◽  
Postoperative Infections ◽  
Irrigation And Debridement ◽  
Medicare Patients

Category: Ankle Arthritis Introduction/Purpose: Peripheral vascular disease (PVD) is often cited as a contraindication for total ankle replacement (TAR); however, there are no studies looking at its impact on postoperative complications. The primary purpose of our study was to identify whether preoperative PVD increased the rate of infection, postoperative irrigation and debridement, or failure of the implant in patients undergoing total ankle arthroplasty using a large dataset. Methods: The PearlDiver Database was used to identify Medicare patients who underwent a TAR from 2005 to 2014 using ICD- 9 and CPT codes. The cohort was queried for postoperative infections within 90 days, subsequent irrigation and debridement, and failure of TAR. Failure of TAR was defined was a revision, conversion to tibiotalar arthrodesis, lower extremity amputation, or implant removal. A diagnosis of preoperative PVD only included those patients who had PVD as an ICD-9 diagnosis code and underwent a preoperative lower extremity angiogram prior to TAR. Preoperative co-morbidities including prior corticosteroid injections, diabetes mellitus, smoking, rheumatoid arthritis, congestive heart failure, hypertension, obesity, and end-stage renal disease requiring dialysis were taken into consideration. Three multivariable logistic regression models were then developed in order to identify risk factors associated with postoperative infections and failure after TAR. Results: 10,698 Medicare patients who underwent a primary TAR were identified. 334 patients had a postoperative infection within 90 days of their TAR and 95 of those patients required an irrigation and debridement. Patients with a preoperative diagnosis of PVD had the highest acute infection rate at 10.5% as well as the highest incidence of failure at 12.3%. Multivariable logistic regression modeling demonstrated that patients with PVD had the greatest risk of developing a postoperative infection within 90 days (OR 2.85, 95% CI 1.45-5.13, P<0.01). Preoperative PVD was the most important risk factor for requiring an irrigation and debridement postoperatively (OR 4.87, 95% CI 1.94–10.6, P<0.001) (Table 1) and placed patients at the highest risk of TAR failure (OR 2.67, 95% CI 1.43–4.63, P<0.001). Conclusion: Our study suggests that a preoperative diagnosis of PVD has significant negative effects on outcomes following TAR. Preoperative PVD is an independent risk factor for an acute postoperative infection, postoperative irrigation and debridement, and failure of the implant.

scholarly journals Association of Peripheral Vascular Disease With Complications After Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984337
Author(s):  
Matthew S. Conti ◽  
Oleksandr Savenkov ◽  
Scott J. Ellis
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Postoperative Infection ◽  
Significant Risk ◽  
Total Ankle Arthroplasty ◽  
Peripheral Vascular ◽  
Postoperative Infections ◽  
Ankle Arthroplasty ◽  
Irrigation And Debridement ◽  
Medicare Patients

Background: Despite limited evidence, peripheral vascular disease is often cited as a contraindication for total ankle arthroplasty. The purpose of our study was to identify whether peripheral vascular disease in patients undergoing total ankle arthroplasty increased the rate of infection, postoperative irrigation and debridement, or failure of the implant. Methods: The PearlDiver Database was used to identify Medicare patients who underwent a total ankle arthroplasty from 2005 to 2014. These data were then analyzed for postoperative infections within 90 days, subsequent irrigation and debridements, and failure of total ankle arthroplasties. A diagnosis of preoperative peripheral vascular disease only included those patients who had peripheral vascular disease as an ICD-9 diagnosis code and underwent a preoperative lower extremity angiogram prior to total ankle arthroplasty. Medical comorbidities were identified using ICD-9 diagnosis codes. Three multivariable logistic regression models were then developed in order to identify risk factors associated with postoperative infections and failure after total ankle arthroplasty. Results: A total of 10 698 Medicare patients who underwent a primary total ankle arthroplasty were identified. There were 334 patients who had a postoperative infection within 90 days of their total ankle arthroplasty, and 95 of those patients required an irrigation and debridement. Regression analysis demonstrated that patients with peripheral vascular disease had the greatest risk of developing a postoperative infection within 90 days (OR 2.85, P < .01), requiring an irrigation and debridement postoperatively (OR 4.87, P < .001), and having a total ankle arthroplasty failure at any time point postoperatively (OR 2.51, P < .001). Conclusions: Our study suggests that preoperative peripheral vascular disease is a significant risk factor for an acute postoperative infection, postoperative irrigation and debridement, and failure of the implant in Medicare patients undergoing a total ankle arthroplasty. Level of Evidence: Level III, therapeutic.

Nonatheromatous Peripheral Vascular Disease of the Lower Extremity in Diabetes Mellitus

Diabetes ◽  
1959 ◽  
Vol 8 (4) ◽  
pp. 261-273 ◽  
Author(s):  
S. Goldenberg ◽  
M. Alex ◽  
R. A. Joshi ◽  
H. T. Blumenthal
Keyword(s):  
Diabetes Mellitus ◽  
Lower Extremity ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Peripheral Vascular

Lower extremity peripheral vascular disease. Part 1: Scanning electron microscopy

1989 ◽  
Vol 79 (11) ◽  
pp. 527-535
Author(s):  
DJ McCarthy ◽  
N Abell ◽  
T Reed
Keyword(s):  
Electron Microscopy ◽  
At Risk ◽  
Scanning Electron Microscopy ◽  
Lower Extremity ◽  
Vascular Disease ◽  
Blood Vessels ◽  
Peripheral Vascular Disease ◽  
Peripheral Vascular ◽  
Tissue Alterations ◽  
Scanning Electron

The surgical loss of the foot or leg is vigorously resisted by podiatrists who are committed to the conservation of limbs at risk because of peripheral vascular disease. Pathologic changes in blood vessels may, however, progress to a point where no other option is available to the patient. This study assesses amputation of the extremities and investigates tissue alterations that can be identified in diseased blood vessels implicated in these circumstances. Gross pathology and scanning electron microscopy are examined in this, the first of a two-part study.

scholarly journals Pseudoexfoliation as a risk factor for peripheral vascular disease: a case-control study

Eye ◽  
2010 ◽  
Vol 25 (2) ◽  
pp. 174-179 ◽  
Author(s):  
M R Praveen ◽  
S K Shah ◽  
A R Vasavada ◽  
R P Diwan ◽  
S M Shah ◽  
...  
Keyword(s):  
Risk Factor ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Case Control Study ◽  
Case Control ◽  
Peripheral Vascular ◽  
Control Study

scholarly journals Complications of intra-aortic balloon in a cohort of hospitalized patients: implications for nursing care

2009 ◽  
Vol 17 (5) ◽  
pp. 658-663 ◽  
Author(s):  
Renata Bacelar Silva de Assis ◽  
Karina Azzolin ◽  
Marta Boaz ◽  
Eneida Rejane Rabelo
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Nursing Care ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Vascular Complications ◽  
Clinical Situation ◽  
Peripheral Vascular

OBJECTIVES: To describe complications associated to the use of intra-aortic balloon pumps (IABP), and their relationship with dwelling time, presence of risk factors/comorbidities, and nursing records. METHODS: Retrospective cohort study, in which medical records were analyzed through the completion of specifically designed forms. RESULTS: In total, 104 patients were included, with mean age 65±11 years, 52% men; 26 (25%) of them presented vascular complications, more frequently ischemia (25%); peripheral vascular disease was the risk factor/comorbidity more frequently related to complications (56.3%; p=0.003). Nursing records showed that the use of catheter was recorded in 30 cases (29%), and the patient's clinical situation after its removal in 28 cases (27%). CONCLUSION: This study showed that the frequency of complications related to IABP is high. Considering risk factor/comorbidity factors, peripheral vascular disease was significantly associated to complications. Nursing records were sub-optimal.

scholarly journals Study of 89 Cases of Peripheral Vascular Disease by CT Angiography in a Centre of Bangladesh

1970 ◽  
Vol 1 (2) ◽  
pp. 193-200
Author(s):  
M Faruque ◽  
AEMM Islam ◽  
S Haque ◽  
MT Islam ◽  
MG Kibria ◽  
...  
Keyword(s):  
Risk Factor ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Ct Angiography ◽  
Disease Risk ◽  
Venous Malformation ◽  
Peripheral Vascular ◽  
Morphological Pattern ◽  
Noninvasive Technique ◽  
Ct Angiogram

Background: The peripheral arterial disease generally refers to a disorder that obstructs the blood supply to upper and lower extremities, most commonly caused by atherosclerosis. Objective: The purpose of this study was to observe the morphological pattern and risk factors for development of peripheral vascular disease in Bangladeshi patients suffering from peripheral vascular disease by CT angiography using a multidetector scanner. Method: Eighty nine patients with peripheral vascular disease who were referred for evaluation of peripheral vascular disease underwent CT angiography. We scanned patients from the level of the cerebral arteries to the pedal arteries in a single helical scan. CT angiograms were produced using maximum-intensity-projection, multiplanous reformation and reconstructions. Findings were graded according to nine categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis); 3, moderate (50-74% stenosis); 4, severe (>75% stenosis); 5, tortuosity; 6, aneurysm, 7, calcification, 8, Arteriovenous malformation (AVM), and 9, haematoma. Results: We found Most of the patients in our study were male (69 out of 89 patients). The mean age was 54.49 ±18.36 yrs in male and 49.45 ±17.89 yrs for female. Commonest risk factor in our study was hypertension 46.1%, followed by diabetes 30.3%, family history 27%, smoking 23.6%, dyslipidaemia13.5%. Stenosis (5.61%) was the predominate lesion followed by haematoma (4.49%) and arterio–venous malformation (4.49%). Abdominal aorta was mostly affected in the studied population (58.43%) followed by Lower limb (37.08%), Carotid (22.47%), Renal (7.87%) and Upper limb arteries (4.49%). Conclusion: CT angiography is a noninvasive technique for the imaging of peripheral vascular disease. Since no data is available from a well designed study in PVD in our country, till then the data obtained from this study can be used in Bangladesh. Key words: CT angiogram, Peripheral vascular disease, Risk factor DOI: http://dx.doi.org/10.3329/cardio.v1i2.8238 Cardiovasc. j. 2009; 1(2): 193-200

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