scholarly journals The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients

2021 ◽  
Author(s):  
Suci Indriani ◽  
Suko Adiarto ◽  
Hananto Andriantoro ◽  
Ismoyo Sunu ◽  
Taofan Siddiq ◽  
...  
Keyword(s):  
Vitamin E ◽  
Hospital Mortality ◽  
Reperfusion Injury ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Logistic Regression Models ◽  
Cardiovascular Center ◽  
Huge Challenge

Background Management of acute limb ischemia (ALI) is still a huge challenge. Current advances of endovascular therapeutic approach in management of ALI have decreased the overall amputation rate, nevertheless, mortality rate remains high which may be caused by metabolic consequences of reperfusion injury. Aim To understand the role of vitamin E to intra-hospital and 30-day mortality among acute limb ischemia patients. Methods This retrospective cohort study included all patients with ALI between 2015 to 2018. Vitamin E 2x400 mg orally for seven days was given based on physician preference after ALI diagnosis was confirmed. Data were collected from Vascular Registries of National Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Univariate analysis and logistic regression models were used to explore factors that contribute to intra-hospital and 30-day mortality. Results                                        A total of 160 patients with ALI involving 192 limbs were admitted to our hospital. Mostly were male (63.1%) and mean age were 56±13 years old. Majority of the patients had unilateral lesion (80%), and were diagnosed with Rutherford stage IIA (36.3%), followed by stage IIB (33.8%), stage I (20%), and stage III (10%) respectively. Intra-hospital and 30-day mortality were 28.1% and 36.9%, respectively. Low treatment of vitamin E increased intra-hospital mortality (HR 5,6 95%CI 1.7-18.3), however, it did not affect 30-day mortality. Other factors including IABP insertion, arrhythmia, bleeding requiring transfusion and acute renal failure were associated with higher intra-hospital and 30-day mortality. In addition, menopause (HR 3.2; CI 1.16-8.85) was also a predictor of 30-day mortality. Conclusion Vitamin E administration reduced intra-hospital mortality but not on 30-day mortality in acute limb ischemia patients. Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injury

scholarly journals Neutrophil-to-Lymphocyte Ratio Could Predict Outcome in Patients Presenting with Acute Limb Ischemia

2021 ◽  
Vol 10 (19) ◽  
pp. 4343
Author(s):  
Maurizio Taurino ◽  
Francesco Aloisi ◽  
Flavia Del Porto ◽  
Martina Nespola ◽  
Tommaso Dezi ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Final Analysis ◽  
Limb Ischemia ◽  
Neutrophil To Lymphocyte Ratio ◽  
Acute Limb Ischemia ◽  
Mortality And Morbidity ◽  
Lymphocyte Ratio ◽  
Unselected Population ◽  
Event Rates

Introduction: Acute limb ischemia (ALI), classified according to Rutherford’s classification (RC), is a vascular emergency burdened by high rates of mortality and morbidity. The need of new and different prognostic values for ALI has emerged, and, among all, the neutrophil-to-lymphocyte ratio (NLR) has been proven as a strong outcome predictor in vascular disease. The aim of this study is to investigate the role of preoperative NLR in predicting clinical outcomes in patients presenting acute limb ischemia. Material and Methods: A single-center retrospective study was conducted between January 2015 and December 2019. Demographic and clinical characteristics, procedural technical aspects, postoperative and early (up to 30-day) outcomes were recorded. All enrolled patients were categorized into low- and high-NLR at baseline, using a cut-off value of 5. Study outcomes were 30-day all-cause mortality and amputation rates. Results: A total of 177 ALI patients were included in the final analysis (6 RC I, 44 RC IIA, 108 RC IIB, and 19 RC III), 115 males (65%), mean age 78.9 ± 10.4 years. Mean NLR at hospital presentation was 6.65 ± 6.75 (range 0.5–35.4), 108 (61.1%) patients presented a low-NLR, 69 (38.9%) a high-NLR. Immediate technical success was achieved in 90.1% of cases. At 30 days, freedom from amputation and freedom from death rates were 87.1% and 83.6%, respectively. At the univariate analysis, amputation (p < 0.0001, OR: 9.65, 95%CI: 3.7–25.19), mortality (p = 0.0001, OR: 9.88, 95%CI: 3.19–30.57), and cumulative event rates (p < 0.001, OR: 14.45, 95%CI: 6.1–34.21), were significantly different between the two groups according to NLR value. Multivariate analysis showed that a high baseline NLR value was an independent predictor of unfavorable outcomes in all enrolled patients. Consistently, at ROC analysis, a preoperative NLR > 5 was strongly associated with all outcome occurrences. Conclusion: Preoperative NLR value seems to be strongly related to ALI outcomes in this unselected population. The largest series should be evaluated to confirm present results.

scholarly journals Predictors of In-hospital Mortality in Patients with Acute Limb Ischemia – Lesson Learnt from A Tertiary Hospital in Jakarta

2020 ◽  
Author(s):  
Suci Indriani ◽  
Suko Adiarto ◽  
Hananto Andriantoro ◽  
Ismoyo Sunu ◽  
Taofan Siddiq ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Vitamin E ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Limb Ischemia ◽  
Clinical History ◽  
Tertiary Hospital ◽  
Acute Limb Ischemia ◽  
History Of

Abstract Background This study aims to identify risk factors associated with in-hospital and 30-days mortality in patients with acute limb ischemia (ALI). Methods This study was a single-centered cohort enrolling a total of 160 consecutive patients with a diagnosis of ALI. The ALI diagnosis was based on clinical history, physical examination, and Doppler studies of the extremities. The main outcome of this study is in-hospital and 30-days mortality. Results There were a total of 170 patients involving 192 limbs with the diagnosis of ALI. Intra-aortic balloon pump (IABP) insertion (HR 3.4; 95% CI 1.0-11.3, p = 0.042), no vitamin E treatment (HR 5.6; CI 1.7–18.3, 0.004), arrhythmia (HR 12.00; CI 3.8–37.7, p < 0.001), and acute renal failure (HR 6.70; CI 1.88–24.3, p = 0.003) were an independent predictor of intra-hospital mortality. For 30-days mortality, the independent predictors were menopause (HR 3.2; CI 1.16–8.85, p = 0.02); IABP insertion (HR 4.51; CI 1.14–17.92, p = 0.03); arrhythmia (HR 0.11; CI 0.04–0.32, p < 0.001); bleeding requiring transfusion (HR 3.77; CI 0.10-14.28, p = 0.05); and acute renal failure (HR 5.5; CI 1.79–16.95, p = 0.003). Conclusion In-hospital mortality in patients with ALI remains high in our center. Several factors contributing to mortality were arrhythmia, renal failure, no vitamin E supplementation, and a history of recent cardiac operation.

scholarly journals Effect of DNase I treatment and neutrophil depletion on acute limb ischemia-reperfusion injury in mice

2016 ◽  
Vol 64 (2) ◽  
pp. 484-493 ◽  
Author(s):  
Hassan Albadawi ◽  
Rahmi Oklu ◽  
Rita Elise Raacke Malley ◽  
Ryan M. O'Keefe ◽  
Thuy P. Uong ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Limb Ischemia ◽  
Dnase I ◽  
Acute Limb Ischemia ◽  
Neutrophil Depletion

scholarly journals Embolism to the main limb arteries in patients with atrial fibrillation

2022 ◽  
Vol 20 (4) ◽  
pp. 14-20
Author(s):  
M. V. Mel’nikov ◽  
A. V. Sotnikov ◽  
D. S. Kozhevnikov ◽  
M. V. Solov’yeva ◽  
S. A . Boldueva
Keyword(s):  
Atrial Fibrillation ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Surgical Department ◽  
The Past ◽  
Group 3 ◽  
Group 1

Introduction. Acute limb ischemia due to embolism in patients with atrial fibrillation remains poorly studied. Objective – to study the clinical significance and role of atrial fibrillation (AF) in the development of embolism to the bifurcation of the aorta and the main arteries of the limbs. Materials and methods. Treatment results of 1816 patients with acute ischemia of the extremities due to embolism treated at a specialized vascular surgical department for the past 30 years were analyzed. 1611 (88.7 %) of them had AF. The distribution into studied groups was according to the period time factor. Group 1 (n = 744) consisted of patients admitted in the period from 1991 to 2000; in group 2 (n = 568) – admitted in the period from 2001 to 2010, in group 3 (n = 299) – from 2011 to 2020. Methods included clinical examination, electrocardiography, Doppler-ultrasound, echocardiography. Results. The role of rheumatic heart disease as a cause of AF has decreased over the past decades by almost 10 times (from 19.5 % in group 1 to 2.0 % in group 3). Currently, the main background diseases for the development of AF are arterial hypertension and various forms of coronary artery disease. Embolism in patients with AF may develop in the arteries of all vascular areas of the systemic circulation, but in the practice of a vascular surgeon more often in the main arteries of minor caliber – the brachial (24.5 %) and popliteal (13.0 %). Multiple embolisms to various vascular areas were found in 2.8 % of patients. Urgent surgical revascularization of the limb by open embolectomy was performed in 1481 (91.9 %) patients that allowed 1348 (83.7 %) to be discharged with limb-sparing. Conclusion. In patients with acute limb ischemia of embologenic ethiology, comorbid AF has 88.7 % of them. Urgent embolectomy allows 83.7 % of patients to be discharged without limb amputation. Hospital mortality in the period 1991–2000 was 15.6 %, the last decade has been reduced to 7.4 %.

scholarly journals In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system

2021 ◽  
Vol 20 ◽  
Author(s):  
João Henrique Fonseca do Nascimento ◽  
André Gusmão Cunha ◽  
André Bouzas de Andrade ◽  
Monique Magnavita Borba da Fonseca Cerqueira
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Public Health Problem ◽  
Secondary Data ◽  
Limb Ischemia ◽  
Public Health Care ◽  
Acute Limb Ischemia ◽  
Atypical Manifestations ◽  
Icd 10

Abstract Background Arterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI). Objectives To analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019. Methods An ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant. Results From 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories. Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased. Conclusions There was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged.

scholarly journals Acute Occlusion of Abdominal Aorta: Duration of Bilateral Limb Ischemia and its Influence on Early-Term and Mid-Term Outcomes

2021 ◽  
Author(s):  
Denis Skrypnik ◽  
Sultan Butaev ◽  
Artur Arakelyan ◽  
Coral Falco ◽  
Roman Vinogradov ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Limb Ischemia ◽  
Time Frame ◽  
Adverse Outcomes ◽  
Rank Test ◽  
Acute Limb Ischemia ◽  
Infrarenal Aorta ◽  
Survival Group ◽  
Free Survival ◽  
Log Rank Test

Abstract Background To investigate the influence of duration of bilateral acute limb ischemia (BALI) due to acute aortic occlusion (AAO) on the amputation-free survival in the early- and mid-term follow-ups (FUs). Methods A retrospective analysis of patients treated due to primary occlusion of the infrarenal aorta and BALI was performed. Univariate analysis was used to determine the risk factors of adverse outcomes and to compare the duration of BALI between amputation-free survival and the non-amputation-free survival group. The log-rank test was used to compare amputation-free survival in the FU. Results The data of 16 patients, with a mean age of 70 ± 11 years, were analyzed. Predominantly females (56.3%, 9/16) were included in the study. The median FU was 32 months (range, 26–108 months). The mean ischemia time was significantly shorter in the amputation-free survival group compared to that in the non-amputation-free survival group (7.4 ± 3.5 hours vs. 22.4 ± 16.3 hours, p = .01). The time frame for successful bilateral lower limb revascularization was at <11h (p= .001, Cramer’s V= .71). Amputation-free survival in the early- and mid-term FUs was improved, if the duration of BALI was < 11 hours (log rank test, p = .006). Conclusions The duration of BALI due to AAO < 11 hours was shown to be associated with improved amputation-free survival in the early- and mid-term FUs. Trial registration: The study was retrospectively registered in TCTR international registry (identification no. TCTR20210609002).

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