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Kim TI, DeWan A, Murray M, Wang H, Mani A, Mena-Hurtado C, Guzman RJ, Ochoa Chaar CI. Anticoagulation in Patients with Premature Peripheral Artery Disease Undergoing Lower Extremity Revascularization. Ann Vasc Surg 2024; 105:150-157. [PMID: 38593922 DOI: 10.1016/j.avsg.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Premature peripheral artery disease (PAD), defined by lower extremity revascularization (LER) at age ≤ 50 years, is associated with poor major adverse limb events. The early onset of disease is thought to be influenced by genetic factors that regulate homeostasis of the vascular wall and coagulation. The aim of this study is to investigate the effect of anticoagulation as an adjunct to antiplatelet therapy on the outcomes of LER in patients with premature PAD. METHODS There were 8,804 patients with premature PAD on preoperative and postoperative antiplatelet therapy only and 1,236 patients on preoperative and postoperative anticoagulation plus antiplatelet therapy in the Vascular Quality Initiative peripheral vascular intervention, infrainguinal, and suprainguinal files. Propensity score matching (2:1) was performed between patients with premature PAD who were on antiplatelet therapy and those on anticoagulation plus antiplatelet therapy. Perioperative and 1-year outcomes were analyzed including reintervention, major amputation, and mortality. RESULTS Patients on anticoagulation were more likely to have coronary artery disease (48.7% vs. 41.2%, P < 0.001), congestive heart failure (20.2% vs. 13.1%, P < 0.001), and have undergone prior LER (73.9% vs. 49.2%, P < 0.001) compared to patients on antiplatelet therapy only. They were also less likely to be independently ambulatory (74.2% vs. 81.8%, P < 0.001) and be on a statin medication (66.8% vs. 74.3%, P < 0.001) compared to patients on antiplatelet therapy only. Patients on anticoagulation were also less likely to be treated for claudication (38.1% vs. 48.6%, P < 0.001), and less likely to be treated with an endovascular procedure (64.8% vs. 73.8%, P < 0.001). After matching for baseline characteristics, there were 1,256 patients on antiplatelet therapy only and 628 patients on anticoagulation. Patients on anticoagulation were more likely to require a return to the operating room (3.7% vs. 1.6%, P < 0.001) and had higher perioperative mortality (1.1% vs. 0.3%, P = 0.032), but major amputation was not significantly different (1.8% vs. 1.6%, P = 0.798) compared to patients on antiplatelet therapy alone. At 1 year, amputation-free survival was higher in patients on antiplatelets only compared to patients on anticoagulation and antiplatelet medications (87.5% vs. 80.9%, log-rank P = 0.001). CONCLUSIONS Anticoagulation in addition to antiplatelet therapy in patients with premature PAD undergoing LER is associated with increased reintervention and mortality at 1 year.
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Affiliation(s)
- Tanner I Kim
- Queen's Health System, Honolulu, HI; Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI.
| | | | - Michael Murray
- Department of Genetics, Yale School of Medicine, New Haven, CT
| | - He Wang
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Arya Mani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
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Sivakumar A, Satam K, Wu Z, Alameddine D, Aboian E, Chaer R, Schermerhorn M, Moreira C, Guzman R, Chaar CIO. Presentation and patterns of reinterventions after revascularization in patients with premature Peripheral Arterial Disease. J Vasc Surg 2024:S0741-5214(24)01516-7. [PMID: 39002606 DOI: 10.1016/j.jvs.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/30/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Premature peripheral arterial disease (PAD) (age ≤ 50) has been shown to negatively impact the outcomes of lower extremity revascularization (LER). Patients with premature PAD have an increased risk of major amputation compared to older patients. The primary goal of this study is to compare the frequency of reinterventions after LER in patients with premature PAD to their older counterparts with common age of presentation (i.e., 60-80 years). METHODS A retrospective review of consecutive patients undergoing LER for PAD in a single center was performed. Clinical, procedural, and socioeconomic characteristics were compared between patients with premature PAD and the older group. Perioperative as well as long-term outcomes were captured and compared including mortality, major amputation, reintervention rate and frequency, as well as major adverse limb events (MALEs). RESULTS There were 1,274 patients who underwent LER (4.3% premature, 61.8% age 60-80). Premature PAD patients were more likely to be females of racial minorities. Notably, the mean distressed communities index (DCI) score was significantly higher in the premature PAD group compared to the older patients. Patients with premature PAD were significantly more likely to have end-stage renal disease but less likely to have hypertension, hyperlipidemia, and coronary artery disease compared to older patients. There was no significant difference in perioperative complications. After a mean follow up of 5 years, patients with premature PAD were significantly more likely to undergo more frequent reinterventions compared to older patients. Kaplan-Meier curves showed similar overall survival and MALE-free survival between the 2 groups. CONCLUSIONS Patients with premature PAD are likely to undergo more frequent reinterventions after initial LER and have similar 5-year survival curves compared to patients at least 20 years older. Demographic and socioeconomic differences impacting patients with premature PAD, even in this relatively underpowered institutional experience, are striking and warrant further investigation.
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Affiliation(s)
| | - Keyuree Satam
- Division of Vascular and Endovascular Surgery, Stanford Hospital
| | - Zhen Wu
- Department of Environmental Health Science, Yale School of Public Health, Yale University
| | - Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine
| | - Edouard Aboian
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine
| | - Rabih Chaer
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center
| | - Marc Schermerhorn
- Division of Vascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center
| | - Carla Moreira
- Divison of Vascular Surgery, Department of Surgery, Brown University
| | - Raul Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine
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Hou B, Gang Q, Li X, Lun Y, Jiang H, Shen S, Xin S, Zhang J. Clinical implications of diverse calcification patterns in endovascular therapy for femoral-popliteal arterial occlusive disease. J Vasc Surg 2024; 80:188-198.e1. [PMID: 38301808 DOI: 10.1016/j.jvs.2024.01.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The aim of this study was to investigate whether intimal arterial calcification (IAC) and medial arterial calcification (MAC) are correlated with the various clinical outcomes following endovascular therapy (EVT) for peripheral arterial disease (PAD). METHODS This single-center retrospective study comprised 154 consecutively hospitalized individuals with PAD who underwent EVT for de novo femoral-popliteal calcific lesions from January 2016 to July 2021. The predominant calcification patterns of IAC and MAC were assessed using a semi-quantitative computed tomography scoring system. The Kaplan-Meier method and Cox regression were conducted to evaluate the correlations between calcification patterns and medium- to long-term outcomes. RESULTS The distribution of calcification patterns was as follows: IAC in 111 patients (72%) and MAC in 43 patients (28%). No remarkable variation was noted between the IAC and MAC groups regarding age (P = .84) and gender (P = .23). The MAC group indicated lower rates of 4-year primary patency, assisted primary patency, secondary patency, and amputation-free survival (AFS) compared with the IAC group (24% ± 7% vs 40% ± 6%; P = .003; 30% ± 8% vs 51% ± 6%; P = .001; 51% ± 8% vs 65% ± 5%; P = .004; and 43% ± 9% vs 76% ± 5%; P < .001, respectively). There was no significant difference in the rate of freedom from clinically driven target lesion revascularization between the MAC and IAC groups (63% ± 10% vs 73% ± 5%; P = .26). Stepwise multivariable Cox regression analysis demonstrated that MAC was associated with poor patency (hazard ratio, 1.81; 95% confidence interval, 1.12-2.93; P = .016) and AFS (hazard ratio, 2.80; 95% confidence interval, 1.52-5.16; P = .001). CONCLUSIONS Compared with IAC, MAC is independently associated with lower medium- to long-term patency and AFS after EVT for de novo femoral-popliteal occlusive lesions.
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Affiliation(s)
- Bingchen Hou
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Qingwei Gang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Xinyang Li
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yu Lun
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Han Jiang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shikai Shen
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shijie Xin
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Jian Zhang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China.
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Yuan F, Tracci MC, Clouse WD, Robinson WP. Outcomes of open and endovascular infra-inguinal revascularization are poor in young patients with atherosclerotic peripheral artery disease but do not differ between genders. Vascular 2024; 32:337-346. [PMID: 36377515 DOI: 10.1177/17085381221140160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES The effect of gender on the outcomes of revascularization procedures in young patients with premature atherosclerotic peripheral arterial disease (PAD) is not known. The objective of this study was to compare short-term and long-term outcomes between young males and females undergoing infra-inguinal revascularization procedures. METHODS We examined postoperative outcomes of male and female PAD patients under the age of 55 who underwent infra-inguinal revascularization procedures at a single tertiary institution from 2011 to 2019. Primary outcomes included 30-day morbidity, patency of the revascularization procedures, and major adverse limb events (MALE). Secondary outcomes included survival, amputation rate, reintervention rate, improvement of ankle-brachial index (ABI), and number of reinterventions. RESULTS Eighty-one infra-inguinal revascularization procedures (46 endovascular and 35 open procedures) were reviewed including 45 procedures in 37 males and 36 procedures in 31 females. Fifty-three (65.4%) of the procedures were performed in patients with chronic limb-threatening ischemia symptoms. The rest were treated for life-disabling claudication. The female patients were younger, had higher body mass index, and were more likely to have diabetes, hyperlipidemia, or chronic obstructive pulmonary disease in comparison to males. Thirty-day major adverse cardiovascular event was 0.0% and MALE was 16.0%. Mean follow-up was 806.2 days. At 1 year, primary patency was 34.4 ± 6.2%, primary assisted patency was 52.7 ± 6.5%, secondary patency was 61.8 ± 6.3%, and MALE-free rate was 47.0 ± 6.4%. For secondary outcomes at 1 year, amputation-free rate was 92.5 ± 3.2%, reintervention-free rate was 50.2 ± 6.4%, and survival was 96.2 ± 2.6%. By the end of the study, overall mortality rate was 14.8% and major amputation rate was 13.6%. No major differences were observed between males and females among these outcomes. A smaller improvement in ABI after revascularization was noted in females compared to males (female 0.2 ± 0.2 vs male 0.4 ± 0.2, p = .04). Among patients who required reintervention, females required a higher number of reinterventions than males (female 1.7 ± 2.5 vs male 0.8 ± 1.1, p = .03). CONCLUSIONS There were no significant differences in short-term and long-term outcomes between males and females under the age of 55 after infra-inguinal revascularization. Poor patency, high MALE rate, and high mid-term mortality, and amputation rates after revascularization in young PAD patients highlight the need for improved strategies to treat premature PAD.
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Affiliation(s)
- Fang Yuan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - William P Robinson
- Division of Vascular Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
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Telianidis S, Aitken SJ. The prevalent causes of death in patients with peripheral artery disease undergoing revascularisation or amputation. Vascular 2024:17085381241236562. [PMID: 38411009 DOI: 10.1177/17085381241236562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Preventing untimely death in patients with peripheral artery disease (PAD) requires a detailed understanding of the predominant causes of death (COD). This literature review aims to describe how short- and long-term COD are reported in patients who had surgery for PAD. METHODS A literature review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for articles reporting specific causes of mortality in patients who had surgery for all stages of PAD. Articles were included if they reported COD after open surgical or endovascular revascularisation, or major or minor amputation for PAD. Critical appraisals were conducted according to included study types, using the Joanna Briggs Institute tools. RESULTS Cause of death was reported in 21 publications. Twenty were observational and one was a randomised control trial. Study size ranged from 25 to 10,505 patients. Cardiovascular disease was the most prevalent COD in perioperative periods (42.5% from 13 studies). Long-term follow-up ranged from 1 month and 7 years with 15 studies reporting cardiac related mortality as the most frequent cause of death. However, mortality from neoplasia, respiratory disease (including pneumonia and pulmonary emboli), stroke and sepsis were prevalent. Many studies were low-average quality, with few population-based observational studies. CONCLUSION Whilst cardiovascular COD are the most prevalent reasons for mortality in patients with PAD, the proportion of patients dying from neoplasia and respiratory disease is high. Improved reporting standards for COD in studies examining PAD are needed.
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Affiliation(s)
- Stacey Telianidis
- Master of Surgery Student, Vascular Surgery at The Austin Hospital, University of Sydney, and Unaccredited Vascular Surgery Registrar, The Austin Hospital Melbourne, Melbourne, VIC, Australia
| | - Sarah Joy Aitken
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, and Concord Institute of Academic Surgery, Concord, NSW, Australia
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Kim TI, Loh S, DeWan A, Murray M, Mojibian H, Mani A, Mena-Hurtado C, Ochoa Chaar CI. Major adverse limb events among patients with premature peripheral artery disease compared with those at the common age undergoing revascularization in the Vascular Quality Initiative. Ann Vasc Surg 2022; 87:188-197. [PMID: 35926786 DOI: 10.1016/j.avsg.2022.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Premature peripheral artery disease (PAD), defined as ≤ 50 years of age, is associated with poor outcomes following lower extremity revascularization (LER). However, the specific characteristics and outcomes of this group of patients compared to those at the common age undergoing revascularization have not been examined. The aim of this study is to compare patients with early versus late onset premature PAD undergoing LER focusing on major adverse limb events (MALEs). METHODS All LER procedures (open and endovascular) in the Vascular Quality Initiative (VQI) were reviewed. A histogram of patient age at the time of initial LER (no prior LER) was used to define the common age, which included all patients within one standard deviation of the mean. Characteristics and outcomes of patients with premature PAD were compared to patients treated at the common age of presentation undergoing LER. RESULTS A histogram of all patients undergoing LER was used to define 60 to 80 years as the common age. Patients with premature PAD were more likely to be female, African American, and Hispanic compared to patients at the common age. Patients with premature PAD were also more likely to have insulin-dependent diabetes, be current smokers, on dialysis, and be treated for claudication. Patients with premature PAD were less likely to have Transatlantic Intersociety Consensus (TASC II) C or D disease and were less likely to be on antiplatelets and statins. These differences were more pronounced in patients with chronic limb-threatening ischemia (CLTI). Cox proportional hazards regression demonstrated that premature PAD was independently associated with major adverse limb events (MALEs) at one-year for patients with claudication (HR:1.7, 95% CI:1.4-2.0) and CLTI (HR:1.3, 95% CI:1.2-1.5) compared to patients 60 to 80 years of age. CONCLUSION Patients with premature PAD have significant differences in characteristics compared to patients treated at the common age. Vascular providers should emphasize medical therapy prior to LER given the lower rates of medical optimization and worse one-year MALEs in patients with premature PAD.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Sarah Loh
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - Michael Murray
- Department of Genetics, Yale School of Medicine, New Haven, CT
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Arya Mani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Nick S, Inge F, Hilde R, Leandra BDW, Cedric S, Michael F, Lijckle VDL. Age-dependent outcome of first-line endovascular and surgical revascularization strategies in chronic limb-threatening ischemia. Ann Vasc Surg 2022; 85:133-145. [PMID: 35395378 DOI: 10.1016/j.avsg.2022.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/09/2022] [Accepted: 03/20/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Chronic limb-threatening ischemia (CLTI) has a high mortality and amputation risk even after revascularization. Due to an ageing population the incidence of peripheral arterial disease is rising. However, the current age distribution in patients with CLTI and the impact of age on outcome remains unclear. For this reason we performed an age-dependent analysis of mortality, morbidity, and amputation-free survival after open surgical revascularization (OSR) and endovascular revascularization therapy (ERT) with identification of risk factors for mortality. Standardized mortality ratios (SMR) were calculated, comparing observed deaths in the study population to expected deaths based on age and gender specific mortality rates of the overall Dutch population. METHODS Patients revascularized for a first episode of CLTI between 2013 and 2018 were included in this multicenter retrospective cohort study. The cohort was divided in two treatment groups (OSR and ERT) who were each stratified in three age groups: early age group <65 years (G1), middle age group 65-74 years (G2) and elderly age group ≥75 years (G3). RESULTS During the study period 274 limbs (43.9%) were treated with OSR and 350 limbs (56.1%) with ERT. The young population (G1) is only a small part of the whole CLTI population, namely for OSR 22% and ERT 18%. The risk profile of the early age group was characterized by male sex and smoking, while the elderly age group was characterized by poor arterial runoff, tissue loss, hypertension, hypercholesterolemia, chronic kidney disease, history of heart disease, COPD and cerebrovascular disease. One year amputation rates were similar between the age groups. However, significantly higher one year mortality rates were observed in patients ≥75 years in comparison to the low mortality rates in patients <75 years. (OSR: G3 19.8% vs G2 7.1% and G1 6.7%, P = .006; ERT: G3 30.7 vs G2 12.7% and G1 7.8%, P = .001). The SMR in this elderly group equaled 3.72 after OSR and 4.04 after ERT. Independent risk factors for mortality after OSR were age, hazard ratio (HR) 1.03 (95% confidence interval (CI) 1.01-1.06; P = .006), preoperative hemoglobin level, HR 0.79 (95% CI 0.67-0.92; P = .003), tissue loss, HR 1.85; 95% CI 1.22-2.79; P = .004), cardiac history, HR 1.56 (95% CI 1.06-2.30; P = .024) and development of postoperative delirium, HR 2.75 (95% CI 1.61-4.71; P < .001) . After ERT we identified age, HR 1.06 (95% CI 1.04-1.08; P < .001), preoperative hemoglobin level, HR 0.75 (95% CI 0.65-0.87; P < .001), tissue loss, HR 1.71 (95% CI 1.15-2.53; P = .008), history of chronic obstructive pulmonary disease (COPD), HR 1.99 (95% CI 1.43-1.79; P < .001), history of cerebrovascular accident (CVA), HR 1.55 (95% CI 1.09-2.21; P = .015), the development of postoperative pneumonia, HR 2.27 (95% CI 1.24-4.16; P = .008), postoperative acute kidney injury (AKI), HR 2.42 (95% CI 1.29-4.54; P = .006) and postoperative CVA, HR 8.17 (95% CI 1.96-34.15; P = .004) as risk factors. CONCLUSIONS The current CLTI population consists mostly of elderly patients and only a small part is younger than 65 years. This shift in the population is important because increasing age is associated with considerable higher one year mortality rates regardless of the method of revascularization in patients with CLTI. The mortality rates in the elderly group are three to four times larger than expected in the general population. In relation to the high mortality of the elderly patient, we assume that interventions to prevent postoperative delirium and correct preoperative anemia may be warranted as they appear to be independent risk factors for mortality.
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Affiliation(s)
- Smet Nick
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Fourneau Inge
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Roeleveld Hilde
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Boonman-de Winter Leandra
- Department of Science and Statistics, Amphia Hospital, Breda, the Netherlands; Management Board, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Schraepen Cedric
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Favoreel Michael
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - van der Laan Lijckle
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Cardiovascular Sciences, Research group of Vascular Surgery, KU Leuven, Leuven, Belgium.
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Kim TI, Zhang Y, Cardella JA, Guzman RJ, Ochoa Chaar CI. Outcomes of bypass and endovascular interventions for advanced femoropopliteal disease in patients with premature peripheral artery disease. J Vasc Surg 2021; 74:1968-1977.e3. [PMID: 34090986 DOI: 10.1016/j.jvs.2021.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with premature peripheral artery disease (PAD), defined as age ≤50 years at presentation, have had poor outcomes with open and endovascular lower extremity revascularization. It is unclear whether either strategy is associated with better outcomes because comparative studies have been limited to case series in this patient population. The aim of the present study was to compare the outcomes of patients with premature PAD who had undergone bypass or endovascular revascularization for advanced femoropopliteal disease. Our hypothesis was that open bypass would provide superior long-term outcomes compared with endovascular intervention for patients with premature advanced femoropopliteal PAD. METHODS All the patients with premature PAD who had undergone isolated femoropopliteal lower extremity revascularization and included in the Vascular Quality Initiative infrainguinal bypass and peripheral vascular intervention files were reviewed from 2003 through 2019. Propensity score matching (1:1) was performed between patients who had undergone femoropopliteal bypass and endovascular interventions for isolated femoropopliteal Trans-Atlantic Classification System C or D lesions. The 1-year outcomes, including reintervention, patency, major amputation, and mortality, were analyzed. RESULTS Of the 2538 included patients, 902 had undergone isolated femoropopliteal endovascular intervention and 1636 had undergone femoropopliteal bypass. The endovascular intervention group were more likely to have diabetes (68.9% vs 54.0%; P < .001), coronary artery disease (31.0% vs 23.0%; P < .001), renal failure requiring dialysis (14.2% vs 7.2%; P < .001), and claudication (45.1% vs 36.6%; P < .001) compared with the bypass group. After propensity score matching, 466 patients were in each group with no significant differences in the baseline characteristics. Perioperative morbidity was higher with femoropopliteal bypass compared with endovascular intervention (12.0% vs 7.9%; P = .038); however, the rates of major amputation and mortality were not different. At 1 year, patients who had undergone femoropopliteal bypass were less likely to require reintervention (17.0% vs 25.2%; P = .012). However, no differences were found in major amputation (7.7% vs 7.9%; P = .928) or mortality (5.2% vs 5.2%; P = 1.00). Propensity score matching was also performed between femoropopliteal bypass with the great saphenous vein and isolated femoropopliteal endovascular interventions, and the outcomes were similar. CONCLUSIONS For patients with premature PAD and advanced femoropopliteal disease, bypass surgery decreased the reintervention rate at 1 year but was associated with increased perioperative morbidity and hospital length of stay compared with endovascular therapy. No differences were found in major amputation or mortality between the two strategies.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Yawei Zhang
- Department of Surgery, Yale University School of Medicine, New Haven, Conn; Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, Conn
| | - Jonathan A Cardella
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Raul J Guzman
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
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Madigan MC, Farber A, Rybin DV, Doros G, Robinson WP, Siracuse JJ, Eldrup-Jorgensen J, Eslami MH. Younger patients have worse outcomes after peripheral endovascular interventions for suprainguinal arterial occlusive disease. J Vasc Surg 2020; 73:1715-1722. [PMID: 32987148 DOI: 10.1016/j.jvs.2020.08.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The choice of intervention for treating suprainguinal arterial disease, open bypass vs endovascular intervention, is often tempered by patient age and comorbidities. In the present study, we compared the association of patient age with 1-year major adverse limb events (MALE)-free survival and reintervention-free survival (RFS) rates among patients undergoing intervention for suprainguinal arterial disease. METHODS The Vascular Quality Initiative datasets for bypass and peripheral endovascular intervention (PVI; aorta and iliac only) were queried from 2010 to 2017. The patients were divided into two age groups: <60 and ≥60 years at the procedure. Age-stratified propensity matching of patients in bypass and endovascular procedure groups by demographic characteristics, comorbidities, and disease severity was used to identify the analysis samples. The 1-year MALE-free survival and RFS rates were compared using the log-rank test and Kaplan-Meier plots. Proportional hazard Cox regression was used to perform propensity score-adjusted comparisons of MALE-free survival and RFS. RESULTS A total of 14,301 cases from the Vascular Quality Initiative datasets were included in the present study. Propensity matching led to 3062 cases in the ≥60-year group (1021 bypass; 2041 PVI) and 2548 cases in the <60-year group (1697 bypass; 851 PVI). In the crude comparison of the matched samples, the older patients undergoing bypass had had significantly greater in-hospital (4.6% vs 0.9%; P < .001) and 1-year (10.5% vs 7.5%; P = .005) mortality compared with those who had undergone endovascular intervention. The rates of MALE (7.5% vs 14.3%; P < .001) and reintervention (6.7% vs 12.7%; P < .001) or death were significantly higher for the younger group undergoing PVI than bypass at 1 year. However, the rates of MALE (12.9% vs 14.3%; P = .298) and reintervention (12.7% vs 12.9%; P = .881) or death for were similar both procedures for the older group. Both log-rank analyses and the adjusted propensity score analyses of MALE-free survival and RFS in the two age groups confirmed these findings. The adjusted comparison of outcomes using propensity score matching favored PVI at 1-year survival (hazard ratio, 1.4; 95% confidence interval, 1.1-1.9; P = .003) for the older group but was not different for the younger group (hazard ratio, 0.6; 95% confidence interval, 0.3-1.0; P = .054). CONCLUSIONS Among the patients aged <60 years undergoing intervention for suprainguinal arterial disease, the choice of therapy should be open surgical intervention given the higher risk of reintervention and MALE with endovascular intervention. Endovascular intervention should be favored for patients aged ≥60 years because of reduced perioperative mortality.
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Affiliation(s)
- Michael C Madigan
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical School, Pittsburgh, Pa
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass
| | - Denis V Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Gheorhge Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - William P Robinson
- Division of Vascular Surgery, East Carolina University Brody School of Medicine, Greenville, NC
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass
| | | | - Mohammad H Eslami
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical School, Pittsburgh, Pa.
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Kim TI, Aboian E, Fischer U, Zhang Y, Guzman RJ, Ochoa Chaar CI. Lower Extremity Revascularization for Chronic Limb-Threatening Ischemia among Patients at the Extremes of Age. Ann Vasc Surg 2020; 72:517-528. [PMID: 32927042 DOI: 10.1016/j.avsg.2020.08.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with chronic limb-threatening ischemia (CLTI) at the extremes of age are thought to have distinct risk factor profiles and poor outcomes after lower extremity revascularization (LER). The aim of this study is to examine the relationships among age, risk factor profiles, and outcomes of LER in patients with CLTI in a large database focusing on the extreme age groups. METHODS Patients undergoing LER for CLTI in the Vascular Quality Initiative suprainguinal bypass, infrainguinal bypass, and peripheral vascular intervention files were reviewed through 2019. Patients were stratified into 3 groups: premature peripheral artery disease (PAD) (≤50 years old), 51-84 years old, and elderly (≥85 years old). Trends in major amputation and mortality by age group were analyzed. RESULTS There were 156,513 patients who underwent LER for CLTI. Of these, 9,063 (5.79%) patients had premature PAD, 131,694 (84.14%) patients were 51-84 years old, and 15,756 (10.07%) were elderly. Patients with premature PAD were more likely to have insulin-dependent diabetes, be dialysis-dependent, and be active smokers compared to patients 51-84 years old and the elderly. Elderly patients were more likely to undergo an endovascular procedure for tissue loss compared to younger groups. Perioperative and 1-year major amputation rates were highest among patients with premature PAD and decreased with increasing age (P < 0.001), while perioperative and 1-year mortality increased with age (P < 0.001). On multivariable analysis, premature PAD was associated with an increased risk of major amputation (odds ratio, OR = 1.41 [1.22-1.62]), while elderly age was associated with decreased odds of major amputation compared to patients 51-84 years old (OR = 0.61 [0.51-0.73]). CONCLUSIONS Patients at the extremes of age have significantly different outcomes after LER for CLTI. Although mortality increases with age, the risk of major amputation decreases. Patients with premature PAD constitute a group of patients with a high risk of perioperative and 1-year major amputation.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edouard Aboian
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Uwe Fischer
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Yawei Zhang
- Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
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11
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Torrealba JI, Osman M, Kelso R. Hypercoagulability predicts worse outcomes in young patients undergoing lower extremity revascularization. J Vasc Surg 2018; 70:175-180. [PMID: 30583891 DOI: 10.1016/j.jvs.2018.09.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Although we know that young patients with peripheral artery disease (PAD) have worse outcomes than older patients, there is a scarcity of information about the incidence of hypercoagulability in this population. Our aim was to analyze outcomes of young patients diagnosed with a hypercoagulable state (unusual tendency toward thrombosis) after lower extremity revascularization compared with similar patients without hypercoagulability. METHODS All patients 50 years of age or younger undergoing an initial procedure for lower extremity PAD from 2000 to 2015 at the Cleveland Clinic were retrospectively analyzed. Patients with a hypercoagulability panel were included and classified into groups as hypercoagulable positive (HP) or hypercoagulable negative (HN). Demographics, preoperative risk factors, form of presentation, level of disease, and type of intervention were analyzed in addition to perioperative complications, early failure, and length of stay. Primary outcomes were limb loss and primary, primary assisted, and secondary patencies. Outcomes were analyzed and Kaplan-Meier curves generated. RESULTS Ninety-one patients were included for a total of 118 limbs. Mean follow-up was 32 months; 55% of patients had a hypercoagulable disorder, with 59% having lupus anticoagulant and 32% hyperhomocysteinemia. In the HP group, 71% were men; 49% were men in the HN group. Patients overall had a high prevalence of smoking (86%), hypertension (36%), and hyperlipidemia (33%). Acute limb ischemia was the most common form of presentation for both groups (50% HP, 38% HN). The aortoiliac segment was the most commonly affected (38% HP, 50% HN). The most frequent operation in the HN group was endarterectomy or bypass (32%); in the HP group, it was an endovascular intervention (29%). Perioperative occlusion or failure was 18% in the HN group vs 30% in the HP group (P > .05). Primary patency, primary assisted patency, and secondary patency at 36 months were all better for the HN group (no statistical significance) in all treatment groups. Major amputation at 36 months was significantly worse for the HP group (40% vs 10% in the HN group; P < .005). There was no difference in perioperative complications or length of stay. CONCLUSIONS Young patients undergoing lower extremity revascularization for PAD have worse outcomes when associated with hypercoagulability. There are trends to decreased patency of revascularization in these patients, with significantly more major amputations. No clear differences between modalities of treatment were demonstrated.
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Affiliation(s)
- Jose Ignacio Torrealba
- Vascular and Endovascular Department, Cleveland Clinic Foundation, Cleveland, Ohio; Vascular and Endovascular Department, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Mohamed Osman
- Vascular and Endovascular Department, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rebecca Kelso
- Vascular and Endovascular Department, Novant Health Heart and Vascular Institute, Charlotte, NC
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The acute effects of lower limb intermittent negative pressure on foot macro- and microcirculation in patients with peripheral arterial disease. PLoS One 2017; 12:e0179001. [PMID: 28591174 PMCID: PMC5462420 DOI: 10.1371/journal.pone.0179001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/22/2017] [Indexed: 02/04/2023] Open
Abstract
Background Intermittent negative pressure (INP) applied to the lower leg and foot increases foot perfusion in healthy volunteers. The aim of the present study was to describe the effects of INP to the lower leg and foot on foot macro- and microcirculation in patients with lower extremity peripheral arterial disease (PAD). Methods In this experimental study, we analyzed foot circulation during INP in 20 patients [median (range): 75 (63-84yrs)] with PAD. One leg was placed inside an air-tight vacuum chamber connected to an INP-generator. During application of INP (alternating 10s of -40mmHg/7s of atmospheric pressure), we continuously recorded blood flow velocity in a distal foot artery (ultrasound Doppler), skin blood flow on the pulp of the first toes (laser Doppler), heart rate (ECG), and systemic blood pressure (Finometer). After a 5-min baseline sequence (no pressure), a 10-min INP sequence was applied, followed by 5-min post-INP (no pressure). To compare and quantify blood flow fluctuations between sequences, we calculated cumulative up-and-down fluctuations in arterial blood flow velocity per minute. Results Onset of INP induced an increase in arterial flow velocity and skin blood flow. Peak blood flow velocity was reached 3s after the onset of negative pressure, and increased 46% [(95% CI 36–57), P<0.001] above baseline. Peak skin blood flow was reached 2s after the onset of negative pressure, and increased 89% (95% CI 48–130), P<0.001) above baseline. Cumulative fluctuations per minute were significantly higher during INP-sequences compared to baseline [21 (95% CI 12–30)cm/s/min to 41 (95% CI 32–51)cm/s/min, P<0.001]. Mean INP blood flow velocity increased significantly ~12% above mean baseline blood flow velocity [(6.7 (95% CI 5.2–8.3)cm/s to 7.5 (95% CI 5.9–9.1)cm/s, P = 0.03)]. Conclusion INP increases foot macro- and microcirculatory flow pulsatility in patients with PAD. Additionally, application of INP resulted in increased mean arterial blood flow velocity.
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Uhl C, Steinbauer M, Torsello G, Bisdas T, Adili F, Balzer K, Billing A, Böckler D, Brixner D, Debus SE, Eckstein HH, Florek HJ, Gkremoutis A, Grundmann R, Hupp T, Hwang SW, Keck T, Wojciech K, Lang W, May B, Meyer A, Mühling B, Oberhuber A, Reinecke H, Reinhold C, Ritter RG, Schelzig H, Schlensack C, Schmitz-Rixen T, Schulte KL, Spohn M, Stavroulakis K, Storck M, Trede M, Weis-Müller B, Wenk H, Zeller T, Zhorzel S, Zimmermann A. Outcomes After Endovascular Revascularization in Octogenarians and Non-Octogenarians With Critical Limb Ischemia. J Endovasc Ther 2017; 24:471-477. [DOI: 10.1177/1526602817711424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christian Uhl
- Department of Vascular Surgery, Barmherzige Brueder Hospital, Regensburg, Germany
| | - Markus Steinbauer
- Department of Vascular Surgery, Barmherzige Brueder Hospital, Regensburg, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, University Clinic of Münster, Germany
- Department of Vascular Surgery, St Franziskus Hospital GmbH, Münster, Germany
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14
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De Santis F, Pattaro C, Mani G, Pramstaller PP, Loreni G, Martini G. Factors Affecting Long-Term Results of Above-Knee Femoropopliteal Bypass. Vasc Endovascular Surg 2016; 50:72-9. [DOI: 10.1177/1538574415627866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: The aim of this study was to assess whether individual patients’ or bypass characteristics may influence long-term results of prosthetic above-knee femoropopliteal bypasses in patients with claudication in today’s endovascular era. Methods: Seventy-one consecutivee Expanded Polytetrafluoroethylene (e-PTFE) bypasses were considered. All patients presented a debilitating claudication. Patency of grafts was achieved by Kaplan-Meier method. The association between individual patients’ or graft characteristics and primary patency (PP) or secondary patency (SP) was assessed via Cox regression models. Results: An immediate technical success was achieved in all cases. No patient was lost during follow-up (8-90 months, median = 34 months). The median PP was 48 months. Occlusion occurred in 32 bypasses (45%). Eight (25%) of these were treated conservatively. Fifty-two bypasses (73%) were still patent at the end of follow-up, and 13 (25%) of these had been submitted to one or more surgical revisions. There were 2 graft infections. Of 17 (25%) patients with occluded graft at the end of follow-up, 2 (2.8%) had significant aggravation followed by limb loss. The PP was directly influenced by undetected minor distal anastomosis technical defects (hazard ratio [HR] = 5.89, P value = .000002), popliteal artery size (HR = 0.62, P value = 0.007), and distal anastomosis angle ≥40° (HR = 5.55, P value = .003). The SP was associated strictly to technical defects (HR = 11.08, P value = .000007). Multivariable analyses confirmed the influence of technical defects (HR = 6.42, P value = .000003) and anastomosis angle (HR = 1.05, P value = .009) on PP and that of technical defects on SP (HR = 10.84, P value = .00003). A significantly shorter SP was also observed after a previous failed endovascular treatment on the superficial femoral artery (HR = 3.73, P value = .02). Conclusion: An adequate arterial size, an ideal anastomotic angle, and the absence of minor, technical defects have a major role in prosthetic above-knee femoropopliteal bypass long-term outcome. A previous, failed endovascular procedure on the superficial femoral artery could markedly alter the natural history of patients with claudication because this approach seems to have a detrimental effect on long-term outcome of grafts needing surgical revisions
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Affiliation(s)
| | - Cristian Pattaro
- Center for Biomedicine, European Academy of Bolzano (EURAC), Affiliated Institute of the University of Lübeck, Germany
| | - Gabriele Mani
- Department of Vascular Surgery, Bressanone Hospital, Bressanone, Italy
| | - Peter Paul Pramstaller
- Center for Biomedicine, European Academy of Bolzano (EURAC), Affiliated Institute of the University of Lübeck, Germany
| | - Giorgio Loreni
- Department of Interventional Radiology, Sandro Pertini Hospital, Rome, Italy
| | - Guido Martini
- Department of Vascular Surgery, Bressanone Hospital, Bressanone, Italy
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Spinelli F, Pipitò N, Martelli E, Benedetto F, De Caridi G, Spinelli D, Stilo F. Endo first is not appropriate in some patients with critical limb ischemia because "bridges are burned". Ann Vasc Surg 2014; 29:272-7. [PMID: 25433285 DOI: 10.1016/j.avsg.2014.09.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aims of this study were to determine the effect of failed prior endovascular treatment (EV) on early and midterm outcomes of subsequent lower extremity open surgical (OS) bypass. METHODS Patients undergoing infrainguinal bypass for critical limb ischemia (CLI) from January 2008 to December 2011 were retrospectively reviewed. The results after first-line bypass and bypass after failure of EV treatment were compared. A total of 213 patients (65.25% men; average age, 73.30 years) underwent bypass. OS patients were then divided into 2 groups: group 1 consisted of 138 patients who underwent primary OS for CLI without prior EV (control group) and group 2 consisted of 75 patients who had OS after a failed attempt at elective EV for peripheral vascular disease. Of the 213 bypass performed, 34% had a prior infrainguinal failed EV. The primary study end points were early and 1-year major amputations and graft occlusion. The secondary outcomes included early and 1-year mortality and the level of distal revascularization. RESULTS Secondary patency and limb salvage rates were significantly better in group 1 up to 1 year (99% vs. 86%; P < 0.001 at 1 month and 95% vs. 76%, P < 0.05 at 12 months, respectively). CONCLUSIONS Previous failed EV should be predictive of poor outcome in patients undergoing distal OS for CLI.
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Affiliation(s)
- Francesco Spinelli
- Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy.
| | - Narayana Pipitò
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Eugenio Martelli
- Division of Vascular Surgery, University of Sassari, Sassari, Italy
| | - Filippo Benedetto
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Giovanni De Caridi
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Domenico Spinelli
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Francesco Stilo
- Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy
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Friedell ML, Stark KR, Kujath SW, Carter RR. Current status of lower-extremity revascularization. Curr Probl Surg 2014; 51:254-90. [DOI: 10.1067/j.cpsurg.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/25/2014] [Indexed: 11/22/2022]
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Pulli R, Dorigo W, Guidotti A, Fargion A, Alessi Innocenti A, Pratesi C. The role of infrainguinal bypass surgery in the endovascular era. Ann Vasc Dis 2014; 7:7-10. [PMID: 24719655 DOI: 10.3400/avd.ra.13-00124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/19/2013] [Indexed: 11/13/2022] Open
Abstract
The current worldwide trend in the treatment of peripheral arterial disease (PAD) is towards an increase in endovascular procedures either in the aorto-iliac area or in the infrainguinal district. However, the role of the open repair with a femoro-popliteal bypass is still debated and in our opinion there still a room for traditional surgery in the presence of complex lesions involving the superficial femoral artery and the popliteal and tibial vessels. In this field, vein bypass provides better results than prosthetic grafts, but in selected cases and not only in the absence of a suitable vein, new modified grafts may be used with satisfactory results. The choice between the two options, open and endovascular, that in some cases can be associated in hybrid procedures, depends on several factors. Only if we are able to take into account all the different preoperative issues, we could choose the right procedure in the right patient.
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Affiliation(s)
- Raffaele Pulli
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Walter Dorigo
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Azzurra Guidotti
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Aaron Fargion
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | | | - Carlo Pratesi
- Department of Vascular Surgery, University of Florence, Florence, Italy
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Evolución del uso de técnicas endovasculares para revascularización infrainguinal de miembros inferiores en el periodo 2005-2011. Experiencia de nuestro centro. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2013.03.009] [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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