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Shan LL, Yang LS, Tew M, Westcott MJ, Spelman TD, Choong PF, Davies AH. Quality of Life in Chronic Limb Threatening Ischaemia: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 64:666-683. [PMID: 35952907 DOI: 10.1016/j.ejvs.2022.07.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the comparative effectiveness and temporal changes in quality of life (QoL) outcomes after revascularisation, major lower extremity amputation (MLEA), and conservative management (CM) in chronic limb threatening ischaemia (CLTI). DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science. REVIEW METHODS A systematic review and meta-analysis were performed on QoL measured by any QoL instrument in adult patients with CLTI after open surgery (OS), endovascular intervention (EVI), MLEA, or CM. Randomised controlled trials and prospective observational studies published in any language between 1 January 1990 and 21 May 2021 were included. There was a pre-specified measurement time point of six months. Random effects meta-analysis was conducted on total scores for each QoL instrument. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach (PROSPERO registration: CRD42021253953). RESULTS Fifty-five studies with 8 909 patients were included. There was significant heterogeneity in the methods used to measure QoL, and the study characteristics. In particular, 14 different QoL instruments were used with various combinations of disease specific and generic instruments within each study. A narrative summary is therefore presented. Comparative effectiveness data showed there was reasonable certainty that QoL was similar between OS and EVI at six months. Temporal outcomes suggested small to moderate improvements in QOL six months after OS and EVI compared with baseline. Limited data indicated that QoL can be maintained or slightly improved after MLEA or CM. Treatment effects were overestimated owing to small study effects, selective non-reporting, attrition, and survivorship bias. CONCLUSION QoL after OS and EVI appears to be similar. Revascularisation may provide modest QoL benefits, while MLEA or CM can maintain QoL. However, certainty of evidence is generally low or very low, and interpretation is hampered by significant heterogeneity. There is a need for a CLTI specific QoL instrument and methodological standardisation in QoL studies.
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Affiliation(s)
- Leonard L Shan
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Linda S Yang
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Tew
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark J Westcott
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Tim D Spelman
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter F Choong
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Alun H Davies
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Weissler EH, Clare RM, Lokhnygina Y, Buse JB, Goodman SG, Katona B, Iqbal N, Pagidipati NJ, Sattar N, Holman RR, Hernandez AF, Mentz RJ, Patel MR, Jones WS. Predicting major adverse limb events in individuals with type 2 diabetes: Insights from the EXSCEL trial. Diabet Med 2021; 38:e14552. [PMID: 33690915 PMCID: PMC8429063 DOI: 10.1111/dme.14552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
AIMS Although models exist to predict amputation among people with type 2 diabetes with foot ulceration or infection, we aimed to develop a prediction model for a broader range of major adverse limb events (MALE)-including gangrene, revascularization and amputation-among individuals with type 2 diabetes. METHODS In a post-hoc analysis of data from the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial, we compared participants who experienced MALE with those who did not. A multivariable model was constructed and translated into a risk score. RESULTS Among the 14,752 participants with type 2 diabetes in EXSCEL, 3.6% experienced MALE. Characteristics associated with increased risk of MALE were peripheral artery disease (PAD) (HRadj 4.83, 95% CI: 3.94-5.92), prior foot ulcer (HRadj 2.16, 95% CI: 1.63-2.87), prior amputation (HRadj 2.00, 95% CI: 1.53-2.64), current smoking (HRadj 2.00, 95% CI: 1.54-2.61), insulin use (HRadj 1.86, 95% CI: 1.52-2.27), coronary artery disease (HRadj 1.67, 95% CI: 1.38-2.03) and male sex (HRadj 1.64, 95% CI: 1.31-2.06). Cerebrovascular disease, former smoking, age, glycated haemoglobin, race and neuropathy were also associated significantly with MALE after adjustment. A risk score ranging from 6 to 96 points was constructed, with a C-statistic of 0.822 (95% CI: 0.803-0.841). CONCLUSIONS The majority of MALE occurred among participants with PAD, but participants without a history of PAD also experienced MALE. A risk score with good performance was generated. Although it requires validation in an external dataset, this risk score may be valuable in identifying patients requiring more intensive care and closer follow-up.
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Affiliation(s)
- E. Hope Weissler
- Division of Vascular Surgery, Duke University School of Medicine, Durham, NC
| | - Robert M. Clare
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - John B. Buse
- Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Shaun G. Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, and St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Katona
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD USA
| | - Nayyar Iqbal
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD USA
| | - Neha J. Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rury R. Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Robert J. Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
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Peters CML, Lodder P, de Vries J, Steunenberg SL, Veen EJ, de Groot HGW, Ho GH, van der Laan L. Two-year Outcome of Quality of Life and Health Status for the Elderly with Chronic Limb-threatening Ischemia. Clin Interv Aging 2020; 15:2383-2395. [PMID: 33376314 PMCID: PMC7765754 DOI: 10.2147/cia.s272078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In elderly patients with chronic limb-threatening ischemia (CLTI), there is little scientific understanding of the long-term changes of quality of life (QoL) and health status (HS) after treatment. The primary goal of this study was to provide long-term QoL and HS results for elderly CLTI patients after therapy. Treatments consisted of endovascular revascularization, surgical revascularization, or conservative treatment. Furthermore, the aim of this study was to identify the distinctive trajectories of QoL and HS. Patients and Methods CLTI patients aged ≥70 years were included in a prospective observational cohort study with a two-year follow-up. The WHOQOL-BREF was used to asses QoL. The 12-Item Short Form Health Survey was used to measure HS. The QoL and HS scores were compared to the scores in the general elderly Dutch population. Latent class trajectory analysis was used. Results A total of 195 patients were included in this study. After two years, in all treatment groups patients showed significantly higher physical QoL score compared to baseline and there was no significant difference with the corresponding values in the elderly Dutch population. In the latent class trajectory analysis, there were no overlapping risk factors for poorer QoL or HS. Conclusion This study shows that QoL levels in surviving elderly CLTI patients in the long-term do not differ from the corresponding values for elderly in the general population. There were no disparities in sociodemographic, clinical and treatment characteristics associated with poorer QoL and HS. This study was carried out to encourage further analysis of the influence of biopsychosocial characteristics on QoL and HS in elderly CLTI patients.
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Affiliation(s)
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Elisabeth-TweeSteden Hospital Tilburg University, Tilburg, The Netherlands
| | | | - Eelco J Veen
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Cardiovascular Science, UZ Leuven - University Hospitals, Leuven, Belgium
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Patel KK, Alturkmani H, Gosch K, Mena-Hurtado C, Shishehbor MH, Peri-Okonny PA, Creager MA, Spertus JA, Smolderen KG. Association of Diabetes Mellitus With Health Status Outcomes in Patients With Peripheral Artery Disease: Insights From the PORTRAIT Registry. J Am Heart Assoc 2020; 9:e017103. [PMID: 33153398 PMCID: PMC7763706 DOI: 10.1161/jaha.120.017103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Patients with peripheral artery disease (PAD) and coexisting diabetes mellitus (DM) have greater PAD progression and adverse limb events. Our aim was to study whether PAD‐specific health status differs by DM. Methods and Results The PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) trial is a 16‐center international registry that includes patients with recent exacerbations or new‐onset symptomatic PAD presenting to specialty clinics. We assessed PAD‐specific health status initially and at 3, 6, and 12 months (Peripheral Artery Questionnaire [PAQ]). We used hierarchical, multivariable, linear regression, and repeated measures analyses to study the association between DM and baseline health status initially and over 3 to 12 months. Models were adjusted for demographics, socioeconomic factors, PAD severity, comorbidities, and psychosocial characteristics. The interaction of DM with PAD revascularization on 3‐ to 12‐month health status was also tested. Of 1204 patients, 398 (33%) had DM (94% type 2). Patients with versus those without DM had lower unadjusted PAQ summary scores at baseline and 3, 6, and 12 months (46.1 versus 50.8, 63.6 versus 68.2, 65.7 versus 71.7, and 65.4 versus 72.6; P≤0.01). In fully adjusted models, the effect of DM on baseline (mean difference, −0.65; 95% CI, −2.86 to 1.56 [P=0.56]) and over 3‐ to 12‐month PAQ summary scores (mean difference, −1.59; 95% CI, −4.06 to 0.88 [P=0.21]) was no longer significant. Twelve‐month health status gains following revascularization were similar in both groups (P=0.69). Conclusions Patients with PAD with coexisting DM have poorer health status, mostly explained by the differences in their psychosocial and other comorbidity burden. Patients with PAD and DM versus those without DM experience similar health status benefits following PAD revascularization.
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Affiliation(s)
- Krishna K Patel
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Hani Alturkmani
- University of Missouri-Kansas City Kansas City MO.,Truman Medical Centers Kansas City MO
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Mehdi H Shishehbor
- University Hospital Cleveland Medical Center and Case Western Reserve University School of Medicine Cleveland OH
| | - Poghni A Peri-Okonny
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Mark A Creager
- Dartmouth-Hitchcock Heart and Vascular Center Lebanon NH
| | - John A Spertus
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Kim G Smolderen
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
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Torbjörnsson E, Ottosson C, Boström L, Blomgren L, Malmstedt J, Fagerdahl AM. Health-related quality of life and prosthesis use among patients amputated due to peripheral arterial disease – a one-year follow-up. Disabil Rehabil 2020; 44:2149-2157. [DOI: 10.1080/09638288.2020.1824025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Eva Torbjörnsson
- Department of Clinical Science and Education, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Carin Ottosson
- Department of Clinical Science and Education, Wound Centre, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Lennart Boström
- Department of Clinical Science and Education, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Lena Blomgren
- Faculty of Medicine and Health, Department of Cardiovascular and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Jonas Malmstedt
- Department of Clinical Science and Education, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Wound Centre, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Duff S, Mafilios MS, Bhounsule P, Hasegawa JT. The burden of critical limb ischemia: a review of recent literature. Vasc Health Risk Manag 2019; 15:187-208. [PMID: 31308682 PMCID: PMC6617560 DOI: 10.2147/vhrm.s209241] [Citation(s) in RCA: 192] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/07/2019] [Indexed: 01/15/2023] Open
Abstract
Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains—epidemiologic, clinical, humanistic, and economic—focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient’s physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden—a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.
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Affiliation(s)
- Steve Duff
- Veritas Health Economics Consulting , Carlsbad, CA, USA
| | | | - Prajakta Bhounsule
- Health Economics and Reimbursement, Abbott Vascular, Santa Clara, CA, USA
| | - James T Hasegawa
- Health Economics and Reimbursement, Abbott Vascular, Santa Clara, CA, USA
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7
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Steunenberg SL, Raats JW, te Slaa A, de Vries J, van der Laan L. Quality of Life in Patients Suffering from Critical Limb Ischemia. Ann Vasc Surg 2016; 36:310-319. [DOI: 10.1016/j.avsg.2016.05.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/09/2016] [Accepted: 05/28/2016] [Indexed: 11/28/2022]
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The Use of Transcutaneous Electrical Stimulation of the Calf in Patients Undergoing Infrainguinal Bypass Surgery. Ann Vasc Surg 2015; 29:1524-32. [PMID: 26318552 DOI: 10.1016/j.avsg.2015.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/13/2015] [Accepted: 05/24/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Infrainguinal bypass surgery is frequently associated with postoperative reperfusion edema of the limb. The etiology is thought to be multifactorial, and there is as yet no standardized treatment protocol for this problem. The primary aim of this study was to assess whether the use of intermittent electrical stimulation of the calf muscles after infrainguinal bypass surgery was effective in reducing the incidence of edema, and the secondary aims to determine the effect of calf muscle stimulation on arterial and venous flow in the operated leg. METHODS Forty patients due to undergo infrainguinal bypass surgery for critical lower-limb ischemia (Fontaine grading III-IV or Rutherford grading II-III) were recruited prospectively and randomly divided into the control group, who received the current standard of care, and study group, who received electrical calf muscle stimulation for a 1 hour session twice daily for the first postoperative week. Preoperatively and postoperatively, the leg was measured at 3 predetermined points and a duplex ultrasound scan performed. RESULTS The groups were well matched for all parameters. At 1 week, the below knee and calf girth were less in the study group (P = 0.025 and P = 0.043, respectively). Venous flow volumes at rest and on stimulation were higher in the study group (P = 0.010 and P = 0.029, respectively). At 6 weeks, the below knee girth and amount of pitting edema were less in the study group (P = 0.011 and P = 0.014, respectively). CONCLUSIONS We conclude that transcutaneous electrical stimulation of the calf decreased lower-limb swelling at 1 and 6 weeks, and increased the venous flow volume at rest and on stimulation at 1 week in patients undergoing infrainguinal bypass surgery for critical ischemia regardless of patient factors or the type of bypass surgery performed or graft used.
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9
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Donker J, de Vries J, Ho GH, Gonçalves FB, Hoeks SE, Verhagen HJM, van der Laan L. Review: Quality of life in lower limb peripheral vascular surgery. Vascular 2015; 24:88-95. [PMID: 25827440 DOI: 10.1177/1708538115578961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffering from either claudication or critical limb ischemia. BASIC METHODS A review of the literature was undertaken in the Medline library. A search was performed on quality of life in peripheral arterial disease. Results were stratified according to treatment groups. PRINCIPAL FINDINGS Twenty-one articles described quality of life in approximately 4600 patients suffering from peripheral arterial disease. Invasive treatment generally results in better quality of life scores (at a maximum of 2 years of follow-up), compared with non-invasive treatment. In patients with critical limb ischemia, successful revascularization improves quality of life scores. Only one study reported long-term results. CONCLUSIONS Increase in quality of life scores can be found for any intervention performed for peripheral arterial disease. However, there is scarce information on long-term quality of life after vascular intervention.
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Affiliation(s)
- Jmw Donker
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - J de Vries
- Department of Medical Psychology, Tilburg University & St. Elisabeth Hospital, Tilburg, The Netherlands
| | - G H Ho
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - F Bastos Gonçalves
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Lisbon, Portugal
| | - S E Hoeks
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L van der Laan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
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Peker KD, Aksoy M. Diabetes effect on Quality of Life in the long-term after Limb salvage with Infrageniculate Bypasses accompanied with minor amputations. Pak J Med Sci 2014; 30:1044-9. [PMID: 25225523 PMCID: PMC4163229 DOI: 10.12669/pjms.305.5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/20/2014] [Accepted: 06/05/2014] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Objective : To evaluate the quality of life in patients, who had their limbs salvaged with an infrageniculate bypass and minor amputation in the long term and to see if diabetics are prone to worse results. METHODS The patients with limb salvage following an infrageniculate bypass and minor amputation were asked to complete Short Form 36 at the last follow-up visit. The mean scores in diabetic and non-diabetic population were compared to each other .The mean follow-up period was 58±8 months. Results : Of 142 patients, 40 patients were eligible to be included in the study. 33 (82.5%) patients were male and 7 (17.5%) patients were female. The mean age at the time of intervention was 57±14 (33-83) years. The mean scores for eight domains of SF-36 evaluation ranged from 44 to 67 out of 100. There were no significant differences concerning the mean scores of any dimension between the diabetic and non-diabetic group. Conclusion : Despite a minor amputation, the functional outcome of limb salvage with an infrageniculate bypass is favorable and diabetes does not seem to have negative effect on the functional outcome and Quality of Life.
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Affiliation(s)
- Kivanc Derya Peker
- Kivanc Derya Peker, Peripheral Vascular Surgery Unit, Department of General Surgery, Medical Faculty of Istanbul, Istanbul University, Turkey
| | - Murat Aksoy
- Murat Aksoy, Peripheral Vascular Surgery Unit, Department of General Surgery, Medical Faculty of Istanbul, Istanbul University, Turkey
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11
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Albadawi H, Oklu R, Cormier NR, O'Keefe RM, Heaton JT, Kobler JB, Austen WG, Watkins MT. Hind limb ischemia-reperfusion injury in diet-induced obese mice. J Surg Res 2014; 190:683-91. [PMID: 24655666 DOI: 10.1016/j.jss.2014.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/05/2014] [Accepted: 01/10/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Obesity is a major risk factor for the development of diabetes. Limb ischemia-reperfusion injury (IR) is a common clinical problem in diabetics who have compromised lower extremity perfusion. This study compared the histologic, metabolic, and functional outcomes after hind limb IR in diet-induced obese (DIO) and non-diabetic (ND) mice during the acute and the regenerative phases of IR. METHODS DIO and ND mice were subjected to 1.5 h unilateral hind limb ischemia followed by 1- or 28-d IR. Muscle morphology, metabolic, and genomic stress were evaluated at days 1 and 28 IR; Acute inflammation and thrombosis were only measured at day-1 IR. At day 28, IR, skeletal muscle contractility, and maturation were also assessed. RESULTS At day-1 IR, similar levels of acute muscle fiber necrosis were seen in both groups. DIO mice demonstrated substantially greater inflammatory, prothrombotic, and genomic stress responses, which were also associated with a greater reduction in energy substrates and Akt phosphorylation. At 28d, there was no difference in the peak forces generated in the hind limbs for the two groups. DIO mice had reduced fatigue resistance compared with ND and larger areas of fat accumulation although there was no significant difference in muscle fiber maturation. CONCLUSIONS DIO mice had an exacerbated acute response to IR with enhanced metabolic deficit, fat accumulation, and defective functional recovery during the regenerative phase of IR. These changes in fatigue resistance reflect compromised functional recovery after IR injury and have relevance for the functional recovery of patients with metabolic syndrome and insulin resistance.
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Affiliation(s)
- Hassan Albadawi
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Vascular and Endovascular Surgery, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Rahmi Oklu
- Division of Vascular Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nicholas R Cormier
- Division of Vascular and Endovascular Surgery, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan M O'Keefe
- Division of Vascular and Endovascular Surgery, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James T Heaton
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James B Kobler
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - William G Austen
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael T Watkins
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Vascular and Endovascular Surgery, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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12
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Donker JMW, te Slaa A, de Vries J, Ho GH, Mulder PGH, van der Laan L. Midterm follow-up of quality of life following peripheral bypass surgery. Ann Vasc Surg 2013; 27:1115-23. [PMID: 23816388 DOI: 10.1016/j.avsg.2012.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 10/01/2012] [Accepted: 10/06/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peripheral bypass surgery is an important treatment option for patients with peripheral arterial disease. Short-term results of quality of life (QoL) after peripheral bypass surgery showed an increase in QoL at 3 months. Little is known about QoL at more than 2 years of follow-up. This study was performed to analyze QoL at midterm follow-up, and overall survival after peripheral bypass surgery. METHODS This study was part of a randomized control trial in which intermittent pneumatic compression was compared with compression stockings in the treatment of edema after bypass surgery. Patients completed a QoL questionnaire before surgery, 14 days and 3 months postoperatively, and at least 2 years after the original operation. A survival analysis was performed to calculate survival for patients who received both autologous and polytetrafluoroethylene (PTFE) bypass grafts. RESULTS The original study consisted of 93 patients, and QoL midterm follow-up was achieved for 42. QoL scores at midterm follow-up were comparable to the preoperative baseline scores for both the autologous and the PTFE groups. Three-year survival rates were 75% and 54%, respectively. CONCLUSION Although peripheral bypass surgery significantly increased QoL 3 months after surgery, midterm follow-up showed a return to baseline scores. No significant difference was found in survival between patients in the autologous and PTFE groups.
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Zegelman M, Guenther G, Waliszewski M, Pukacki F, Stanisic MG, Piquet P, Passon M, Halloul Z, Tautenhahn J, Claeys L, Agostinho C, Simici D, Doebrich D, Mueller C, Balzer K. Results from the International Silver Graft Registry for high-risk patients treated with a metallic-silver impregnated vascular graft. Vascular 2013; 21:137-47. [DOI: 10.1177/1708538113478773] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this postmarket surveillance registry was to document the efficacy of a vascular prosthesis coated with metallic silver in high-risk patients undergoing vascular reconstructions. Patency (primary endpoint) and freedom from graft infection (secondary endpoint) data were assessed at a minimum of 12 months in patients with significant co-morbidity and/or confirmed graft infections or infected native vessels. Between November 2006 and December 2009, 230 patients with high-risk factors underwent aortic, peripheral and/or extra-anatomic reconstructions with Silver Graft® (SG) in six German, one French and one Polish vascular center. All participating centers used the metallic silver-coated polyester graft (SG) in various diameters and lengths including tubular and bifurcate vascular grafts. Doppler ultrasound follow-ups to determine graft patency were planned at 12 months or done at an earlier time in case the patient became symptomatic. A total of 230 patients were studied. Ten of these 230 patients had graft infections at baseline whereas the remaining 220 subjects had significant risk factors such as coronary artery disease (62.7%, 138/220), vascular access in scar tissue (27.3%, 60/220), Fontaine III/IV (38.2%, 84/220), chronic renal insufficiency (26.8%, 59/220) and diabetes (21.0%, 46/220). The long-term follow-up at 15.5 ± 8.3 months revealed a secondary patency rate of 93.2% (205/220) and an ‘all cause’ mortality rate of 18.6% (41/220). There was a freedom from de novo graft infection rate of 95.9% (211/220) in the high-risk group without graft infections at baseline. One regraft infection occurred distal of the revisional reconstruction in the 10 patients with graft infection at baseline. The presence of perigraft fluid at follow-up and Fontaine III/IV at baseline were found to be predictors for graft patency whereas perigraft fluid presence was the only predictor for de novo graft infections. This registry revealed favorable patency and freedom from de novo infections rates in a ‘high-risk’ population with significant co-morbidities.
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Affiliation(s)
- Max Zegelman
- Department of Vascular and Thoracic Surgery, Krankenhaus Nordwest, Frankfurt a. M
| | - Gisela Guenther
- Department of Vascular and Thoracic Surgery, Krankenhaus Nordwest, Frankfurt a. M
| | | | - Fryderyk Pukacki
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Goran Stanisic
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Philippe Piquet
- Hôpital de la Timone, Assistance Publique Hôpiteaux de Marseille, Marseille, France
| | - Marius Passon
- Department of General, Visceral and Vascular Surgery, Bethesda Hospital Diakonie, Freudenberg
| | - Zuhir Halloul
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg
| | | | - Luc Claeys
- Department of Vascular Surgery Marienhospital, Herne
| | | | | | | | - Carsten Mueller
- Clinic for Vascular Surgery and Kidney Transplantation, University Clinic Düsseldorf, Düsseldorf, Germany
| | - Kai Balzer
- Clinic for Vascular Surgery and Kidney Transplantation, University Clinic Düsseldorf, Düsseldorf, Germany
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Engelhardt M, Boos J, Bruijnen H, Wohlgemuth W, Willy C, Tannheimer M, Wölfle K. Critical Limb Ischaemia: Initial Treatment and Predictors of Amputation-free Survival. Eur J Vasc Endovasc Surg 2012; 43:55-61. [DOI: 10.1016/j.ejvs.2011.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 09/09/2011] [Indexed: 10/16/2022]
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15
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Öztürk Ç, te Slaa A, Dolmans DEJGJ, Ho GH, de Vries J, Mulder PGH, van der Laan L. Quality of life in perspective to treatment of postoperative edema after peripheral bypass surgery. Ann Vasc Surg 2011; 26:373-82. [PMID: 22063233 DOI: 10.1016/j.avsg.2011.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/06/2011] [Accepted: 07/13/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND To examine the effects of peripheral bypass surgery on patients' quality of life (QoL) as well as to compare two treatment modalities to reduce postoperative edema with regard to patients' QoL. METHODS This was a randomized controlled trial set in the department of vascular surgery in a nonacademic teaching hospital. Ninety-three patients (mean age, 70 years; 33% Rutherford 5-6), enrolled between August 2006 and September 2009, who underwent peripheral bypass surgery (autologous 57, polytetrafluoroethylene 36). Patients were assigned to intermittent pneumatic compression (n = 46) or to compression stockings (n = 47). The main outcome measure was QoL, measured with the World Health Organization Quality of Life assessment instrument (short form: WHOQOL-BREF). RESULTS QoL improved on the domain of Physical Health by 7.18 points (P < 0.001 [range, 0-100]) after 2 weeks and by 10.03 points (P < 0.001) after 3 months. Patients who received a polytetrafluoroethylene bypass scored 0.45 points (P = 0.0008 [range, 1-5]) lower at baseline on Global QoL than patients who received an autologous bypass. Type of bypass or edema treatment method did not affect the improvements. Edema did not correlate with QoL. CONCLUSION Improvement in QoL on the domain Physical Health following femoropopliteal bypass surgery was found as soon as 2 weeks after surgery. Improvement in QoL domains was not influenced by the type of bypass reconstruction. No specific effects of edema on QoL were detected.
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Affiliation(s)
- Çiğdem Öztürk
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
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16
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Sprengers RW, Teraa M, Moll FL, de Wit GA, van der Graaf Y, Verhaar MC. Quality of life in patients with no-option critical limb ischemia underlines the need for new effective treatment. J Vasc Surg 2010; 52:843-9, 849.e1. [PMID: 20598482 DOI: 10.1016/j.jvs.2010.04.057] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide a solid baseline reference for quality of life (QoL) in patients with no-option critical limb ischemia (CLI). CLI is associated with surgery, endovascular interventions, hospitalization, and a poor prognosis. An increasing number of clinical trials are, therefore, investigating new treatment strategies (eg, therapeutic neovascularization) in patients with CLI. QoL serves as an important secondary endpoint in many of these trials, but solid reference QoL data for patients with no-option CLI are lacking. METHODS The Medical Outcomes Study Short Form 36 (SF-36) and the EuroQol-5D (EQ-5D) questionnaires were used to obtain baseline QoL scores from 47 patients with no-option CLI participating in a therapeutic neovascularization trial. To allow for easy comparability, a norm-based scoring (NBS) method was used to report the results of the SF-36. Scores of patients with CLI were furthermore compared with scores of patients with milder forms of peripheral arterial disease (PAD) and with patients with cardiovascular risk factors only. Determinants of QoL in patients with PAD were identified using multiple linear regression methods. RESULTS Patients with no-option CLI reported QoL scores below the general population mean on every health dimension of the SF-36. Physical functioning, role physical functioning, and bodily pain were affected most intensively. These poor physical QoL scores were further underlined when compared with other patients with milder forms of PAD or patients with cardiovascular risk factors only. Patients with CLI scored poorly on the pain/discomfort and the usual activities domain of the EQ-5D. Diabetes, female gender, body mass index, and the ankle-brachial index at rest were significant determinants of the QoL in PAD on multivariate analysis. CONCLUSION The QoL data of patients with no-option CLI using NBS methods for the SF-36 provide a baseline reference for ongoing clinical trials on new treatment strategies. Our data stress the need for new revascularization therapies in patients with no-option CLI.
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Affiliation(s)
- Ralf W Sprengers
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Hernández-Lahoz Ortiz I, Paz-Esquete J, Vázquez-Lago J, García-Casas R. Calidad de vida en pacientes revascularizados por isquemia crítica de miembros inferiores. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70015-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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20
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Engelhardt M, Wohlgemuth WA, Willy C, Tannheimer M, Wölfle KD. [Patient assessments of quality of life following bypass for chronic critical limb ischaemia]. Chirurg 2008; 80:324-30. [PMID: 19048220 DOI: 10.1007/s00104-008-1643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The value of infrainguinal bypass surgery for critical limb ischaemia (CLI) in elderly patients is being scrutinised more as medical resources decline. Despite technically successful revascularisation, patient quality of life seems impaired by delayed wound healing and repeated hospitalisation for interventions and operations. Therefore it is questionable whether these frail patients benefit from bypass surgery with respect to their health-related quality of life. This review examines current evidence of patients with CLI and summarises the effect of bypass surgery on their own quality of life assessments. All in all, patients benefit from the revascularisation because ambulation status improves and independence is preserved. From a patient's perspective these improvements in quality of life justify an aggressive approach towards revascularisation for CLI.
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Affiliation(s)
- M Engelhardt
- Klinik für Gefässchirurgie, Bundeswehrkrankenhaus, Oberer Eselsberg 40, Ulm, Germany.
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