scholarly journals Outcomes and Complications after Intraarterial Thrombolysis for Limb Ischemia: a 4 Year Study at a Single Centre

2016 ◽  
Vol 16 (2) ◽  
pp. 3-7
Author(s):  
Arturs Ligers ◽  
Patricija Ivanova ◽  
Gvido Bergs ◽  
Andris Levis ◽  
Sanita Ponomarjova ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Thrombolytic Therapy ◽  
Clinical Outcomes ◽  
Abdominal Aorta ◽  
High Mortality ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Duration Of Symptoms ◽  
Intraarterial Thrombolysis ◽  
The Mean

SummaryIntroduction.The reason for using thrombolytic therapy is to eliminate vascular thrombosis and promote vascular permeability. Acute limb ischemia is associated with significant morbidity and mortality. ROCHESTER, STILE and TOPAS studies showed that thrombolytic therapy for acute limb ischemia decreases the rate of surgical interventions and significantly increases the rate of limb salvage.Aim of the Study.The purpose of this study is to assess the efficacy and outcomes of intra-arterial thrombolysis in the treatment of acute occlusions of the lower limb over a four-year period.Material and Methods.We analysed 103 patients who had been treated in our department. There were acute ischemias of stage IIa and IIb according to the Rutherford classification. The data prior to, and after thrombolysis was analysed. We usedAlteplaseas a thrombolytic agent (mean dose 62 mg ±23.5). Procedural success was based on angiographic and clinical outcomes. Statistics were calculated by SPSS 16.Results.The mean duration of symptoms prior to hospitalisation was 2.5 days (IQR 5-96 hours). The mean age at the time of thrombolysis was 63±11 for males 69±10 years for females. The success of intraarterial thrombolysis was defined by angiographic and clinical outcomes (successful in 86.4% and failed in 13.6%). Adjunctive angioplasty was performed on 39 (37.9%) patients, and immediate reconstructive surgery was required on 19 (18.4%) patients. The incidence of complications was 17,4 %, with the most common being-bleeding from the puncture side, the urinary tract or the gastrointestinal tract. Overall mortality was 8.7%. The women who required thrombolysis were older (p=0,034) and with a higher death rate (p=0.047). A CDT (catheter-directed thrombolysis) for an abdominal aorta thrombosis carries a significantly high mortality rate (p=0.00013). There were no statistically significant differences between the duration of symptoms and limb amputation and between other analysed data.Conclusions.Intraarterial thrombolysis is an effective treatment method in acute limb ischemia for selected patients, as long as accurate procedural monitoring is ensured. Thrombolysis often leads to the discovery of underlying vascular lesions. A CDT for an abdominal aorta thrombosis carries a significantly high mortality rate.

Abstract 17605: Cost-Effectiveness of Contemporary Endovascular Treatment Compared to Open Surgical Revascularization for Cardioembolic Acute Limb Ischemia

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Elizabeth A Genovese ◽  
Kenneth J Smith ◽  
Neal R Barshes ◽  
Michel S Makaroun ◽  
Donald T Baril
Keyword(s):  
Mortality Rate ◽  
Endovascular Treatment ◽  
Cost Effective ◽  
Limb Ischemia ◽  
Morbidity And Mortality ◽  
Adverse Event Rate ◽  
Parameter Estimates ◽  
Acute Limb Ischemia ◽  
Technical Success ◽  
Life Years

Introduction: Treatment of acute limb ischemia (ALI) has a high morbidity and mortality given patients’ multiple comorbidities, poor physiologic reserve, and the need for emergent intervention. Traditionally ALI of embolic origin has been treated with open revascularization (OR), however with increasing experience with thrombolytic therapy and adjuvant techniques, endovascular revascularization (ER) for ALI has become a more common treatment due to the lower associated morbidity and mortality. Hypothesis: Although associated with higher initial costs and lower technical success rates, ER will be cost effective given the decreased adverse event rate and mortality in a frail patient population. Methods: A Markov state-transition model was created to simulate patient oriented outcomes, including technical success, adverse events, limb salvage, discharge facility and quality adjusted life years (QALY) for patients presenting with Rutherford Classification I/IIa/IIb ALI secondary to cardiac embolism. A societal perspective was assumed with a 10-year time horizon. Parameter estimates were derived from published literature and primary data of cardioembolic ALI patients treated at our institution from 2005-2011 with either ER or OR. Costs were adjusted to 2013 U.S. dollars. Results: In the model, OR was technically successful in 87% patients, with a $23,881 cost for the initial hospitalization and a 11.5% perioperative mortality rate; ER was technically successful in 71% of patients, with a $39,619 initial cost, and a 4% mortality rate. At 10 years, the ER strategy cost $92,659/QALY gained compared to OR. Sensitivity analyses demonstrated that ER was favorable at a willingness to pay (WTP) threshold of $100,000/QALY when ER technical success was >70%, initial ER hospitalization cost was <$41,052 or if OR mortality was >10%. At a WTP of $50,000/QALY, ER was cost effective if technical success reached 79%, if ER cost was <$31,287 or if OR mortality was >23%. Conclusions: Contemporary endovascular treatment of cardioembolic ALI carries a greater cost compared to open revascularization, however it is associated with a decreased mortality rate. ER is potentially cost-effective in patients who are at high risk of post-operative mortality following OR.

scholarly journals Surgical or Endovascular Options for Patients With Acute Limb Ischemia? The Hybrid Procedures May Increase Clinical Outcomes

2013 ◽  
Vol 57 (5) ◽  
pp. 18S
Author(s):  
Gianmarco de Donato ◽  
Francesco Setacci ◽  
Pasqualino Sirignano ◽  
Giuseppe Galzerano ◽  
Rosaria Massaroni ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Hybrid Procedures

“Silent” thrombosis of an abdominal aortic aneurysm not producing acute limb ischemia

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 265-267 ◽  
Author(s):  
Moulakakis ◽  
Maras ◽  
Bountouris ◽  
Pomoni ◽  
Georgakis ◽  
...  
Keyword(s):  
Blood Flow ◽  
Abdominal Aortic Aneurysm ◽  
Mortality Rate ◽  
Aortic Aneurysm ◽  
Acute Pain ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Acute Limb Ischemia ◽  
Abdominal Aortic ◽  
Flow Through

Thrombosis of an abdominal aortic aneurysm is a rare devastating complication with an estimated mortality rate of 50%. Simultaneous acute pain, pallor and coldness of the lower limbs, mottling from the level of iliac crests or umbilicus, paraplegia and absence of femoral pulses are all manifestations of a sudden and acute interruption of blood flow through the aneurysmatic aorta. We report a case of an occlusion of an abdominal aortic aneurysm during hospitalization which was not manifested with symptoms of limb ischemia. In this case we feature the rare and unusually “silent” presentation of the event.

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

2014 ◽  
Vol 120 (6) ◽  
pp. 1484-1495 ◽  
Author(s):  
Paulo Roberto Lacerda Leal ◽  
Charlotte Barbier ◽  
Marc Hermier ◽  
Miguel Angelo Souza ◽  
Gerardo Cristino-Filho ◽  
...  
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Clinical Outcomes ◽  
Pearson Correlation ◽  
P Value ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Trigeminal Nerves ◽  
Grade Iii

Object The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes. Methods Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22–79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient. Results The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm3) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm3 and 89.09 ± 14.72 mm3, respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm2) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm2 and 5.64 ± 0.85 mm2, respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralTN in cured patients had a smaller mean CSA than that on the ipsilateralTN of patients with partial pain relief or treatment failure (p < 0.05). The same finding was almost found in relation to measurements of V, but the p value was slightly higher at 0.05. Conclusions Results showed that TGN atrophy in patients with TN can be demonstrated by high-resolution imaging. These data suggest that atrophic changes in TGNs, which significantly correlated with the severity of compression and clinical outcomes, may help to predict long-term prognosis after vascular decompression.

scholarly journals Clinical Outcomes of Pediatric Chronic Intestinal Pseudo-Obstruction

2021 ◽  
Vol 10 (11) ◽  
pp. 2376
Author(s):  
Dayoung Ko ◽  
Hee-Beom Yang ◽  
Joong Youn ◽  
Hyun-Young Kim
Keyword(s):  
Mortality Rate ◽  
Parenteral Nutrition ◽  
Clinical Outcomes ◽  
Associated Factors ◽  
Rare Condition ◽  
Onset Age ◽  
The Mean ◽  
Intestinal Pseudo Obstruction ◽  
Overall Mortality

Chronic intestinal pseudo-obstruction (CIPO) is an extremely rare condition with symptoms of recurrent intestinal obstruction without any lesions. The outcomes of pediatric CIPO and predictors for the outcomes have not yet been well established. We analyzed the clinical outcomes and associated factors for the outcomes of pediatric CIPO. We retrospectively reviewed 66 primary CIPO patients diagnosed between January 1985 and December 2017. We evaluated parenteral nutrition (PN) factors such as PN duration, PN use over 6 months, home PN, and mortality as outcomes. We selected onset age, presence of urologic symptoms, pathologic type, and involvement extent as predictors. The early-onset CIPO was found in 63.6%, and 21.2% of the patients presenting with urologic symptoms. Of the 66 patients, 47 and 11 had neuropathy and myopathy, respectively. The generalized involvement type accounted for 83.3% of the cases. At the last follow-up, 24.2% of the patients required home PN management. The mean duration of PN was 11.8 ± 21.0 months. The overall mortality rate of primary CIPO was 18.2%. PN factors were predicted by the urologic symptoms and extent of involvement. However, mortality was predicted by pathologic type. The onset age was not significantly associated with the outcomes. CIPO with urologic symptoms and generalized CIPO had poor PN outcomes. Myopathy is suggested as a predictor of mortality in children with primary CIPO.

scholarly journals COVID-19 and Most Affected Section of the Society

2021 ◽  
Vol 58 (2) ◽  
pp. 551-558
Author(s):  
Kaveri Rusia, Dr. Swaroopa Chakole
Keyword(s):  
Mortality Rate ◽  
Clinical Outcomes ◽  
High Mortality ◽  
Targeted Delivery ◽  
Human Life ◽  
Clear Picture ◽  
Differential Impact ◽  
Extreme Poverty ◽  
Migrant Laborers ◽  
Negative Effect

BACKGROUND   COVID-19 or coronavirus disease 2019 is constantly emerging pandemic that has created unprecedented challenge in front of humanity as a whole. Extremely high spreading ability and high mortality rate and negative clinical outcomes is what mostly feared of.    SUMMARY   COVID-19 has affected almost every person directly or indirectly. The multispectral impact on human life is unprecedented. The differential impact on various strata of the society needed more vigorous study on it so that clear picture emerges out. The plight of migrant laborers and daily wagers were seen by many and consoled. The vulnerable section mentioned had negative effect on health, sociopolitical and economic aspect of their lives. More person are on the verge of extreme poverty than never before.    CONCLUSION   More philanthropic activity and poverty alleviating programs are needed to avoid widespread social distress among population. Sectional research and targeted delivery of schemes may be needed so that true beneficiary will get the benefit.  

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