An Observational Study on Patients with Acute Limb Ischemia and SARS-CoV-2 Infection: Early and Late Results in Limb Salvage Rate

An observational study on 22 patients presenting with acute limb ischemia and SARS-CoV-2 infection, and without any other embolic risk factors, was performed. All patients were classified according to Rutherford classification for acute limb ischemia. The primary goal of this study was to assess the risk of amputation in these patients after revascularization procedures. The secondary goal was to find the correlation between acute limb ischemia (ALI) severity, patient comorbidities, risk of death, and the association of SARS-CoV-2 infection. The patients were treated by open surgery (18 patients—81.81%) or by the means of endovascular techniques (four patients—18.18%). The amputation-free survival rate was 81.81% in hospital and 86.36% at 1-month follow-up. In this study, the presence of SARS-CoV-2 infection did not influence the amputation-free survival rate: it was only the risk factor for the arterial thrombosis and the trigger for the acute ischemic event. The application of the standard treatment—open surgery or endovascular revascularization—in patients with acute limb ischemia and SARS-CoV-2 infection represents the key to success for lower limb salvage.

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Ultrasound-Accelerated Thrombolysis has Higher Success and Limb Salvage Rates and Similar Costs Compared to Catheter-Directed Thrombolysis for Acute Limb Ischemia

Journal of Cardiology & Current Research ◽

10.15406/jccr.2016.07.00242 ◽

2016 ◽

Vol 7 (2) ◽

Keyword(s):

Limb Salvage ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Catheter Directed Thrombolysis

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Safety of transfer, type of procedure, and factors predictive of limb salvage in a modern series of acute limb ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.08.174 ◽

2019 ◽

Vol 69 (4) ◽

pp. 1174-1179 ◽

Cited By ~ 1

Author(s):

Jake Hemingway ◽

Davidson Emanuels ◽

Shahram Aarabi ◽

Elina Quiroga ◽

Nam Tran ◽

...

Keyword(s):

Limb Salvage ◽

Limb Ischemia ◽

Acute Limb Ischemia

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P3571Comparable limb salvage and amputation free survival in diabetic and non-diabetic patients with critical limb ischemia undergoing endovascular revascularization

European Heart Journal ◽

10.1093/eurheartj/ehy563.p3571 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

B P Y Yan ◽

W M Chan ◽

W H S Lai ◽

A O W Cheng ◽

C K Y Chan ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Free Survival ◽

Endovascular Revascularization

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FT17. Factors Predicting Limb Salvage in Acute Limb Ischemia Treated at a Tertiary Referral Center

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.03.043 ◽

2017 ◽

Vol 65 (6) ◽

pp. 22S-23S

Author(s):

Shahram Aarabi ◽

David Emanuels ◽

Elina Quiroga ◽

Nam Tran ◽

Benjamin W. Starnes ◽

...

Keyword(s):

Limb Salvage ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Referral Center

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Treatment with Biologic Agents Improves the Prognosis of Patients with Rheumatoid Arthritis and Amyloidosis

The Journal of Rheumatology ◽

10.3899/jrheum.111453 ◽

2012 ◽

Vol 39 (7) ◽

pp. 1348-1354 ◽

Cited By ~ 12

Author(s):

TAKESHI KURODA ◽

NAOHITO TANABE ◽

DAISUKE KOBAYASHI ◽

HIROE SATO ◽

YOKO WADA ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Survival Rate ◽

Biologic Therapy ◽

Statistical Significance ◽

Biologic Agents ◽

Aa Amyloidosis ◽

Free Survival ◽

Risk Of Death ◽

Amyloid A ◽

Systemic Complication

Objective.Reactive amyloid A (AA) amyloidosis is a serious and life-threatening systemic complication of rheumatoid arthritis (RA). We evaluated the safety of therapy with anti-tumor necrosis factor and anti-interleukin 6 biologic agents in RA patients with reactive AA amyloidosis, together with prognosis and hemodialysis (HD)-free survival, in comparison with patients with AA amyloidosis without such therapy.Methods.One hundred thirty-three patients with an established diagnosis of reactive AA amyloidosis participated in the study. Clinical data were assessed from patient records at the time of amyloid detection and administration of biologics. Survival was calculated from the date when amyloid was first demonstrated histologically or the date when biologic therapy was started until the time of death or to the end of 2010 for surviving patients. Patients who had started HD were selected for inclusion only after the presence of amyloid was demonstrated.Results.Fifty-three patients were treated with biologic agents (biologic group) and 80 were not (nonbiologic group). Survival rate was significantly higher in the biologic group than in the nonbiologic group. Nine patients in the biologics group and 33 in the nonbiologic group started HD. Biologic therapy had a tendency for reduced risk of initiation of HD without any statistical significance.Conclusion.Patients with amyloidosis have a higher mortality rate, but the use of biologic agents can reduce risk of death. The use of biologics may not significantly influence the HD-free survival rate.

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Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

Journal Of Cardiovascular Emergencies ◽

10.1515/jce-2017-0028 ◽

2017 ◽

Vol 3 (4) ◽

pp. 160-171

Author(s):

Theodora Benedek ◽

István Kovács ◽

Imre Benedek

Keyword(s):

Surgical Treatment ◽

Limb Salvage ◽

Arterial Occlusion ◽

Limb Ischemia ◽

Therapeutic Angiogenesis ◽

Lower Limbs ◽

Current Status ◽

High Morbidity ◽

Acute Limb Ischemia ◽

Promising Alternative

Abstract Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.

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Endovascular Revascularization Strategies Using Catheter-Based Thrombectomy Versus Conventional Catheter-Directed Thrombolysis for Acute Limb Ischemia

10.21203/rs.3.rs-733076/v1 ◽

2021 ◽

Author(s):

Maofeng Gong ◽

Xu He ◽

Boxiang Zhao ◽

Jie Kong ◽

Jianping Gu ◽

...

Keyword(s):

Limb Salvage ◽

Clinical Success ◽

Limb Ischemia ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Clinical Event ◽

Comparable Efficacy ◽

Acute Limb Ischemia ◽

Technical Success Rate ◽

Catheter Directed Thrombolysis

Abstract Background Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). Methods A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to August 2018 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. Results More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P < .001). Patients who underwent primary CBT achieved a higher technical success rate than those who underwent primary CDT in a shorter procedure time (P < .001), whereas 42.1% of patients who underwent CBT did not need adjunctive CDT. The duration and dosage of adjunctive CDT in the CBT group were significantly decreased compared with those in the primary CDT group (both P < .001), and the CBT group achieved a shorter in-hospital length of stay (P < .001). Subgroup analysis revealed that patients treated with AngioJet and Rotarex catheters achieved slightly lower dosages, shorter CDT durations and shorter in-hospital stay lengths than those treated with large-bore catheters (P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent primary CBT had slightly fewer complications than those who underwent primary CDT (P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.5%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. Conclusions Endovascular treatment of ALI with the use of catheter-based therapies is a safe and effective modality with similar safety and clinical outcome to conventional CDT alone, and this treatment modality overcomes the common shortcomings of CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

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

10.21203/rs.3.rs-669091/v1 ◽

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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Survival outcomes following laparoscopic vs open surgery for non-metastatic rectal cancer: a two-center cohort study with propensity score matching

Gastroenterology Report ◽

10.1093/gastro/goaa046 ◽

2020 ◽

Vol 8 (4) ◽

pp. 319-325

Author(s):

Kang-Lian Tan ◽

Hai-Jun Deng ◽

Zhi-Qiang Chen ◽

Ting-Yu Mou ◽

Hao Liu ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Survival Rate ◽

Propensity Score ◽

Propensity Score Matching ◽

Open Surgery ◽

Laparoscopic Group ◽

Term Survival ◽

Free Survival

Abstract Background:?> Laparoscopic surgery for rectal cancer is commonly performed in China. However, compared with open surgery, the effectiveness of laparoscopic surgery, especially the long-term survival, has not been sufficiently proved. Methods:?> Data of eligible patients with non-metastatic rectal cancer at Nanfang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese Medicine between 2012 and 2014 were retrospectively reviewed. Long-term survival outcomes and short-term surgical safety were analysed with propensity score matching between groups. Results Of 430 cases collated from two institutes, 103 matched pairs were analysed after propensity score matching. The estimated blood loss during laparoscopic surgery was significantly less than that during open surgery (P = 0.019) and the operative time and hospital stay were shorter in the laparoscopic group (both P < 0.001). The post-operative complications rate was 9.7% in the laparoscopic group and 10.7% in the open group (P = 0.818). No significant difference was observed between the laparoscopic group and the open group in the 5-year overall survival rate (75.7% vs 80.6%, P = 0.346), 5-year relapse-free survival rate (74.8% vs 76.7%, P = 0.527), or 5-year cancer-specific survival rate (79.6% vs 87.4%, P = 0.219). An elevated carcinoembryonic antigen, <12 harvested lymph nodes, and perineural invasion were independent prognostic factors affecting overall survival and relapse-free survival. Conclusions:?> Our findings suggest that open surgery should still be the priority recommendation, but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer.

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