301
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Varela C, Acin F, Lopez de Maturana I, de Haro J, Bleda S, Paz B, Esparza L. Safety and efficacy outcomes of infrapopliteal endovascular procedures performed in patients with critical limb ischemia according to the Society for Vascular Surgery objective performance goals. Ann Vasc Surg 2013; 28:284-94. [PMID: 24189007 DOI: 10.1016/j.avsg.2013.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/06/2013] [Accepted: 04/01/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Objective performance goals (OPGs) are a set of standardized end points generated from well documented historical controls against which new therapeutic procedures may be compared in single-arm studies. Recently, the Society for Vascular Surgery suggested a set of OPGs designed from vein bypass controls that could be used to evaluate the safety and efficacy of endovascular devices applied to critical limb ischemia through a noninferiority analysis. Our aim is to analyze the results of infrapopliteal endovascular procedures performed in patients with critical limb ischemia according to these OPG end points. METHODS This is a retrospective study of 121 infrapopliteal endovascular procedures. The tibial intervention was combined with a femoropopliteal angioplasty in 70 procedures. Major adverse cardiovascular events (MACEs), major adverse limb events (MALEs), and major amputations at 30 days were recorded as safety outcomes. Freedom from any MALE or perioperative death (Freedom from MALE + POD) and amputation-free survival were calculated as primary efficacy end points at both 12 months and at 8 years. The 95% confidence intervals (CIs) of all the end points were calculated to perform a noninferiority comparison using OPGs as the reference. RESULTS The incidence of MACEs, MALEs, and amputation at 30 days were 5% (95% CI: 2-10% [OPG-MACE <10%]), 2.5% (95% CI: 0.5-7% [OPG-MALE <9%]), and 1.7% (95% CI: 0.2-6% [OPG-major amputation <4%]), respectively. We recorded a freedom from MALE + POD of 76% (95% CI: 67-83% [OPG-MALE + POD >67%]) and an amputation-free survival of 78% (95% CI: 69-85% [OPG-amputation-free survival >68%]) at 12 months. Freedom from MALE + POD and amputation-free survival at 8 years decreased to 60% (95% CI: 49-69%) and to 26% (95% CI: 11-44%), respectively. CONCLUSIONS Infrapopliteal endovascular procedures performed in everyday vascular surgery practice could meet the main OPG end points proposed for catheter-based treatment of critical limb ischemia.
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Affiliation(s)
- Cesar Varela
- Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain.
| | - Francisco Acin
- Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain
| | | | - Joaquin de Haro
- Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain
| | - Silvia Bleda
- Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain
| | - Belky Paz
- Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain
| | - Leticia Esparza
- Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain
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302
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Endovascular-first approach is not associated with worse amputation-free survival in appropriately selected patients with critical limb ischemia. J Vasc Surg 2013; 59:392-9. [PMID: 24184092 DOI: 10.1016/j.jvs.2013.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Endovascular interventions for critical limb ischemia are associated with inferior limb salvage (LS) rates in most randomized trials and large series. This study examined the long-term outcomes of selective use of endovascular-first (endo-first) and open-first strategies in 302 patients from March 2007 to December 2010. METHODS Endo-first was selected if (1) the patient had short (5-cm to 7-cm occlusions or stenoses in crural vessels); (2) the disease in the superficial femoral artery was limited to TransAtlantic Inter-Society Consensus II A, B, or C; and (3) no impending limb loss. Endo-first was performed in 187 (62%), open-first in 105 (35%), and 10 (3%) had hybrid procedures. RESULTS The endo-first group was older, with more diabetes and tissue loss. Bypass was used more to infrapopliteal targets (70% vs 50%, P = .031). The 5-year mortality was similar (open, 48%; endo, 42%; P = .107). Secondary procedures (endo or open) were more common after open-first (open, 71 of 105 [68%] vs endo, 102 of 187 [55%]; P = .029). Compared with open-first, the 5-year LS rate for endo-first was 85% vs 83% (P = .586), and amputation-free survival (AFS) was 45% vs 50% (P = .785). Predictors of death were age >75 years (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.7-6.6; P = .0007), end-stage renal disease (ESRD) (HR, 3.4; 95% CI, 2.1-5.6; P < .0001), and prior stroke (HR, 1.6; 95% CI, 1.03-2.3; P = .036). Predictors of limb loss were ESRD (HR, 2.5; 95% CI, 1.2-5.4; P = .015) and below-the-knee intervention (P = .041). Predictors of worse AFS were older age (HR, 2.03; 95% CI, 1.13-3.7; P = .018), ESRD (HR, 3.2; 95% CI, 2.1-5.11; P < .0001), prior stroke (P = .0054), and gangrene (P = .024). CONCLUSIONS At 5 years, endo-first and open-first revascularization strategies had equivalent LS rates and AFS in patients with critical limb ischemia when properly selected. A patient-centered approach with close surveillance improves long-term outcomes for both open and endo approaches.
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303
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Siracuse JJ, Gill HL, Schneider DB, Graham AR, Connolly PH, Jones DW, Meltzer AJ. Assessing the Perioperative Safety of Common Femoral Endarterectomy in the Endovascular Era. Vasc Endovascular Surg 2013; 48:27-33. [DOI: 10.1177/1538574413508827] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Common femoral endarterectomy (CFE) has historically been the preferred treatment for atherosclerotic lesions involving the common femoral artery. The objectives of this study are to delineate the safety of this open procedure in the endovascular era, establish contemporary benchmarks for morbidity and mortality after CFE, and identify the subgroup of patients at increased risk of postoperative adverse events. Methods: Patients undergoing elective CFE in the 2007 to 2010 National Surgical Quality Improvement Project database were examined. Univariate analyses were used to identify the factors associated with major morbidity and mortality. Significant variables by univariate analysis were used to create multivariate logistic regression models for morbidity and mortality. Results: A total of 1513 patients underwent elective CFE. The 30-day mortality rate was 1.5%. Postoperative morbidities included cardiac (1.0%), pulmonary (1.9%), renal (0.4%), urinary tract infection (1.7%), thromboembolic (0.5%), neurologic (0.4%), sepsis (2.7%), superficial (6.3%), and deep surgical site complications (2.0%). At least 1 complication, including major and minor, was seen in 7.9% of the patients. By multivariate analysis, partial- and total-dependent functional status (odds ratio [OR] 9.0, 95% confidence interval [CI] 2.8-28.4 and OR 21.3, 95% CI 3.3-139.4) and dyspnea at rest (OR 8.2, 95% 1.2-58.8) predicted mortality. Independent predictors of morbidity include steroid use (OR 2.4, 95% 1.4-4.1), diabetes (OR 1.8, 95% CI 1.3-2.4), and obesity (OR 1.6, 95% CI 1.1-2.4). Discussion: Overall, CFE is tolerated well by the majority of patients with peripheral arterial disease. These results affirm the safety of CFE and can still be used as standard first-line therapy in most patients. Long-term results for endovascular interventions need to be studied to see whether high-risk patients that we identified for CFE would benefit more from an endovascular approach.
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Affiliation(s)
- Jeffrey J. Siracuse
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Heather L. Gill
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Darren B. Schneider
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Ashley R. Graham
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Peter H. Connolly
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Douglas W. Jones
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Andrew J. Meltzer
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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304
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Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2013; 59:220-34.e1-2. [PMID: 24126108 DOI: 10.1016/j.jvs.2013.08.003] [Citation(s) in RCA: 938] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/09/2013] [Accepted: 08/13/2013] [Indexed: 02/08/2023]
Abstract
Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.
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Affiliation(s)
- Joseph L Mills
- Division of Vascular and Endovascular Surgery, Southern Arizona Limb Salvage Alliance, University of Arizona Health Sciences Center, Tucson, Ariz.
| | - Michael S Conte
- University of California San Francisco, San Francisco, Calif
| | - David G Armstrong
- Division of Vascular and Endovascular Surgery, Southern Arizona Limb Salvage Alliance, University of Arizona Health Sciences Center, Tucson, Ariz
| | | | | | - Anton N Sidawy
- George Washington University School of Medicine and Health Sciences, Washington, D.C
| | - George Andros
- Amputation Prevention Center, Valley Presbyterian Medical Center, Van Nuys, Calif
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305
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Sheng N, Chiriano J, Teruya TH, Abou-Zamzam AM, Bianchi C. Evaluation of superficial femoral artery remote endarterectomy for treatment of critical limb ischemia in patients with limited autogenous conduit. Ann Vasc Surg 2013; 28:262.e1-7. [PMID: 24084265 DOI: 10.1016/j.avsg.2013.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/11/2012] [Accepted: 01/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many patients with critical limb ischemia require infrageniculate bypass with a prosthetic graft due to the limited availability of autogenous vein. Prosthetic grafts have been shown to have inferior patency and subject the patient to increased infection rates when compared to bypass with autogenous conduit for lower extremity revascularization. In an effort to avoid the use of prosthetic material, we evaluated the use of remote superficial femoral artery endarterectomy (RSFAE) with distal autogenous revascularization in patients with critical limb ischemia and limited conduit. METHODS This study is a retrospective review of a prospectively maintained database from January 2009 to September 2011. All patients undergoing RSFAE for critical limb ischemia were identified. Patients undergoing RSFAE with simultaneous distal revascularization constituted the study group. Outcome variables, including patency, time to healing, limb salvage, ambulatory status, and survival, were analyzed. RESULTS Twenty-one patients underwent RSFAE at our institution. The study group was comprised of 5 patients undergoing RSFAE and adjunct distal revascularization for critical limb ischemia during the study period. Four patients (80%) presented with tissue loss, and 1 (20%) presented with ischemic rest pain. Three (60%) required simultaneous outflow sequential vein bypass and 2 (40%) required distal endovascular revascularization. The distal target vessels for bypass included the infrageniculate popliteal artery, posterior tibial artery, and peroneal artery. The mean operative time was 5.3 hours. The mean length of hospital stay was 8 days. Technical success was 100%, and there were no early reconstruction failures. There was 1 popliteal wound complication, and no groin wound complications during the study follow-up. At 6 months postoperatively, 4 of 5 reconstructions were patent. Two of 5 patients (40%) required percutaneous reintervention for restenosis at 10 and 11 months, respectively. Primary assisted patency was 80% with a mean follow-up of 12.6 months (range 8-22 months). The 4 patients with tissue loss achieved initial wound healing at a mean time of 4.8 months. The limb salvage rate was 80% and there have been no deaths. CONCLUSIONS Remote superficial femoral artery endarterectomy with distal revascularization allows for autogenous reconstruction in patients with critical limb ischemia and compromised conduit by shortening bypass length. This procedure constitutes an appealing alternative to the use of synthetic material for lower extremity revascularization. Further study is needed to determine whether the long-term results are superior to distal composite bypass or polytetrafluoroethylene bypass alone.
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Affiliation(s)
- Neha Sheng
- Jerry L. Pettis VA Hospital, Loma Linda University Medical Center, Department of Cardiovascular and Thoracic Surgery, Loma Linda, CA.
| | - Jason Chiriano
- Jerry L. Pettis VA Hospital, Loma Linda University Medical Center, Department of Cardiovascular and Thoracic Surgery, Loma Linda, CA
| | - Theodore H Teruya
- Jerry L. Pettis VA Hospital, Loma Linda University Medical Center, Department of Cardiovascular and Thoracic Surgery, Loma Linda, CA
| | - Ahmed M Abou-Zamzam
- Jerry L. Pettis VA Hospital, Loma Linda University Medical Center, Department of Cardiovascular and Thoracic Surgery, Loma Linda, CA
| | - Christian Bianchi
- Jerry L. Pettis VA Hospital, Loma Linda University Medical Center, Department of Cardiovascular and Thoracic Surgery, Loma Linda, CA
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306
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Sohail I, Jonker L, Stanton A, Walker M, Joseph T. Physiological POSSUM as an Indicator for Long-term Survival in Vascular Surgery. Eur J Vasc Endovasc Surg 2013; 46:223-6. [DOI: 10.1016/j.ejvs.2013.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
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307
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Malas MB, Enwerem N, Qazi U, Brown B, Schneider EB, Reifsnyder T, Freischlag JA, Perler BA. Comparison of surgical bypass with angioplasty and stenting of superficial femoral artery disease. J Vasc Surg 2013; 59:129-35. [PMID: 23891488 DOI: 10.1016/j.jvs.2013.05.100] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the contemporary outcome of femoral-popliteal bypass compared with angioplasty and stenting in patients with symptomatic peripheral arterial disease (PAD) in terms of patency and reintervention rates. METHODS We identified all patients evaluated at the Johns Hopkins Bayview Medical Center with the presumptive diagnosis of PAD from September 2005 to September 2010. In this group, we selected all symptomatic patients after failing medical management who received percutaneous transluminal angioplasty/stenting of the superficial femoral artery or femoral-popliteal bypass. We compared the overall patency and reintervention rates between the two groups as well as patency within TransAtlantic Inter-Society Consensus (TASC) II subgroups. Descriptive analyses were performed using χ(2) and two-sided t-tests. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test for categorical variables. Cox proportional hazard model was used to examine the treatment effect within each lesion type, using bypass as the reference group. RESULTS Out of 1237 patients evaluated at Johns Hopkins Bayview Medical Center for PAD from September 2005 to September 2010, we identified 104 symptomatic patients who received percutaneous transluminal angioplasty/stenting of the superficial femoral artery or femoral-popliteal bypass after failing medical management. There were 61 male patients (56%), and the mean age was 68 years in both groups. Both treatment groups had similar risk factors. Overall, 77% of patients with TASC II A and B lesions underwent angioplasty and stenting, whereas 73% of patients with TASC C and D lesions underwent bypass (P < .01). The primary patency at 24 months was better for the stent group 67% (95% confidence interval [CI], 0.52-0.78) vs bypass group 49% (95% CI, 0.32-0.64; P = .05). The rate of reintervention within the 2-year period was higher in the bypass group compared with the stent group (54% vs 31%; P = .02). TASC A and B lesions combined demonstrated a reduced hazard of patency failure compared with TASC C or D lesions combined (hazard ratio, 2.42; 95% CI, 1.26, 4.65; P < .01). CONCLUSIONS This is the first study that documents higher reintervention rates for femoral-popliteal bypass compared with angioplasty and stenting. We believe that the main reason for this finding is the fact that the bypass patients had significantly more advanced disease. This, emphasizes that one must consider the patient population undergoing intervention when comparing revascularization procedures. A prospective randomized trial is needed to determine the overall better treatment option.
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Affiliation(s)
- Mahmoud B Malas
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md.
| | - Ngozi Enwerem
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Umair Qazi
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Brendan Brown
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Eric B Schneider
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Thomas Reifsnyder
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Julie A Freischlag
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Bruce A Perler
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
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308
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Meltzer AJ, Graham A, Connolly PH, Meltzer EC, Karwowski JK, Bush HL, Schneider DB. The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia. J Vasc Surg 2013; 57:1186-95. [DOI: 10.1016/j.jvs.2012.09.083] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/19/2012] [Accepted: 09/25/2012] [Indexed: 12/24/2022]
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309
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Conte MS. Critical appraisal of surgical revascularization for critical limb ischemia. J Vasc Surg 2013; 57:8S-13S. [PMID: 23336860 DOI: 10.1016/j.jvs.2012.05.114] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 05/16/2012] [Accepted: 05/18/2012] [Indexed: 11/18/2022]
Abstract
Peripheral artery disease is growing in global prevalence and is estimated to afflict between 8 and 12 million Americans. Its most severe form, critical limb ischemia (CLI), is associated with high rates of limb loss, morbidity, and mortality. Revascularization is the cornerstone of limb preservation in CLI, and has traditionally been accomplished with open surgical bypass. Advances in catheter-based technologies, coupled with their broad dissemination among specialists, have led to major shifts in practice patterns in CLI. There is scant high-quality evidence to guide surgical decision making in this arena, and market forces have exerted profound influences. Despite this, available data suggest that the expected outcomes for both endovascular and open surgery in CLI are strongly dependent on definable patient factors such as anatomic distribution of disease, vein quality, and comorbidities. Optimal patient selection is paramount for maximizing benefit with each technique. This review summarizes some of the existing data and suggests a selective approach to revascularization in CLI, which continues to rely on vein bypass surgery as a primary option in appropriately selected patients.
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Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA 94143, USA.
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310
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Mwipatayi BP, Thomas S, Angel D, Wong J, Vijayan V. Stent outcomes for infrapopliteal arterial occlusive disease. Vascular 2013; 21:121-8. [PMID: 23518851 DOI: 10.1177/1708538113478734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to determine if the different stent types used in the treatment of infrapopliteal arterial occlusive disease provide any significant advantage over one another at 6 and 12-month follow-up. Consecutive patients undergoing stenting of infrapopliteal lesions were enrolled into a non-randomised prospective registry and followed-up for 1 year. Outcome measures included binary restenosis, target lesion revascularisation, major amputation, and change in Rutherford-Becker score and ankle-brachial index (ABI).Thirty-three patients were enrolled including four patients with bilateral disease. There were 20 target vessels in the drug-eluting stent (DES) group, 13 target vessels in the balloon-expandable bare metal stent (BE-BMS) group and 14 target vessels in the self expandableb are metal stent (SE-BMS) group. Most of the patients in the study were octogenarians except in the SE-BMS group where the mean age was 73 ± 9 years. At 12 months, seven patients had died (DES = 6, BE-BMS = 1) from cardiac and cancer-related diseases. In-stent and peri-stent binary restenosis were non-statistically different between all three groups. There was a nonstatistically significant trend towards higher target vessel revascularisation in the BE-BMS group. Survival curves in all stent types demonstrated restenosis to occur within the first 6 months post-procedure. There was no significant difference in the change in Rutherford-Becker score or ABI between the groups. No major limb amputations occurred during the 12-month period. In conclusion,we did not detect a significant difference in stent performance between the different stent types used to treat infrapopliteal arterial occlusive disease. The choice of stent did not seem to affect patient survival or major amputation-free survival at 1-year follow-up.
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311
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Kraiss LW, Conte MS, Geary RL, Kibbe M, Ozaki CK. Setting high-impact clinical research priorities for the Society for Vascular Surgery. J Vasc Surg 2013; 57:493-500. [PMID: 23337859 DOI: 10.1016/j.jvs.2012.09.069] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/01/2012] [Accepted: 09/25/2012] [Indexed: 11/18/2022]
Abstract
With the overall goal of enhancing the effectiveness and efficiency of vascular care, the Society for Vascular Surgery (SVS) recently completed a process by which it identified its top clinical research priorities to address critical gaps in knowledge guiding practitioners in prevention and treatment of vascular disease. After a survey of the SVS membership, a panel of SVS committee members and opinion leaders considered 53 distinct research questions through a structured process that resulted in identification of nine clinical issues that were felt to merit immediate attention by vascular investigators and external funding agencies. These are, in order of priority: (1) define optimal management of asymptomatic carotid stenosis, (2) compare the effectiveness of medical vs invasive treatment (open or endovascular) of vasculogenic claudication, (3) compare effectiveness of open vs endovascular infrainguinal revascularization as initial treatment of critical limb ischemia, (4) develop and compare the effectiveness of clinical strategies to reduce cardiovascular and other perioperative complications (eg, wound) after vascular intervention, (5) compare the effectiveness of strategies to enhance arteriovenous fistula maturation and durability, (6) develop best practices for management of chronic venous ulcer, (7) define optimal adjunctive medical therapy to enhance the success of lower extremity revascularization, (8) identify and evaluate medical therapy to prevent abdominal aortic aneurysm growth, and (9) evaluate ultrasound vs computed tomographic angiography surveillance after endovascular aneurysm repair.
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Affiliation(s)
- Larry W Kraiss
- Research Council, Society for Vascular Surgery, Chicago, IL 60611, USA.
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312
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Iida O, Nakamura M, Yamauchi Y, Kawasaki D, Yokoi Y, Yokoi H, Soga Y, Zen K, Hirano K, Suematsu N, Inoue N, Suzuki K, Shintani Y, Miyashita Y, Urasawa K, Kitano I, Yamaoka T, Murakami T, Uesugi M, Tsuchiya T, Shinke T, Oba Y, Ohura N, Hamasaki T, Nanto S. Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia. Circ Cardiovasc Interv 2013; 6:68-76. [DOI: 10.1161/circinterventions.112.975318] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Recent technical advances have made endovascular treatment (EVT) an alternative first-line treatment for critical limb ischemia.
Methods and Results—
A prospective multicenter study was conducted to evaluate the clinical outcomes of 314 Japanese critical limb ischemia patients (mean age, 73±10 years) with infrainguinal arterial lesions who underwent EVT. Patients were enrolled from December 2009 to July 2011 and were followed-up for 12 months. The primary end point was amputation-free survival (AFS) at 12 months. Secondary end points were anatomic, clinical, and hemodynamic measures, including 12-month freedom from major adverse limb events. The 12-month AFS rate was 74%, with body mass index <18.5 (hazard ratio [HR], 2.22;
P
=0.008), heart failure (HR, 1.73;
P
=0.04), and wound infection (HR, 1.89;
P
=0.03) associated with a poor prognosis for AFS. The 12-month major adverse limb event-free rate was 88%, with hemodialysis (HR, 1.98;
P
=0.005), heart failure (HR, 1.69;
P
=0.02), and Rutherford classification 6 (HR, 2.25;
P
=0.002) associated with a poor prognosis for major adverse limb events. The median time for wound healing was 97 days, with body mass index <18.5 (HR, 0.54;
P
=0.03) and wound infection (HR, 0.60;
P
=0.04) being significant risk factors for unhealed wounds after EVT. At 12 months, 34% had undergone reintervention (bypass surgery, 2.6%; repeat EVT, 31.7%), and 73% were major adverse event–free.
Conclusions—
The high reintervention rate notwithstanding, EVT was an effective treatment for Japanese critical limb ischemia patients with infrainguinal disease, with satisfactory AFS and major adverse limb event-free rates. The results of this study will be helpful for the future evaluation of critical limb ischemia therapy.
Clinical Trial Registration—
URL:
http://www.umin.ac.jp/ctr
. Unique identifier: UMIN000002830.
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Affiliation(s)
- Osamu Iida
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Masato Nakamura
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yasutaka Yamauchi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Daizo Kawasaki
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yoshiaki Yokoi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Hiroyoshi Yokoi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yoshimistu Soga
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Kan Zen
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Keisuke Hirano
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Nobuhiro Suematsu
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Naoto Inoue
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Kenji Suzuki
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yoshiaki Shintani
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yusuke Miyashita
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Kazushi Urasawa
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Ikuro Kitano
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Terutoshi Yamaoka
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Takashi Murakami
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Michitaka Uesugi
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Taketsugu Tsuchiya
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Toshiro Shinke
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Yasuhiro Oba
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Norihiko Ohura
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Toshimitsu Hamasaki
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
| | - Shinsuke Nanto
- From the Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan (O.I.); Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan (M.N.); Cardiovascular Center, Kikuna Memorial Hospital, Kanagawa, Japan (Y. Yamauchi); Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (D.K.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (Y. Yokoi); Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
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313
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Comparison of Precuffed Expanded Polytetrafluorothylene and Heparin-Bonded Polytetrafluorothylene Graft in Crural Bypass. Ann Vasc Surg 2013; 27:218-24. [DOI: 10.1016/j.avsg.2012.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/10/2012] [Accepted: 04/10/2012] [Indexed: 11/18/2022]
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314
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Saqib NU, Domenick N, Cho JS, Marone L, Leers S, Makaroun MS, Chaer RA. Predictors and outcomes of restenosis following tibial artery endovascular interventions for critical limb ischemia. J Vasc Surg 2013; 57:692-9. [PMID: 23351646 DOI: 10.1016/j.jvs.2012.08.115] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 08/23/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Restenosis following tibial artery endovascular interventions (TAEIs) is thought to be benign but is not well characterized. This study examines the consequences and predictors of recurrent stenosis of TAEIs for critical limb ischemia. METHODS All TAEIs for critical limb ischemia performed between 2004 and 2010 were retrospectively reviewed. Restenosis was detected by noninvasive imaging and angiography when indicated. Restenoses were identified and the limb outcomes recorded. Tibial reinterventions were performed only for persistent, worsening, or recurrent tissue loss or rest pain with evidence of recurrence on duplex ultrasound or hemodynamic imaging. The χ test and logistic regression were applied as indicated. One-year patency rates were calculated using the Kaplan-Meier method. RESULTS A total of 235 limbs in 210 patients were treated for critical limb ischemia (70% tissue loss, 30% rest pain). Tissue loss included gangrene (49%) and ulcers (51%), and involved the forefoot (80%), the heel (14%), or both (6%). Seventy-eight percent of limbs had Trans-Atlantic InterSociety Consensus C/D lesions, with mean preoperative runoff score of 12. Interventions were isolated tibial (45%) or multilevel (55%) (including tibial). Mean postoperative runoff score improved to 6.6, but restenosis occurred in 96 limbs (41%) at a mean of 4 months. The 1-year primary patency was 59% with a mean follow-up of 9 months. Restenosis presented with a persistent wound (32%), worsened wound (42%), rest pain (16%), or no symptoms (10%). A repeat TAEI was performed in 42 (44%), major amputation in 26 (27%), open bypass in 20 (21%), and observation in eight (8%). The overall amputation rate was 13%, but limb loss was significantly higher in patients with restenosis (n = 26 [27%]) than in patients with no restenosis (n = 5 [4%]; P < .001). Patients with restenosis and tissue loss were more likely to have presented with gangrene (63% vs 38%; P = .0003) but had comparable wound distribution (P = NS). There was a trend toward a higher restenosis rate in patients with renal insufficiency (odds ratio, 5.57; P = .08), but this was unaffected by diabetes, statin therapy, or smoking (P = NS). The rate of repeat intervention after the first reintervention was 36%, with an 87% overall limb salvage rate. CONCLUSIONS TAEIs can be used successfully to treat patients with critical limb ischemia with acceptable limb salvage rates. Special attention should be given to patients with extensive tissue loss or gangrene because they are at risk for early restenosis and subsequent limb loss. Strict wound and hemodynamic surveillance, wound care, and timely reinterventions are crucial to achieve successful outcomes in this patient population. Amputation or alternative revascularization options, when feasible, should be considered in patients with restenosis and tissue loss given the high rate of limb loss with tibial reinterventions.
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Affiliation(s)
- Naveed U Saqib
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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315
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Atkinson CJ, Ramaswamy K, Stoneham MD. Regional anesthesia for vascular surgery. Semin Cardiothorac Vasc Anesth 2013; 17:92-104. [PMID: 23327951 DOI: 10.1177/1089253212472985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vascular surgical patients are a diverse group of patients who tend to be elderly, with multiple comorbidities, while vascular procedures may involve significant blood loss and ischemia of tissues beyond the arterial obstruction. Regional anesthesia techniques may offer benefits to patients undergoing vascular surgery because of their cardiorespiratory comorbidities. However, this group of patients is commonly receiving multiple medications, including anticoagulants, so regional techniques are not without risks. This review will discuss this topic based around 3 fundamental revascularization procedures, carotid, abdominal aortic aneurysm repair, and infrainguinal surgery, discussing the clinical applications of regional techniques relevant to each key area.
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316
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A meta-analysis of endovascular versus surgical reconstruction of femoropopliteal arterial disease. J Vasc Surg 2013; 57:242-53. [DOI: 10.1016/j.jvs.2012.07.038] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/01/2012] [Accepted: 07/15/2012] [Indexed: 11/23/2022]
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317
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deFreitas DJ, Love TP, Kasirajan K, Haskins NC, Mixon RT, Brewster LP, Duwayri Y, Corriere MA. Computed tomography angiography-based evaluation of great saphenous vein conduit for lower extremity bypass. J Vasc Surg 2013; 57:50-5; discussion 55. [DOI: 10.1016/j.jvs.2012.06.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 06/01/2012] [Accepted: 06/05/2012] [Indexed: 10/27/2022]
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318
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Waters PS, Fennessey PJ, Hynes N, Heneghan HM, Tawfick W, Sultan S. The effects of normalizing hyperhomocysteinemia on clinical and operative outcomes in patients with critical limb ischemia. J Endovasc Ther 2012; 19:815-25. [PMID: 23210882 DOI: 10.1583/jevt-12-3949mr.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the outcome of patients with medically treated hyperhomocysteinemia (HHC) requiring intervention for critical limb ischemia (CLI). METHODS A parallel observational study was conducted to compare the clinical and revascularization outcomes of CLI patients who received standardized treatment for HHC preoperatively (folic acid and vitamin B12) vs. contemporaneous patients with normal homocysteine levels. The threshold for HHC diagnosis was 13.0 μmol/L. From 2009 to 2011, 169 patients underwent revascularization procedures for CLI. Of these, all 66 patients (40 men; mean age 69.6 ± 11.2 years) with HHC (mean 17.3 μmol/L, range 13.5-34.9) were treated to normalize the homocysteine level prior to lower limb revascularization. The remaining 103 patients (58 men; mean age 72.7±8.1 years) had normal homocysteine levels (8.2 μmol/L, range 5-12.3) before revascularization. The primary endpoint was symptomatic and hemodynamic improvement in the treated HHC group. The secondary endpoints were all-cause survival, binary restenosis, reintervention, amputation-free survival, and major adverse events. The treated HHC cohort was compared to an age/sex-matched historical group of patients with untreated HHC from 2002 to 2006 before HHC pretreatment became routine. All interventions (endovascular, hybrid, and open) were performed by the same surgeon, and the groups were evenly matched. RESULTS Patients with HHC were treated for a mean 12.2 days, which significantly reduced their mean homocysteine level after 3 weeks to 10.1 μmol/L (range 6.2-14.4, p<0.05). After revascularization, immediate clinical improvement was similar between normal homocysteine and medically corrected HHC groups. There was no significant difference in time to binary restenosis (p=0.822). Secondary endpoints and all-cause mortality were similar. Multivariate logistic regression showed that untreated HHC was a significant factor for graft occlusion and limb loss (p<0.0001), but medically corrected HHC was no longer predictive of adverse operative outcome. CONCLUSION Patients with medically corrected HHC have similar outcomes compared to those with normal homocysteine levels. Thus, aggressively treating HHC with folic acid and vitamin B12 may help enhance the clinical outcome of CLI patients undergoing revascularization.
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Affiliation(s)
- Peadar S Waters
- Western Vascular Institute, University College Hospital Galway, Ireland
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319
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Schulte KL, Kralj I, Gissler HM, Bagnaschino LA, Buschmann I, Pernès JM, Haage P, Goverde P, Beregi JP, Válka M, Boudny J, Geibel T, Velkoborsky M, Zähringer M, Paetzel C, Fanelli F, Müller-Hülsbeck S, Zeller T, Langhoff R. MISAGO 2: One-Year Outcomes After Implantation of the Misago Self-Expanding Nitinol Stent in the Superficial Femoral and Popliteal Arteries of 744 Patients. J Endovasc Ther 2012; 19:774-84. [DOI: 10.1583/jevt-12-3861mr.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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320
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Georgakarakos E, Papanas N, Papadaki E, Georgiadis GS, Maltezos E, Lazarides MK. Endovascular treatment of critical ischemia in the diabetic foot: new thresholds, new anatomies. Angiology 2012; 64:583-91. [PMID: 23129734 DOI: 10.1177/0003319712465172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review discusses the role of endovascular treatment in diabetic patients with critical limb ischemia (CLI). Angioplasty of the femoropopliteal region achieves similar technical success and limb salvage rates in diabetic and nondiabetic patients. Angioplasty in as many as possible tibial vessels is accompanied by more complete and faster ulcer healing as well as better limb salvage rates compared to isolated tibial angioplasty. Targeted revascularization of a specific vessel responsible for the perfusion of a specific ulcerated area is a promising new approach: it replaces revascularization of the angiographically easiest-to-access tibial vessel, even if this is not directly responsible for the perfusion of the ulcerated area, by revascularization of area-specific vascular territories. In conclusion, the endovascular approach shows very high efficacy in ulcer healing for diabetic patients with CLI. Larger prospective studies are now needed to estimate the long-term results of this approach.
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321
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Peña-Cortés R, Sanz-Pastor N, Fernández-Samos R, Alonso-Argüeso G, Ortega-Martín J, Vaquero-Morillo F. Tratamiento de la isquemia crítica de las extremidades inferiores. Cirugía distal y endovascular. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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322
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Schamp KB, Meerwaldt R, Reijnen MM, Geelkerken RH, Zeebregts CJ. The Ongoing Battle Between Infrapopliteal Angioplasty and Bypass Surgery for Critical Limb Ischemia. Ann Vasc Surg 2012; 26:1145-53. [DOI: 10.1016/j.avsg.2012.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
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323
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Cost-effectiveness in the contemporary management of critical limb ischemia with tissue loss. J Vasc Surg 2012; 56:1015-24.e1. [DOI: 10.1016/j.jvs.2012.02.069] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/22/2012] [Accepted: 02/22/2012] [Indexed: 11/23/2022]
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324
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Chaar CIO, Makaroun MS, Marone LK, Rhee RY, Al-Khoury G, Cho JS, Leers SA, Chaer RA. Impact of endovascular options on lower extremity revascularization in young patients. J Vasc Surg 2012; 56:703-13.e1-3. [DOI: 10.1016/j.jvs.2012.01.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/20/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
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325
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Affiliation(s)
- David Paul Slovut
- From the Divisions of Cardiology (D.P.S.) and Vascular and Endovascular Surgery (D.P.S., E.C.L.), Montefiore Medical Center, Bronx, NY
| | - Evan C. Lipsitz
- From the Divisions of Cardiology (D.P.S.) and Vascular and Endovascular Surgery (D.P.S., E.C.L.), Montefiore Medical Center, Bronx, NY
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326
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Lepäntalo MJ, Houbballah R, Raux M, LaMuraglia G. Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease. J Vasc Surg 2012; 56:545-54. [DOI: 10.1016/j.jvs.2012.06.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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327
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Comparison of initial hemodynamic response after endovascular therapy and open surgical bypass in patients with diabetes mellitus and critical limb ischemia. J Vasc Surg 2012; 56:380-6; discussion 386. [DOI: 10.1016/j.jvs.2012.01.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 11/19/2022]
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328
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Houbballah R, Raux M, LaMuraglia G. Part Two: Against the Motion. Endovascular Therapy is the Preferred Treatment for Patients <65 Years Old with Symptomatic Infrainguinal Arterial Disease. Eur J Vasc Endovasc Surg 2012; 44:116-9. [DOI: 10.1016/j.ejvs.2012.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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329
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Dosluoglu HH, Lall P, Harris LM, Dryjski ML. Long-term limb salvage and survival after endovascular and open revascularization for critical limb ischemia after adoption of endovascular-first approach by vascular surgeons. J Vasc Surg 2012; 56:361-71. [DOI: 10.1016/j.jvs.2012.01.054] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/18/2012] [Accepted: 01/18/2012] [Indexed: 10/28/2022]
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330
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Part One: For the Motion. Lower Extremity Bypass versus Endovascular Therapy for Young Patients with Symptomatic Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2012; 44:112-5. [DOI: 10.1016/j.ejvs.2012.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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331
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Ballotta E, Gruppo M, Lorenzetti R, Piatto G, DaGiau G, Toniato A. The impact of gender on outcome after infrainguinal arterial reconstructions for peripheral occlusive disease. J Vasc Surg 2012; 56:343-52. [DOI: 10.1016/j.jvs.2012.01.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/12/2012] [Accepted: 01/12/2012] [Indexed: 11/28/2022]
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332
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Conte MS. Diabetic Revascularization: Endovascular Versus Open Bypass—Do We Have the Answer? Semin Vasc Surg 2012; 25:108-14. [DOI: 10.1053/j.semvascsurg.2012.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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333
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Baril DT, Goodney PP, Robinson WP, Nolan BW, Stone DH, Li Y, Cronenwett JL, Schanzer A. Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb. J Vasc Surg 2012; 56:353-60. [PMID: 22480762 DOI: 10.1016/j.jvs.2012.01.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 01/12/2012] [Accepted: 01/12/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To date, history of a contralateral amputation as a potential predictor of outcomes after lower extremity bypass (LEB) for critical limb ischemia (CLI) has not been studied. We sought to determine if a prior contralateral lower extremity amputation predicts worse outcomes in patients undergoing LEB in the remaining intact limb. METHODS A retrospective analysis of all patients undergoing infrainguinal LEB for CLI between 2003 and 2010 within hospitals comprising the Vascular Study Group of New England was performed. Patients were stratified according to whether or not they had previously undergone a contralateral major or minor amputation before LEB. Primary end points included major amputation and graft occlusion at 1 year postoperatively. Secondary end points included in-hospital major adverse events, discharge status, and mortality at 1 year. RESULTS Of 2636 LEB procedures, 228 (8.6%) were performed in the setting of a prior contralateral amputation. Patients with a prior amputation compared to those without were younger (66.5 vs 68.7; P = .034), more like to have congestive heart failure (CHF; 25% vs 16%; P = .002), hypertension (94% vs 85%; P = .015), renal insufficiency (26% vs 14%; P = .0002), and hemodialysis-dependent renal failure (14% vs 6%; P = .0002). They were also more likely to be nursing home residents (8.0% vs 3.6%; P = .036), less likely to ambulate without assistance (41% vs 80%; P < .0002), and more likely to have had a prior ipsilateral bypass (20% vs 12%; P = .0005). These patients experience increased in-hospital major adverse events, including myocardial infarction (MI; 8.9% vs 4.2%; P = .002), CHF (6.1% vs 3.4%; P = .044), deterioration in renal function (9.0% vs 4.7%; P = .006), and respiratory complications (4.2% vs 2.3%; P = .034). They were less likely to be discharged home (52% vs 72%; P < .0001) and less likely to be ambulatory on discharge (25% vs 55%; P < .0001). Although patients with a prior contralateral amputation experienced increased rates of graft occlusion (38% vs 17%; P < .0001) and major amputation (16% vs 7%; P < .0001) at 1 year, there was not a significant difference in mortality (16% vs 10%; P = .160). On multivariable analysis, prior contralateral amputation was an independent predictor of both major amputation (odds ratio, 1.73; confidence interval, 1.06-2.83; P = .027) and graft occlusion (odds ratio, 1.93; confidence interval, 1.39-2.68; P < .0001) at 1 year. CONCLUSIONS Patients with prior contralateral amputations who present with CLI in the intact limb represent a high-risk population, even among patients with advanced peripheral arterial disease. When considering LEB in this setting, both physicians and patients should expect increased rates of perioperative adverse events, increased rates of 1-year graft occlusion, and decreased rates of limb salvage, when compared with patients who have not undergone a contralateral amputation.
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Affiliation(s)
- Donald T Baril
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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334
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Odink H, van den Berg A, Winkens B. Technical and Clinical Long-Term Results of Infrapopliteal Percutaneous Transluminal Angioplasty for Critical Limb Ischemia. J Vasc Interv Radiol 2012; 23:461-7, 467.e1. [DOI: 10.1016/j.jvir.2011.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 11/15/2011] [Accepted: 12/08/2011] [Indexed: 11/27/2022] Open
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335
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Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline). Vasc Med 2012; 16:452-76. [PMID: 22128043 DOI: 10.1177/1358863x11424312] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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336
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Rana MA, Gloviczki P. Endovascular Interventions for Infrapopliteal Arterial Disease: An Update. Semin Vasc Surg 2012; 25:29-34. [DOI: 10.1053/j.semvascsurg.2012.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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337
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Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. Catheter Cardiovasc Interv 2012; 79:501-31. [PMID: 21960485 PMCID: PMC4505549 DOI: 10.1002/ccd.23373] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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338
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McPhee JT, Barshes NR, Ozaki CK, Nguyen LL, Belkin M. Optimal conduit choice in the absence of single-segment great saphenous vein for below-knee popliteal bypass. J Vasc Surg 2012; 55:1008-14. [PMID: 22365176 DOI: 10.1016/j.jvs.2011.11.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/03/2011] [Accepted: 11/03/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Single-segment great saphenous vein (SSGSV) remains the conduit of choice for femoral to below-knee popliteal (F-BK) surgical revascularization. The purpose of this study was to determine the optimal conduit in patients with inadequate SSGSV. METHODS This was a retrospective review of a prospectively maintained vascular registry. Patients underwent F-BK bypass with alternative vein (AV; arm vein, spliced GSV, or composite vein) or prosthetic conduit (PC). RESULTS From January 1995 to June 2010, 83 patients had unusable SSGSV for F-BK popliteal reconstruction. Thirty-three patients had an AV conduit and 50 had PC. The AV group was a lower median age than the PC group (69 vs 75 years). The two groups were otherwise similar in comorbid conditions of diabetes mellitus (57.6% vs 58.0%; P > .99), smoking (15.2% vs 32.0%; P = .12), and hemodialysis (3% vs 12%; P = .23). The groups were similar in baseline characteristics such as limb salvage as indication (93.9% vs 86.0%; P = .31), mean runoff score (5.2 vs 4.6; P = .39), and prior ipsilateral bypass attempts (18.2% vs 18.0%; P > .99). The AV and PC groups were also similar in 30-day mortality (6.1% vs 4.0%; P > .99) and wound infection rates (6.1% vs 6.0%; P > .99). PC patients were more likely to be discharged on Coumadin (Bristol-Myers Squibb, Princeton, NJ) than AV patients (62.0% vs 27.3%; P = .002). Seventeen of the 50 PC patients (34%) had a distal anastomotic vein cuff. A log-rank test comparison of 5-year outcomes for the AV and PC groups found no significant difference in primary patency (55.3% ± 9.9% vs 51.9% ± 10.8%; P = .82), assisted primary patency (68.8% ± 9.6% vs 54.0% ± 11.0%; P = .45), secondary patency (68.4% ± 9.6% vs 63.7% ± 10.4% for PC; P = .82), or limb salvage rates (96.2% ± 3.8% vs 81.1% ± 8.1%; P = .19). Multivariable analysis demonstrated no association between conduit type and loss of patency or limb. The factors most predictive of primary patency loss were limb salvage as the indication for surgery (hazard ratio [HR], 4.23; 95% confidence interval [CI], 1.65-10.9; P = .003) and current hemodialysis (HR, 3.51; 95% CI, 1.08-11.4; P = .037). The most predictive factor of limb loss was current hemodialysis (HR, 7.02; 95% CI, 1.13-43.4; P = .036). CONCLUSIONS For patients with inadequate SSGSV, PCs, with varying degrees of medical and surgical adjuncts, appear comparable to AV sources in graft patency for below-knee popliteal bypass targets. This observation is tempered by the small cohort sample size of this single-institutional analysis. Critical limb ischemia as the operative indication and current hemodialysis predict impaired patency, and hemodialysis is associated with limb loss.
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Affiliation(s)
- James T McPhee
- Brigham and Women’s Hospital, Division of Vascular and Endovascular Surgery, 75 Francis St, Boston, MA 02155, USA.
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339
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Bastos Gonçalves F, Verhagen HJM. Invited comment on: "Benefit of revascularization to critical limb ischemia patients evaluated by a patient-oriented scoring system". Eur J Vasc Endovasc Surg 2012; 43:548. [PMID: 22341514 DOI: 10.1016/j.ejvs.2012.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 11/19/2022]
Affiliation(s)
- F Bastos Gonçalves
- Erasmus University Medical Center, Vascular Surgery, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
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340
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Guía de práctica clíníca de la ESC sobre diagnóstico y tratamiento de las enfermedades arteriales periféricas. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2011.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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341
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Gasper WJ, Runge SJ, Owens CD. Management of Infrapopliteal Peripheral Arterial Occlusive Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:136-48. [DOI: 10.1007/s11936-012-0164-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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342
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Al-Nouri O, Krezalek M, Hershberger R, Halandras P, Gassman A, Aulivola B, Milner R. Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvage. J Vasc Surg 2012; 56:106-10; discussion 110-1. [PMID: 22226187 DOI: 10.1016/j.jvs.2011.10.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Endovascular treatment of superficial femoral artery (SFA) lesions is a well-established practice. The repercussions of failed SFA interventions are unclear. Our goal was to review the efficacy of SFA stenting and define negative effects of its failure. METHODS A retrospective chart review was conducted from January 2007 to January 2010 that identified 42 limbs in 39 patients that underwent SFA stenting. Follow-up ankle-brachial index and a duplex ultrasound scan was performed at routine intervals. RESULTS Mean patient age was 68 years (range, 43-88 years); there were 22 men (56%) and 17 women (44%). Intervention indication was claudication in 15 patients (36%), rest pain in seven patients (17%), and tissue loss in 19 patients (45%). There were 15 patients (36%) with TransAtlantic Inter-Society Consensus (TASC) A, nine patients (21%) with TASC B, five patients (12%) with TASC C, and 13 patients (31%) with TASC D lesions. The majority of lesions intervened on were the first attempt at revascularization. Three stents (7.7%) occluded within 30 days. One-year primary, primary-assisted, and secondary patency rates were 24%, 44%, and 51%, respectively. Limb salvage was 93% during follow-up. Seventeen interventions failed (40%) at 1 year. Of these, seven patients (41%) developed claudication, seven patients (41%) developed ischemic rest pain, and three patients (18%) were asymptomatic. During follow-up, three patients (7.7%) required bypass and three patients (7.7%) major amputation, one after failed bypass. All limbs requiring bypass or amputation had TASC C/D lesions. Thirty-day and 1-year mortality was 2.6% and 10.3%, respectively. CONCLUSIONS Interventions performed for TASC C/D lesions are more likely to fail and more likely to lead to bypass or amputation. Interventions performed for TASC C/D lesions that fail have a negative impact on limb salvage. This should be considered when performing stenting of advanced SFA lesions.
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Affiliation(s)
- Omar Al-Nouri
- Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
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343
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Pulli R, Dorigo W, Pratesi G, Fargion A, Angiletta D, Pratesi C. Gender-related outcomes in the endovascular treatment of infrainguinal arterial obstructive disease. J Vasc Surg 2012; 55:105-12. [DOI: 10.1016/j.jvs.2011.07.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 07/05/2011] [Accepted: 07/08/2011] [Indexed: 11/27/2022]
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344
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Setacci C, de Donato G, Teraa M, Moll F, Ricco JB, Becker F, Robert-Ebadi H, Cao P, Eckstein H, De Rango P, Diehm N, Schmidli J, Dick F, Davies A, Lepäntalo M, Apelqvist J. Chapter IV: Treatment of Critical Limb Ischaemia. Eur J Vasc Endovasc Surg 2011; 42 Suppl 2:S43-59. [DOI: 10.1016/s1078-5884(11)60014-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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345
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Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline). Circulation 2011; 124:2020-45. [DOI: 10.1161/cir.0b013e31822e80c3] [Citation(s) in RCA: 272] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Alan T. Hirsch
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
| | - Sanjay Misra
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
- Society of Interventional Radiology Representative
| | | | - Joshua A. Beckman
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
- Society for Vascular Medicine Representative
| | | | | | - Heather L. Gornik
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
- ACCF/AHA Representative
| | - Jonathan L. Halperin
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
- ACCF/AHA Task Force on Practice Guidelines Liaison
| | - Michael R. Jaff
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
- ACCF/AHA Representative
| | | | - Jeffrey W. Olin
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
- ACCF/AHA Task Force on Performance Measures Liaison
| | | | - Christopher J. White
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
- Society for Cardiovascular Angiography and Interventions Representative
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Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58:2020-45. [PMID: 21963765 DOI: 10.1016/j.jacc.2011.08.023] [Citation(s) in RCA: 457] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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347
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Keese M, Bihari P, Meyn M, Schmandra T, Schmitz-Rixen T. Periphere Bypasschirurgie der unteren Extremität. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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348
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Nguyen BN, Conrad MF, Guest JM, Hackney L, Patel VI, Kwolek CJ, Cambria RP. Late outcomes of balloon angioplasty and angioplasty with selective stenting for superficial femoral-popliteal disease are equivalent. J Vasc Surg 2011; 54:1051-1057.e1. [DOI: 10.1016/j.jvs.2011.03.283] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 11/24/2022]
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349
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Sachs T, Pomposelli F, Hamdan A, Wyers M, Schermerhorn M. Trends in the national outcomes and costs for claudication and limb threatening ischemia: Angioplasty vs bypass graft. J Vasc Surg 2011; 54:1021-1031.e1. [DOI: 10.1016/j.jvs.2011.03.281] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 11/28/2022]
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350
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A Framework for the Evaluation of “Value” and Cost-Effectiveness in the Management of Critical Limb Ischemia. J Am Coll Surg 2011; 213:552-66.e5. [DOI: 10.1016/j.jamcollsurg.2011.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/11/2011] [Accepted: 07/14/2011] [Indexed: 11/20/2022]
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