scholarly journals Accuracy of SVS-WIfI Classification in Predicting Major Amputation in Critical Limb Ischemic Patients

2020 ◽  
Vol 52 (4) ◽  
Author(s):  
Teguh Marfen Djajakusumah ◽  
Rani Septrina ◽  
Putie Hapsari ◽  
Rendy Susanto
Keyword(s):  
Vascular Surgery ◽  
Limb Salvage ◽  
Lower Limb ◽  
Classification System ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Chi Square ◽  
Lower Limb Ischemia ◽  
Cohort Design ◽  
Chi Square Test

In 2014, The Society for Vascular Surgery revealed a new classification system for Critical Limb Ischemia (CLI) referred as the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System based on Wound, Ischemia, and foot Infection (SVS WIfI). This scoring system was created to stratify major amputations risk within 1 year and benefit of revascularization for the patient. This study aimed to assess the accuracy of SVS WIFi in predicting major amputations in patients with lower limb ischemia underwent revascularization at Department of Surgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital in 2016 - 2019. This was a retrospective observational analytic study with cohort design. Patients who fulfilled the inclusion criteria were assessed with SVS WIfI and results after 1 year of revascularization were identified. Data were analyzed statistically using the Chi-square test. 0f 56 subjects, 39 had limb salvage and 17 underwent major amputations within 1 year. In high revascularization benefit group, 31 had limb salvage and 7 underwent amputation. Meanwhile, in moderate-low revascularization benefits group, 8 had limb salvage and 10 underwent amputation. The accuracy of the SVS WIfI recommendation was 73.2%. Therefore, WIfI SVS classification accurately predicts the incidence of major amputations in patients with lower limb ischemia who underwent revascularization.

Safety aspect of intraoperative, local urokinase lysis in patients with acute lower limb ischemia

2021 ◽  
pp. 1-10
Author(s):  
Schierling Wilma ◽  
Bachleitner Kathrin ◽  
Kasprzak Piotr ◽  
Betz Thomas ◽  
Stehr Alexander ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Artery Occlusion ◽  
Outflow Tract ◽  
Intracranial Bleeding ◽  
Minor Bleeding ◽  
Free Survival ◽  
Lower Limb Ischemia

BACKGROUND: Acute lower limb ischemia (ALI) is associated with a high risk of limb loss and death. OBJECTIVE: The present study evaluates the safety of intraoperative, local urokinase lysis in patients with ALI and crural artery occlusion. METHODS: A total of 107 patients (115 legs) were treated surgically for ALI with additional intraoperative urokinase lysis to improve the outflow tract. Minor and major bleeding as well as efficacy of treatment and amputation-free survival were investigated. RESULTS: Complete restoration of at least one run-off vessel was achieved in 64%. Collateralization was improved in 34%. Lysis failed in 2%. Major amputation rate was 27%overall (12%within 30 days) and depended on Rutherford class of ALI (overall/30 day: IIa 11%/6%; IIb 20%/17%; III 37%/15%). Amputation-free survival turned out to be 82%after 30 days, 58%after one, and 41%after five years. Minor bleeding occurred in 21%(24/115) and major bleeding in 3.5%(4/115). One of these patients died of haemorrhage. No patient experienced intracranial bleeding. CONCLUSION: Intraoperative urokinase lysis improves limb perfusion and causes low major and intracranial bleeding. It can be safely applied to patients with severe ischaemia when surgical restoration of the outflow tract fails.

scholarly journals Limb Salvage in Early Versus Delayed Revascularization of Acute Lower Limb Ischemia

2021 ◽  
Vol 15 (9) ◽  
pp. 2239-2241
Author(s):  
Salman Jamil Noor ◽  
Nauman Imtiaz ◽  
Wishal Shaukat ◽  
Athar Abbas Gilani ◽  
Palwasha Shahid ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Lower Limb ◽  
Limb Ischemia ◽  
P Value ◽  
Limb Salvage Rate ◽  
Lower Limb Ischemia ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Salvage Rate

Aim: To compare the limb salvage rate in early versus late presenting patients of Rutherford class IIB acute lower extremity ischemia undergoing revascularization. Study Design: Comparative/observational study Place and duration of study: Department of Surgery, CMH Peshawar from January 2019 to March 2021 Methodology: Twenty eight patients of both genders with ages 20 to 70 years presented with Rutherford class IIB acute lower limb ischemia were enrolled in this study. Patients were divided into two groups. Group I (presented after 6 hours of onset of symptoms) consisted of 20 patients and group II (presented within 6 hours of onset of symptoms) consisted of 8 patients. All the patients underwent femoral embolectomy. Limb salvage rate between both groups was examined at postoperative 3rd month. Data was analyzed by SPSS 24.0. P-value <0.05 was taken as significant. Results: There were 16(80%) male and 4(20%) females with mean age 50.52±11.74 years in group I, in group II 6(75%) were male and 2(25%) were females with mean age 50.08±10.94 years. No significant difference was observed between both groups regarding age and gender with p-value >0.05. In group I, limb salvage found in 19(95%) patients while in group II limb salvage found in 5(62.5%) patients, a significant difference was observed regarding limb salvage rate between both groups (p-value <0.05). Mortality rate was high in group II (delayed presentation) as compared to group I (12.5% Vs 0%) with p-value <0.05. Conclusion: The limb salvage rate was high in early presenting patients than late presenting patients with a significant difference. 30 days mortality rate and amputation rate were significantly high in delayed presentation as compared to early presented cases. Keywords: Acute lower limb ischemia, revascularization, limb salvage

scholarly journals Treatment of critical lower limb ischemia using a hybrid technique

2014 ◽  
Vol 13 (3) ◽  
pp. 257-261
Author(s):  
Ricardo Wagner da Costa Moreira ◽  
Pedro Victor Alcântara da Costa ◽  
David Domingos Rosado Carrilho
Keyword(s):  
Effective Treatment ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Treatment Method ◽  
Major Amputation ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Endovascular Techniques ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Critical ischemia of a lower limb is a condition that threatens its viability and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method and is performed using surgical or endovascular techniques. For patients with thoracoabdominal aortic aneurysms, combining these two approaches into a "hybrid technique" makes it possible to treat patients who could not be adequately treated by either technique in isolation. We report on a case of lower limb critical ischemia treated using a combination of surgery and endovascular techniques, in an application of the hybrid technique in a different arterial bed.

scholarly journals Endovascular treatment of chronic lower limb ischemia - the first experience of consecutive patients in the Kyrgyz Republic

2019 ◽  
Vol 3 (Issue 4) ◽  
pp. 188
Author(s):  
S.D. Chevgun ◽  
I.Z. Abdyldaev ◽  
A.S. Imankulova ◽  
I.H. Bebezov ◽  
D. Ch. Cholponbaev ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Lower Limb ◽  
Ad Hoc ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Regenerative Process ◽  
Modern World ◽  
Kyrgyz Republic ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Objective: Pure atherosclerosis and diabetes mellitus are often responsible for the lesion of lower limb arteries. As a result, critical ischemia may develop. Endovascular treatment of lower extremities chronic ischemia in the modern world one of the most effective methods of limbs salvage. This report is an analysis of the first experience of endovascular treatment in consecutive patients with chronic lower limb ischemia in the Kyrgyz Republic. Methods: In 2016-2018, there were 31 patients with chronic lower limb ischemia in IIb-IV Fontaine's stages who underwent endovascular treatment. The primary endpoint was 6-month painlessness or reduction of the Fontaine stage; freedom from amputation up to six months; active regenerative process or full recovery of ulcers/wounds up to six months. The secondary endpoints included 6-month all-cause mortality and reintervention rate. Results: Overall,  27 (87.1%) patients reached painless form (stage I according to Fontaine (ABI ≥0.9)), with complete regeneration or active reparative process observed in 20 (64. 5%) patients. In general, major amputation was avoided in 29 (93.5%) patients (two patients underwent amputation by E. Burgess). Minor amputations were performed below the level of foot dorsum (Sharp) in 35.5% (11 patients). Simultaneous percutaneous coronary interventions and peripheral interventions were performed in 6 (19. 4%) cases. In total, within 6 months one death was registered (3.2%). Conclusion:  The first endovascular treatment of consecutive patients showed encouraging 6-month results. Simultaneous («Ad-hoc») or stepwise (at the current hospitalization) procedures on coronary and peripheral arteries ensure safety and can provide more chances of  patient`s survival.

Effectiveness of distal arterial bypass with porcine decellularized vascular graft for treating diabetic lower limb ischemia

2020 ◽  
pp. 039139882098002
Author(s):  
Zhu Tong ◽  
Zeqin Xu ◽  
Yisha Tong ◽  
Lixing Qi ◽  
Lianrui Guo ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Vascular Surgery ◽  
Lower Limb ◽  
Vascular Graft ◽  
Mechanical Stability ◽  
Vascular Grafts ◽  
Small Diameter ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Artery Reconstruction

Background: Application of tissue engineered vascular grafts for small-diameter artery reconstruction has been a much anticipated advance in vascular surgery. The aim of this study is to assess the effectiveness of small-diameter decellularized vascular grafts in below-knee bypass surgery for diabetic lower extremity ischemia. Methods: Three patients with diabetic lower limb ischemia were admitted to the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University between May, 2010 and June, 2010. Decellularized porcine arteries with modified surface were implanted in the lower extremity for below-knee arterial revascularization. Imaging examination was performed for assessment of graft mechanical stability and patency at 1 month and 6 months after implantation. Results: At 6 months after implantation, all three grafts were patent with no stenosis or aneurysm formation of the grafts were found on imaging assessment with primary patency rate of 100% (3/3) both at 1 month and 6 months after graft insertion. Conclusion: Decellularized vascular graft with surface modification for the small-diameter artery reconstruction had good clinical results after 6 months follow-up in three patients with diabetic lower limb ischemia.

Impact of Risk Factors on Limb Salvage After Angioplasty in Chronic Critical Lower Limb Ischemia

Angiology ◽  
1994 ◽  
Vol 45 (9) ◽  
pp. 797-804 ◽  
Author(s):  
Pekka J. Matsi ◽  
Hannu I. Manninen ◽  
Markku Laakso ◽  
Pekka Jaakkola
Keyword(s):  
Risk Factors ◽  
Limb Salvage ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Ischemia
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