1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Sivakumar A, Satam K, Wu Z, Alameddine D, Aboian E, Chaer R, Schermerhorn M, Moreira C, Guzman R, Ochoa Chaar CI. 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 years) 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 with 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 (ie, 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 and long-term outcomes were captured and compared including mortality, major amputation, reintervention rate and frequency, as well as major adverse limb events. RESULTS There were 1274 patients who underwent LER (4.3% premature, 61.8% age 60-80). Patients with premature PAD were more likely to be females of racial minorities. Notably, the mean Distressed Communities Index score was significantly higher in the premature PAD group compared with 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 with 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 with older patients. Kaplan-Meier curves showed similar overall survival and major adverse limb event-free survival between the two groups. CONCLUSIONS Patients with premature PAD are likely to undergo more frequent reinterventions after initial LER and have similar 5-year survival curves compared with 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.
Collapse
Affiliation(s)
- Anishaa Sivakumar
- Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT.
| | - Keyuree Satam
- Division of Vascular and Endovascular Surgery, Stanford Hospital, Palo Alto, CA
| | - Zhen Wu
- Department of Environmental Health Science, Yale School of Public Health, Yale University, New Haven, CT
| | - Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edouard Aboian
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Rabih Chaer
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Marc Schermerhorn
- Division of Vascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Carla Moreira
- Divison of Vascular Surgery, Department of Surgery, Brown University, Providence, RI
| | - Raul Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Tsarapatsani K, Sakellarios AI, Tsakanikas VD, Trampisch HJ, Rudolf H, Tachos N, Kleber ME, Marz W, Fotiadis DI. Machine Learning Models Predict the Need of Amputation and/or Peripheral Artery Revascularization in Hypertensive Patients Within 7-Years Follow-Up. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083139 DOI: 10.1109/embc40787.2023.10340447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Lower extremity amputation and requirement of peripheral artery revascularization are common outcomes of undiagnosed peripheral artery disease patients. In the current work, prediction models for the need of amputation or peripheral revascularization focused on hypertensive patients within seven years follow up are employed. We applied machine learning (ML) models using classifiers such as Extreme Gradient Boost (XGBoost), Random Forest (RF) and Adaptive Boost (AdaBoost), that will allow clinicians to identify the patients at risk of these two endpoints using simple clinical data. We used the non-interventional cohort of the getABI study in the primary care setting, selecting 4,191 hypertensive patients out of 6,474 patients with age over 65 years old and followed up for vascular events or death up to 7 years. During this follow up period, 150 patients underwent either amputation or peripheral revascularization or both. Accuracy, Specificity, Sensitivity and Area under the receiver operating characteristic curve (AUC) were estimated for each machine learning model. The results demonstrate Random Forest as the most accurate model for the prediction of the composite endpoint in hypertensive patients within 7 years follow-up, achieving 73.27 % accuracy.Clinical Relevance-This study assists clinicians to better predict and treat these serious outcomes, amputation and peripheral revascularization in hypertensive patients.
Collapse
|
5
|
Wang X, Yang Y, Zhang J, Zang S. Development and validation of a prediction model for the prolonged length of stay in Chinese patients with lower extremity atherosclerotic disease: a retrospective study. BMJ Open 2023; 13:e069437. [PMID: 36759024 PMCID: PMC9923290 DOI: 10.1136/bmjopen-2022-069437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES This study aims to develop and internally validate a prediction model, which takes account of multivariable and comprehensive factors to predict the prolonged length of stay (LOS) in patients with lower extremity atherosclerotic disease (LEAD). DESIGN This is a retrospective study. SETTING China. PARTICIPANTS, PRIMARY AND SECONDARY OUTCOMES Data of 1694 patients with LEAD from a retrospective cohort study between January 2014 and November 2021 were analysed. We selected nine variables and created the prediction model using the least absolute shrinkage and selection operator (LASSO) regression model after dividing the dataset into training and test sets in a 7:3 ratio. Prediction model performance was evaluated by calibration, discrimination and Hosmer-Lemeshow test. The effectiveness of clinical utility was estimated using decision curve analysis. RESULTS LASSO regression analysis identified age, gender, systolic blood pressure, Fontaine classification, lesion site, surgery, C reactive protein, prothrombin time international normalised ratio and fibrinogen as significant predictors for predicting prolonged LOS in patients with LEAD. In the training set, the prediction model showed good discrimination using a 500-bootstrap analysis and good calibration with an area under the receiver operating characteristic of 0.750. The Hosmer-Lemeshow goodness of fit test for the training set had a p value of 0.354. The decision curve analysis showed that using the prediction model both in training and tests contributes to clinical value. CONCLUSION Our prediction model is a valuable tool using easily and routinely obtained clinical variables that could be used to predict prolonged LOS in patients with LEAD and help to better manage these patients in routine clinical practice.
Collapse
Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Yu Yang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
6
|
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.
Collapse
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
| | | |
Collapse
|
7
|
Jain A, Reddy A, Murugesan R, Dutta S, Kumbhar U, Savlania A, Vaka SK. Outcomes of Patients With Acute Limb Ischemia in Patients With COVID-19: A Systemic Review and Meta-Analysis. Cureus 2022; 14:e27370. [PMID: 36046311 PMCID: PMC9418627 DOI: 10.7759/cureus.27370] [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] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
A systemic review and meta-analysis of perioperative outcomes of acute limb ischemia (ALI) in patients with and without coronavirus disease-2019 (COVID-19) to determine the outcomes of ALI and compare the outcomes in patients with and without COVID-19 infection. A literature search of the Medline, Science Direct and Cochrane Library was performed from inception to July 15, 2021. Studies involving ALI in patients with COVID-19 were searched through three electronic databases. The endpoints include limb salvage, re-thrombosis, and mortality, and these outcomes were compared between patients with and without COVID-19 infection and type of management. The primary outcome was early limb salvage (till the patient was discharged from the hospital). The other outcomes assessed were re-thrombosis and mortality. These outcomes were compared between patients with and without COVID-19 infection and the type of management. Pooled estimates were presented as odds ratios (ORs) using a random or fixed effect model based on the results of the chi-square test and calculation of I2. Comparing the ALI outcomes in patients with and without COVID-19 infection, there was no significant difference in limb salvage rate (OR=0.26, 95% CI:0.02-3.09), but there was a significantly higher re-thrombosis (OR=2.65, 95% CI:1.34-5.23) and mortality rate (OR=4.71, 95% CI:1.11-19.99) in patients with COVID-19 infection. On comparing outcomes based on management, intervention group, and anticoagulant alone group, no significant difference was noted concerning limb salvage (OR=1.40, 95% CI:0.27-7.13) and mortality rates (OR=0.2, 95% CI:0.04-1.07). This meta-analysis demonstrates a higher re-thrombosis and mortality in ALI patients with COVID-19 infection when compared to patients without COVID-19 but with similar limb salvage.
Collapse
Affiliation(s)
- Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rajeswari Murugesan
- Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ajay Savlania
- Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sivaranjit K Vaka
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| |
Collapse
|
8
|
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: 11] [Impact Index Per Article: 3.7] [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.
Collapse
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.
| |
Collapse
|
9
|
Saldana-Ruiz N, Dominguez J, Ham SW, Rowe VL, Magee GA, Weaver FA, Han SM, Ziegler KR. Effect of infrainguinal bypass tunneling technique on patency and amputation in patients with limb ischemia. J Vasc Surg 2021; 74:1242-1250. [PMID: 33845170 DOI: 10.1016/j.jvs.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We investigated the association of tunneling technique on patency and amputation in patients undergoing lower extremity bypass for limb ischemia. METHODS The National Vascular Quality Initiative database infrainguinal bypass module from 2008 to 2017 was queried for analysis. We excluded cases with non-great saphenous vein grafts, grafts using multiple segments, aneurysmal disease indications, bypass locations outside the femoral to below the knee popliteal artery or tibial arteries, and missing data on tunneling type and limb ischemia. The main exposure variable was the tunneling type, subcutaneously vs subfascially. Our primary outcomes were primary patency and amputation. The secondary outcomes included primary-assisted patency and secondary patency. Univariate and multivariate logistic regression models were used. RESULTS A total of 5497 bypass patients (2835 subcutaneous and 2662 subfascial) were included. Age, race, graft orientation (reversed vs not reversed), bypass donor and recipient vessels, harvest type, end-stage renal disease, smoking, coronary artery bypass graft, congestive heart failure, P2Y12 inhibitor at discharge, surgical site infection at discharge, and indication (rest pain vs tissue loss vs acute ischemia) were analyzed for an association with the tunneling technique (P < .05). Multivariate analyses demonstrated that the tunneling type was not associated with primary patency, primary-assisted patency, secondary patency, or major amputation (P > .05). CONCLUSIONS Compared with subfascial tunneling, the superficial tunneling technique was not associated with primary patency or major amputation in limb ischemia patients undergoing infrainguinal bypass with a single-segment great saphenous vein.
Collapse
Affiliation(s)
- Nallely Saldana-Ruiz
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Josefina Dominguez
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Sung Wan Ham
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Vincent L Rowe
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Gregory A Magee
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Sukgu M Han
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Kenneth R Ziegler
- Division of Vascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif.
| |
Collapse
|
10
|
Çakmak EÖ, Bayam E, Yilmaz F, Kahyaoğlu M, Çelik M, Öcal L, Çakir Ç, Karagöz A, Izgi IA. Midterm Outcomes on Primary Endovascular Treatment of 395 Aortoiliac Occlusive Disease Patients: A Single-Center Experience. Angiology 2021; 72:640-650. [PMID: 33541091 DOI: 10.1177/0003319721991378] [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] [Indexed: 11/16/2022]
Abstract
We report the results of endovascular treatment of Trans-Atlantic Inter-Society Consensus II (TASC) A&B, TASC C, and TASC D aortoiliac lesions in a single vascular center. In this retrospective, observational cohort study, we analyzed 395 patients (mean age 61.2 ± 9.0; 359 men) between January 2015 and December 2017. Technical success was achieved in 96.5%; in-hospital mortality was 1.2% (n = 5). Median follow-up was 36 months (range 24-49 months). After 1 and 5 years, the primary patency rates were 99% and 85% for TASC A&B, 90%, and 78% for TASC C, and 90% and 74% for TASC D. Secondary patency rates were 99% and 90% for TASC A&B, 98% and 65% for TASC C, and 97% and 65% for TASC D. Previous peripheral revascularization (hazard ratio: 1.76, 95% CI: 1.01-3.08, P = .04) was associated with decreased primary patency along with lower age, TASC C, and TASC D class. This analysis reported the acceptable effectiveness and safety of stenting for all types of aortoiliac occlusive disease in a modern setting, with few complications and excellent long-term primary and secondary patency rates.
Collapse
Affiliation(s)
- Ender Özgün Çakmak
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yilmaz
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Kahyaoğlu
- Department of Cardiology, Gaziantep Abdülkadir Yüksel State Hospital, Gaziantep, Turkey
| | - Mehmet Çelik
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Çayan Çakir
- Department of Cardiology, 215299Van Research and Training Hospital, Van, Turkey
| | - Ali Karagöz
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Akin Izgi
- Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
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.
Collapse
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
| | | |
Collapse
|
12
|
Mehta A, Dhindsa DS, Hooda A, Nayak A, Massad CS, Rao B, Makue LF, Rajani RR, Alabi O, Quyyumi AA, Escobar GA, Wells BJ, Sperling LS. Premature atherosclerotic peripheral artery disease: An underrecognized and undertreated disorder with a rising global prevalence. Trends Cardiovasc Med 2020; 31:351-358. [PMID: 32565142 DOI: 10.1016/j.tcm.2020.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/19/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022]
Abstract
Premature atherosclerotic peripheral artery disease (PAD) of the lower extremities is characterized by disease diagnosis before the age of 50 years. The global prevalence of premature PAD has increased, and the disease is often underdiagnosed given heterogenous patient symptoms. Traditional cardiovascular risk factors like smoking, diabetes, hypertension, and hyperlipidemia as well as non-traditional risk factors like elevated lipoprotein(a), family history of PAD, hypercoagulability, and systemic inflammation are associated with premature PAD. Patients with premature PAD tend to have an aggressive vascular disease process, a high burden of cardiovascular risk factors, and other concomitant atherosclerotic vascular diseases like coronary artery disease. Prevention of cardiovascular events, improvement of symptoms and functional status, and prevention of adverse limb events are the main goals of patient management. In this review, we discuss the epidemiology, risk factors, clinical evaluation, and management of patients with premature PAD.
Collapse
Affiliation(s)
- Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Devinder S Dhindsa
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ananya Hooda
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Aditi Nayak
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Chris S Massad
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Birju Rao
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Leyla Fowe Makue
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ravi R Rajani
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Olamide Alabi
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bryan J Wells
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Laurence S Sperling
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
13
|
Desai R, Patel U, Parekh T, Hanna B, Sitammagari K, Fong HK, Lodhi MU, Varma Y, Damarlapally N, Doshi R, Savani S, Kumar G, Sachdeva R. Nationwide Trends in Prevalent Cardiovascular Risk Factors and Diseases in Young Adults: Differences by Sex and Race and In-Hospital Outcomes. South Med J 2020; 113:311-319. [PMID: 32483642 DOI: 10.14423/smj.0000000000001106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.
Collapse
Affiliation(s)
- Rupak Desai
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Upenkumar Patel
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Tarang Parekh
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Bishoy Hanna
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Kranthi Sitammagari
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Hee Kong Fong
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Muhammad Uzair Lodhi
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Yash Varma
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Nanush Damarlapally
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Rajkumar Doshi
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Sejal Savani
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Gautam Kumar
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Rajesh Sachdeva
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| |
Collapse
|
14
|
Groot Jebbink E, Holewijn S, Versluis M, Grimme F, Hinnen JW, Sixt S, Angle JF, Dorigo W, Reijnen MMPJ. Meta-analysis of Individual Patient Data After Kissing Stent Treatment for Aortoiliac Occlusive Disease. J Endovasc Ther 2018; 26:31-40. [PMID: 30499352 PMCID: PMC6330696 DOI: 10.1177/1526602818810535] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate short- and long-term technical and clinical outcomes after kissing stent treatment of aortoiliac occlusive disease (AIOD) based on an individual participant data (IPD) meta-analysis. MATERIALS AND METHODS A search of the Scopus database identified 156 articles on KS treatment of AIOD; of these 22 met the inclusion criteria. Authors of 19 articles with contact information were approached to join an IPD consortium. Eight author groups responded and 5 provided anonymized data for merging into an IPD database. The number of included procedures was equal before and after 2005. The primary study outcome was the cumulative patency at 24 months. Secondary outcomes were patency at up to 60 months, complications, and changes in Rutherford category and ankle-brachial index. The predictive value of stent protrusion length, pre-/postdilation, stent type, and patient demographics on primary patency were examined with Cox proportional hazard modeling; outcomes are reported as the hazard ratio (HR). The Kaplan-Meier method was employed to estimate patency rates. RESULTS In total, 605 (40.9%) of 1480 patients presented in the literature were included in the IPD analysis. The indication for intervention was intermittent claudication in 84.2% and critical limb ischemia in 15.8%. Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) A or B in 52.8% and TASC C and D in 47.2%. The overall primary patency estimate was 81% at 24 months. Primary patency significantly increased after 2005 (p=0.005). Cox regression analysis revealed only age as a significant predictor of sustained primary patency (HR 0.60, p<0.005). Any previous endovascular intervention (HR 2.52, p=0.02) was the main predictor for loss of secondary patency; history of cardiovascular disease (HR 0.27, p=0.04) was the main predictor of sustained secondary patency. CONCLUSION The kissing stent technique has a good safety profile and acceptable patency rates up to 2 years, even in TASC C and D lesions, supporting an endovascular-first approach for AIOD.
Collapse
Affiliation(s)
- Erik Groot Jebbink
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.,2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands.,3 Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Suzanne Holewijn
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel Versluis
- 2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands.,3 Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Frederike Grimme
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jan Willem Hinnen
- 4 Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Sebastian Sixt
- 5 Cardiovascular Center, Hamburg University, Hamburg, Germany
| | - John F Angle
- 6 Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Walter Dorigo
- 7 Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy
| | - Michel M P J Reijnen
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.,2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands
| |
Collapse
|
15
|
Maillet A, Desormais I, Rivière AB, Aboyans V, Lacroix P, Mirault T, Messas E, Bataille V, Constans J, Boulon C. Peripheral Atheromatous Arterial Disease in the Young: Risk Factors, Clinical Features, and Prognosis From the COPART Cohort. Angiology 2017; 68:893-898. [DOI: 10.1177/0003319717699501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the cardiovascular risk factors, clinical presentation, and prognosis in a comparative study of patients with peripheral artery disease (PAD) from the Cohorte des Patients ARTériopathes (COPART) cohort, which includes patients hospitalized for PAD in France. Among the 2514 patients included in the cohort, 189 had PAD before or at the age of 50 years and 2325 had it after. Young patients with PAD had diabetes less frequently (34% vs 46%, P < .001), were more frequent active smokers (58% vs 23%, P < 0.001), had lower high-density lipoprotein cholesterol (HDL-C; 41 ± 14 vs 44 ± 15 mg/dL, P = .026), and had a less frequent family and personal history of coronary heart disease. In a subset of 59 patients whose lipoprotein (a) (Lp(a)) was measured, the Lp(a) levels were higher in the young patients than in the older ones (89.7 mg/dL [9.7-151.3] vs 19.9 mg/dL [3.0-207.9], P = .004). Survival and amputation-free survival was 2.2 times higher (1.5-3.2, P < .001) in the young after 1 year. The onset of PAD before 50 years was associated with active smoking, low HDL-C, high Lp(a), and lower mortality.
Collapse
Affiliation(s)
- Alexandre Maillet
- Médecine vasculaire, Hôpital St Andre, Bordeaux, France
- Bordeaux University, Bordeaux, France
| | | | - Alessandra Bura Rivière
- Service de Médecine Vasculaire, CHU Toulouse, Toulouse, France
- StromaLab UMR 5273/INSERM U1031, Toulouse, France
- Université de Toulouse III, Toulouse, France
| | - Victor Aboyans
- Service de Cardiologie, Hôpital Universitaire Dupuytren, Limoges, France
| | | | - Tristan Mirault
- Department of Vascular Medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, APHP, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - Emmanuel Messas
- Department of Vascular Medicine, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, APHP, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | | | - Joël Constans
- Médecine vasculaire, Hôpital St Andre, Bordeaux, France
- Bordeaux University, Bordeaux, France
| | - Carine Boulon
- Médecine vasculaire, Hôpital St Andre, Bordeaux, France
- Bordeaux University, Bordeaux, France
| |
Collapse
|
16
|
Gaudry M, Bartoli JM, Bal L, Giorgi R, De Masi M, Magnan PE, Piquet P. Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis. PLoS One 2016; 11:e0161716. [PMID: 27611997 PMCID: PMC5017627 DOI: 10.1371/journal.pone.0161716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/10/2016] [Indexed: 12/03/2022] Open
Abstract
Background Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis. Methods We performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013. The primary endpoints were the technical success, the presence of in-stent restenosis >50% or occlusion, either symptomatic or asymptomatic, during the follow-up period, and risk factors for restenosis. The secondary endpoints were early and late morbidity and mortality (TIA, stroke, myocardial infarction, or death). Results A total of 153 CAS procedures were performed for post-CEA restenosis, primarily because of asymptomatic lesions (137/153). The technical success rate was 98%. The 30-day perioperative stroke and death rate was 2.6% (two TIAs and two minor strokes), and rates of 2.2% (3/137) and 6.2% (1/16) were recorded for asymptomatic and symptomatic patients, respectively. The average follow-up time was 36 months (range, 6–171 months). In-stent restenosis or occlusion was observed in 16 patients (10.6%). Symptomatic restenosis was observed in only one patient. We found that young age (P = 0.002), stenosis > 85% (P = 0.018), and a lack of stent coverage of the common carotid artery (P = 0.006) were independent predictors of in-stent restenosis. Conclusion We identified new risk factors for in-stent restenosis that were specific to this population, and we propose a technical approach that may reduce this risk.
Collapse
Affiliation(s)
- Marine Gaudry
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
- * E-mail:
| | | | - Laurence Bal
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
| | - Roch Giorgi
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- APHM, Hôpital Timone, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
| | - Mariangela De Masi
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
| | | | - Philippe Piquet
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
| |
Collapse
|
17
|
Amrock SM, Weitzman M. Multiple biomarkers for mortality prediction in peripheral arterial disease. Vasc Med 2016; 21:105-12. [DOI: 10.1177/1358863x15621797] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Few studies have assessed which biomarkers influence mortality risk among those with peripheral arterial disease (PAD). We analyzed data from 556 individuals identified to have PAD (i.e. ankle–brachial index ⩽0.9) with available measurements of C-reactive protein, the neutrophil-to-lymphocyte ratio (NLR), homocysteine, and the urinary albumin-to-creatinine ratio (UACR) in the 1999–2004 National Health and Nutrition Examination Survey. We investigated whether a combination of these biomarkers improved the prediction of all-cause and cardiovascular mortality beyond conventional risk factors. During follow-up (median, 8.1 years), 277 of 556 participants died; 63 deaths were attributed to cardiovascular disease. After adjusting for conventional risk factors, Cox proportional-hazards models showed the following to be most strongly associated with all-cause mortality (each is followed by the adjusted hazard ratio [HR] per 1 standard deviation increment in the log values): homocysteine (1.31), UACR (1.21), and NLR (1.20). UACR alone significantly predicted cardiovascular mortality (1.53). Persons in the highest quintile of multimarker scores derived from regression coefficients of significant biomarkers had elevated risks of all-cause mortality (adjusted HR, 2.45; 95% CI, 1.66–3.62; p for trend, <0.001) and cardiovascular mortality (adjusted HR, 2.20; 95% CI, 1.02–4.71; p for trend, 0.053) compared to those in the lowest two quintiles. The addition of continuous multimarker scores to conventional risk factors improved risk stratification of all-cause mortality (integrated discrimination improvement [IDI], 0.162; p<0.00001) and cardiovascular mortality (IDI, 0.058; p<0.00001). In conclusion, the addition of a continuous multimarker score to conventional risk factors improved mortality prediction among patients with PAD.
Collapse
Affiliation(s)
- Stephen M Amrock
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
- College of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
18
|
Dermody M, Homsy C, Zhao Y, Goodney PP, Estes JM. Outcomes of infrainguinal bypass determined by age in the Vascular Study Group of New England. J Vasc Surg 2015; 62:83-92. [PMID: 25953015 PMCID: PMC5292267 DOI: 10.1016/j.jvs.2015.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/09/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many believe extremes of age correlate with poorer outcomes in treatment for lower extremity peripheral arterial disease (PAD). We hypothesized that the youngest patients would have significantly poorer outcomes compared with older cohorts due to the precocious nature of their PAD. METHODS We studied all patients in the Vascular Study Group of New England database undergoing infrainguinal bypass for PAD between 2003 and 2013. Age was grouped by <50 years, 50 to 79 years, and ≥80 years. Our primary outcomes were 1-year freedom from a major adverse limb event (MALE), defined as ipsilateral amputation or need for secondary intervention, and amputation-free survival. A second analysis was performed to analyze the subgroup of patients aged <50 years with critical limb ischemia (CLI), which included a Cox regression model to determine risk factors for MALE or death at 1 year. RESULTS Of 5265 patients who were treated with infrainguinal bypass for PAD, 324 (6.2%) were aged <50 years. The mean age was 44.6 years, and 66.4% were male. The proportion of African Americans was significantly higher in the youngest age group (<50 years: 6.8% vs 50-79 years: 3.5%, P = .002; vs ≥80 years: 3.5%, P = .013). More bypasses were done for claudication than acute limb ischemia in patients aged <50 years (33.3% vs 11.4%). More vein grafts were used vs prosthetic (<50 years: 72.1% vs 50-79 years: 65.9%, P = .024; vs ≥80 years: 62.6%, P = .002). Fewer concomitant proximal procedures were performed compared with the older groups (<50 years: 37.7% vs 50-79 years: 51.1%, P < .001; vs ≥80 years: 39.5%, P = .045). More young patients returned to the operating room within their initial hospitalization for early graft thrombosis (<50 years: 5.6% vs 50-79 years: 2.9%, P = .001; vs ≥80 years: 2.4%, P = .009) and revision (<50 years: 4.7% vs 50-79 years: 2.2%, P = .012; vs ≥80 years: 1.4%, P = .002) compared with the older patients. Overall, MALE-free survival was similar across age groups (P = .323), as were patency and amputation rates. When considering only patients with CLI, MALE-free survival in the youngest patients was again similar (P = .171) but with significantly more major amputations at 1 year (P = .022). CONCLUSIONS For patients aged <50 undergoing infrainguinal bypass surgery, this large series demonstrates similar overall medium-term graft-related outcomes compared with older cohorts. Further, although the youngest patients with CLI have similar MALEs, their amputation rates are higher than in older cohorts.
Collapse
Affiliation(s)
- Meghan Dermody
- Division of Vascular Surgery, Lancaster General Health Physicians Surgical Group, Lancaster, Pa.
| | | | - Yuanyuan Zhao
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - James M Estes
- Division of Vascular Surgery, The Cardiovascular Center, Tufts Medical Center, Boston, Mass
| |
Collapse
|
19
|
Age does not predict need for reintervention in patients with critical limb ischemia. J Vasc Surg 2015; 61:413-8. [DOI: 10.1016/j.jvs.2014.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/01/2014] [Indexed: 11/22/2022]
|
20
|
Chaar CIO, Makaroun MS, Marone LK, Rhee RY, Al-Khoury G, Cho JS, Leers SA, Chaer RA. Impact of endovascular options on lower extremity revascularization in young patients. J Vasc Surg 2012; 56:703-13.e1-3. [DOI: 10.1016/j.jvs.2012.01.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/20/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
|
21
|
Ni L, Liu CW, Ricco JB, Dick F, Liu B, Ye W. Role of Thrombophilia in Premature Peripheral Arterial Obstructive Disease – Experience of a Vascular Centre in China. Eur J Vasc Endovasc Surg 2012; 44:158-63. [DOI: 10.1016/j.ejvs.2012.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/01/2012] [Indexed: 11/30/2022]
|
22
|
Forbes T, Ricco JB. Lower Extremity Bypass versus Endovascular Therapy for Young Patients with Symptomatic Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2012; 44:120. [DOI: 10.1016/j.ejvs.2012.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Forbes TL, Ricco JB. Editors' commentary. J Vasc Surg 2012; 56:554-5. [PMID: 22840906 DOI: 10.1016/j.jvs.2012.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
Kiernan TJ, Hynes BG, Ruggiero NJ, Yan BP, Jaff MR. Comprehensive evaluation and medical management of infrainguinal peripheral artery disease: "when to treat, when not to treat". Tech Vasc Interv Radiol 2010; 13:2-10. [PMID: 20123428 DOI: 10.1053/j.tvir.2009.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripheral artery disease (PAD) is a highly prevalent atherosclerotic syndrome associated with significant morbidity and mortality. PAD is defined by atherosclerotic obstruction of the arteries to the legs that reduce arterial flow during exercise or at rest, and is associated with systemic atherosclerosis. The clinical presentation of PAD is quite varied, including patients with atypical leg symptoms, classic intermittent claudication, and critical limb ischemia. Clinical assessment of these patients includes a comprehensive history, physical examination, and noninvasive and invasive vascular studies. The major risk factors for PAD include diabetes mellitus, tobacco abuse, hyperlipidemia, hypertension, and advanced age. Because of the presence of these risk factors, the systemic nature of atherosclerosis, and the high risk of ischemic events, patients with PAD should be candidates for comprehensive secondary prevention strategies, including aggressive glycemic control, all attempts at tobacco cessation, lipid lowering and antihypertensive treatment, antiplatelet therapy, and thorough foot care. This article reviews the comprehensive diagnostic algorithm and medical treatment strategies for patients with infrainguinal PAD.
Collapse
Affiliation(s)
- Thomas J Kiernan
- Section of Vascular Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | |
Collapse
|
25
|
Should Incidental Asymptomatic Angiographic Stenoses and Occlusions Be Treated in Patients with Peripheral Arterial Disease? J Vasc Interv Radiol 2009; 20:1133-40. [DOI: 10.1016/j.jvir.2009.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 05/18/2009] [Accepted: 05/20/2009] [Indexed: 11/18/2022] Open
|
26
|
Constans J, Solanilla A, Boulon C, Conri C. [Peripheral occlusive arterial disease in the young patient]. Presse Med 2009; 39:11-6. [PMID: 19442482 DOI: 10.1016/j.lpm.2009.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 01/21/2009] [Indexed: 11/17/2022] Open
Abstract
Lower limb arterial disease has unusual features when occurring before 50 years old. The most important one is the number of causes: atherosclerosis in 2/3 cases, Leo Buerger's disease in 1/4, but also sometimes embolic cardiopathies, antiphospholipid syndrome, myeloproliferative disorders, genetic or compressive diseases, inflammatory arterial disease. When peripheral arterial disease occurs before 50, explorations have to be performed according to anamnesis: duplex echography, EKG, blood sample. Afterwards other explorations may be performed such as other vascular imaging techniques, echocardiography or more complete biological investigation. Results from an ongoing multicenter study should be soon available and give more knowledge about these special peripheral arterial diseases.
Collapse
Affiliation(s)
- Joël Constans
- Service de médecine vasculaire et médecine interne, Hôpital Saint-André, F-33075 Bordeaux, France.
| | | | | | | |
Collapse
|
27
|
A case of polyarteritis nodosa presenting initially as peripheral vascular disease. J Gen Intern Med 2008; 23:1528-31. [PMID: 18560943 PMCID: PMC2518022 DOI: 10.1007/s11606-008-0683-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 04/16/2008] [Accepted: 05/01/2008] [Indexed: 10/21/2022]
Abstract
Polyarteritis nodosa is a rare necrotizing vasculitis that can be progressive and fatal, and its initial presenting symptom may be leg claudication due to peripheral vascular ischemia. To date, there have been fewer than ten case reports of polyarteritis nodosa presenting as peripheral vascular disease. We report a case of a 38-year-old man initially diagnosed to have premature peripheral vascular disease who presented 1 year later with symptoms consistent with giant cell arteritis and subsequently developed bowel ischemia leading to a fatal outcome. Based on the autopsy and the patient's clinical course, the final diagnosis was polyarteritis nodosa. This case illustrates the challenges in diagnosing polyarteritis nodosa and the importance of considering vasculitis in young patients presenting with atypical presentations of diseases such as peripheral vascular disease or giant cell arteritis.
Collapse
|
28
|
Garofolo L, Barros N, Miranda F, D'Almeida V, Cardien LC, Ferreira SR. Association of Increased Levels of Homocysteine and Peripheral Arterial Disease in a Japanese-Brazilian Population. Eur J Vasc Endovasc Surg 2007; 34:23-8. [PMID: 17482486 DOI: 10.1016/j.ejvs.2007.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim was to evaluate the possible association between homocysteine levels and peripheral arterial disease (PAD) in a population-based study of Japanese-Brazilians. MATERIALS AND METHODS This cross-sectional study was derived from a population-based survey on the prevalence of diabetes and associated diseases conducted in Japanese-Brazilians. A total of 1330 male and female subjects aged>or=30 years were submitted to clinical examination and laboratory procedures including homocysteine measurement. The ankle-brachial index (ABI) was calculated; subjects with ABI values <0.9 were diagnosed with PAD. The evaluable population included 1008 subjects. Logistic regression was used taking PAD as the dependent variable. RESULTS Mean age of the population was 56.5 years and overall prevalence of PAD was 20%. A worse cardiovascular profile was found in male patients, including significantly higher homocysteine levels (11.9+/-1.8 vs. 9.1+/-1.1micromol/L, p<0.001). Men with PAD had higher prevalence rates of hyperhomocysteinemia compared to women (22.7% vs 7.6%). Univariate analysis showed an odds ratio of hyperhomocysteinemia for PAD of 1.51 [1.02-2.25] in men and 1.69 [1.06-2.68] in women. After adjustment for other cardiovascular risk factors, higher levels of homocysteine were only significantly related to PAD in men. CONCLUSION In a Japanese-Brazilian population, elevated levels of homocysteine are associated with PAD in men. Prospective studies are necessary to confirm this finding.
Collapse
Affiliation(s)
- L Garofolo
- Post-Graduation Course on Cardiac, Vascular and Thoracic Surgery, Surgery Department, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
29
|
Lane JS, Vittinghoff E, Lane KT, Hiramoto JS, Messina LM. Risk factors for premature peripheral vascular disease: results for the National Health and Nutritional Survey, 1999-2002. J Vasc Surg 2006; 44:319-24; discussion 324-5. [PMID: 16890861 DOI: 10.1016/j.jvs.2006.04.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 04/04/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE Premature peripheral vascular disease (PVD), occurring <60 years of age, is associated with significant cardiovascular morbidity, limb loss, and death. We hypothesized that different risk factors predict the development of PVD in patients <60 years than in patients > or =60 years. METHODS To address this question, we conducted a population-based observational study using the National Health and Nutritional Survey (NHANES) data set, which represents the noninstitutionalized civilian population in the United States. From 1999 to 2002, 5083 participants were analyzed as part of the NHANES survey. PVD status was defined by an ankle-brachial index (ABI) of <0.9. Putative risk factors for the development of PVD were collected by physical examination, interview, and laboratory testing. Univariate and multivariate logistic regression analyses were used to evaluate interactions between age strata and the development of PVD. RESULTS Premature PVD was found in 2.1% +/- 0.2% of the population <60 years, and PVD was found in 12.0% +/- 0.8% of the population > or =60 years. This corresponds to approximately 1.44 million people with premature PVD. Multivariate analysis determined coronary artery disease (odds ratio [OR] 2.90 vs 1.26, P = .083) and elevated serum fibrinogen (OR 1.07 vs 1.03, P = .034) were stronger predictors of PVD in subjects <60 years than in older subjects. Chronic renal insufficiency (OR 1.02 vs 1.16, P = .006) was more highly predictive of PVD in subjects >60 years. Other significant predictors, irrespective of age, in the multivariate model included hypertension (OR 1.99, P < .001), smoking (OR 2.22, P < .001), and serum homocysteine (OR 1.27, P = .067). CONCLUSIONS Clinicians should be aware of the high risk of developing premature PVD in patients <60 years with coexisting coronary artery disease or elevated plasma fibrinogen. Routine screening by ABI measurements in high-risk patients would enhance the detection of subclinical premature PVD and allow for secondary intervention.
Collapse
Affiliation(s)
- John S Lane
- Department of Surgery, University of California, San Francisco, CA, USA
| | | | | | | | | |
Collapse
|
30
|
Aboyans V, Criqui MH, Denenberg JO, Knoke JD, Ridker PM, Fronek A. Risk factors for progression of peripheral arterial disease in large and small vessels. Circulation 2006; 113:2623-9. [PMID: 16735675 DOI: 10.1161/circulationaha.105.608679] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data on the natural history of peripheral arterial disease (PAD) are scarce and are focused primarily on clinical symptoms. Using noninvasive tests, we assessed the role of traditional and novel risk factors on PAD progression. We hypothesized that the risk factors for large-vessel PAD (LV-PAD) progression might differ from small-vessel PAD (SV-PAD). METHODS AND RESULTS Between 1990 and 1994, patients seen during the prior 10 years in our vascular laboratories were invited for a new vascular examination. The first assessment provided baseline data, with follow-up data obtained at this study. The highest decile of decline was considered major progression, which was a -0.30 ankle brachial index decrease for LV-PAD and a -0.27 toe brachial index decrease for SV-PAD progression. In addition to traditional risk factors, the roles of high-sensitivity C-reactive protein, serum amyloid-A, lipoprotein(a), and homocysteine were assessed. Over the average follow-up interval of 4.6+/-2.5 years, the 403 patients showed a significant ankle brachial index and toe brachial index deterioration. In multivariable analysis, current smoking, ratio of total to HDL cholesterol, lipoprotein(a), and high-sensitivity C-reactive protein were related to LV-PAD progression, whereas only diabetes was associated with SV-PAD progression. CONCLUSIONS Risk factors contribute differentially to the progression of LV-PAD and SV-PAD. Cigarette smoking, lipids, and inflammation contribute to LV-PAD progression, whereas diabetes was the only significant predictor of SV-PAD progression.
Collapse
Affiliation(s)
- Victor Aboyans
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0607, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Chew DK, Nguyen LL, Owens CD, Conte MS, Whittemore AD, Gravereaux EC, Menard MT, Belkin M. Comparative analysis of autogenous infrainguinal bypass grafts in African Americans and Caucasians: The association of race with graft function and limb salvage. J Vasc Surg 2005; 42:695-701. [PMID: 16242557 DOI: 10.1016/j.jvs.2005.06.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 06/10/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE African Americans (AAs) are at risk for developing diabetes mellitus and atherosclerosis. Whether race influences the results of infrainguinal arterial reconstruction is unclear. The purpose of this study was to compare the results of autogenous infrainguinal bypasses in AAs and Caucasians to determine the association of race with graft function and limb salvage. METHODS This was a retrospective, comparative cohort study of AA and Caucasian patients who had undergone autogenous infrainguinal bypass surgery. Only single-limb bypasses in each patient cohort were considered in this analysis. In patients who had undergone bilateral lower limb bypasses, the first limb bypass was chosen as the index bypass procedure. RESULTS From January 1985 to December 2003, 1459 autogenous infrainguinal bypasses were performed in 1459 patients for lower limb ischemia. Within this group, 89 AA patients/vein grafts formed the study cohort. The control group comprised 1370 Caucasian patients/vein grafts. Compared with the Caucasian cohort, AA patients were significantly younger (median age, 65 vs 70 years, respectively; P = .001) and predominantly female (57% vs 41%, respectively; P = .002). AA patients also had a higher prevalence of diabetes mellitus, hypertension, cerebrovascular disease, congestive heart failure, and dialysis-dependent renal failure. More AA than Caucasian patients presented with gangrene (34% vs 16%, respectively; P = .001), and more underwent bypass surgery for limb salvage indications (91% vs 81%, respectively; P = .01). The venous conduit used was predominantly the greater saphenous vein (AA, 83%; Caucasian, 85%), and the site of distal anastomosis was at the tibial/pedal level in 67% of AA and 61% of Caucasian patients. Overall morbidity (AA, 28%; Caucasian, 23%) and 30-day mortality (AA, 3%; Caucasian, 3%) were similar. Thirty-day graft failure was significantly greater in AAs than Caucasians (12% vs 5%, respectively; P = .003). The overall 5-year primary graft patency (+/-SE) was significantly worse in AA patients (AA, 52% +/- 6%; Caucasian, 67% +/- 2%; P = .009). The 5-year limb salvage rate (+/-SE) was also significantly worse in AA patients (AA, 81% +/- 5%; Caucasian, 90% +/- 1%; P = .04). With the Cox proportional hazard model, significant risk factors associated with primary graft failure were AA race, age younger than 65 years, female sex, secondary reconstructions, tibial bypasses, and critical limb ischemia. Significant risk factors associated with limb loss were age younger than 65 years, female sex, absence of coronary disease, presence of critical limb ischemia, and secondary reconstructions. CONCLUSIONS Autogenous infrainguinal bypass surgery in AAs is associated with poorer primary graft patency and limb salvage rates compared with those of Caucasians. This may partially account for the higher rate of limb loss in AA patients with peripheral arterial occlusive disease.
Collapse
Affiliation(s)
- David K Chew
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Invited commentary. J Vasc Surg 2005. [DOI: 10.1016/j.jvs.2005.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
33
|
Valentine RJ, Guerra R, Stephan P, Scoggins E, Clagett GP, Cohen J. Family history is a major determinant of subclinical peripheral arterial disease in young adults. J Vasc Surg 2004; 39:351-6. [PMID: 14743135 DOI: 10.1016/j.jvs.2003.07.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular disease is prevalent in first-degree relatives of young adults with premature-onset peripheral arterial occlusive disease (premature PAD), but it is not known whether the genetic influence is independent of other risk factors, the most prevalent of which is smoking. This study was performed to determine the relative contributions of family history and smoking to the development of occult PAD in siblings of patients with premature PAD. METHODS The prevalence of occult PAD was determined with carotid, abdominal, and lower extremity duplex ultrasound scanning in 50 asymptomatic siblings (25 men, 25 women) of patients with premature PAD (onset <or=49 years). Thirty of the siblings (60%) were active smokers, and 20 had never smoked. Age-matched and sex-matched reference groups included 50 asymptomatic heavy smokers (>20 cigarettes/day) and 50 nonsmokers. RESULTS Duplex ultrasound scans demonstrated raised arterial lesions in 20 asymptomatic siblings (40%), 20 heavy smokers (40%), and 2 nonsmoking control subjects (4%), resulting in 42 affected and 108 unaffected subjects. As expected, smokers were far more likely to have arterial lesions than were nonsmokers (odds ratio [OR], 11.19; 95% confidence interval [CI], 4.1-30.7; P <.0001). Individuals with a family history of premature PAD were almost three times more likely to have arterial lesions than those with no family history of cardiovascular disease (OR, 2.76; 95% CI, 1.3-5.8; P =.006). Stratified and multivariable logistic regression indicated no interaction between smoking and family history, indicating simple additive effects on PAD. CONCLUSIONS Family history is a major determinant of occult PAD in young adults, and is at least as important as standard atherosclerotic risk factors. A high proportion of heavy smokers have clearly detectable lesions even though asymptomatic. Smoking and family history act additively to increase the risk for premature PAD.
Collapse
Affiliation(s)
- R James Valentine
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9031, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Saltzberg SS, Pomposelli FB, Belfield AK, Sheahan MG, Campbell DR, Skillman JJ, LoGerfo FW, Hamdan AD. Outcome of lower-extremity revascularization in patients younger than 40 years in a predominately diabetic population. J Vasc Surg 2003; 38:1056-9. [PMID: 14603217 DOI: 10.1016/s0741-5214(03)00938-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Incidence of perioperative complications is increased and outcome is poor in young patients undergoing vascular surgery. We extensively reviewed results of lower-extremity procedures in this group of patients to further define the extent of short-term and long-term morbidity. METHODS Results from our vascular registry were retrospectively reviewed for 76 lower-extremity revascularization procedures performed between January 1990 and May 2000 in 51 patients younger than 40 years. This represents 1.88% of 4052 lower-extremity bypass procedures performed during this period. Perioperative cardiac complications, long-term survival, graft patency, and limb salvage were evaluated. Kaplan-Meier curves were generated, and their significance was determined with the Cox-Mantel test. RESULTS Forty-nine percent of patients were male, and 51% were female; mean age at presentation was 35.9 years (range, 27.5-39.8 years). Preoperative morbidity included diabetes mellitus (96.1%), smoking (70.6%), hypertension (78.4%), coronary artery disease (37.3%), hyperlipidemia (33.3%), and renal dysfunction (52.9%). Overall rate for 30-day postoperative mortality was 0.0%, for myocardial infarction was 0.0%, and for congestive heart failure was 1.32%. Thirty-day graft failure was 11.1% (n = 9). At 1 year, primary patency was 71.0%, secondary patency was 82.5%, and limb salvage was 87.1%; and at 5 years these rates were 51.9%, 63.4%, and 77.2%, respectively. After the initial surgery 11.8% (n = 6) of patients required at least one additional ipsilateral revascularization procedure, 31.3% (n = 16) required a bypass graft in the contralateral limb, and 23.5% (n = 12) ultimately required amputation. In patients who required additional ipsilateral procedures, 1-year primary patency rate was 66.7%, secondary patency rate was 62.5%, and limb salvage rate was 77.8%, compared with 5-year rates of 44.4%, 41.7%, and 64.8%, respectively, representing a decrease in patency compared with primary revascularization procedures. Overall survival at 1 year was 88.2%, compared with 73.3% at 5 years. Patients with preexisting renal disease had significantly decreased survival at 5 years compared with those without renal dysfunction (64.5% vs 82.6%; P =.019). CONCLUSIONS Our data suggest that age younger than 40 years is not associated with increased perioperative morbidity and mortality. However, these patients have a significant rate of early graft failure and dismal long-term survival, especially in patients with preexisting renal dysfunction. In addition, ipsilateral repeat operations have a marginal success rate.
Collapse
Affiliation(s)
- Stephanie S Saltzberg
- Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Peripheral arterial disease (PAD) is a prevalent illness that most commonly affects patients older than 60 years. As the population ages, the prevalence of PAD and its associated adverse outcomes will also increase. Adverse outcomes in PAD are either systemic (ie, cardiovascular events such as myocardial infarctions or strokes) or localized to the legs (ie, bypass surgery or amputation). Although much research has focused on adverse systemic outcomes in patients with PAD, less is known about those factors related to adverse limb events. The Centers for Disease Control and Prevention estimate that more than 100,000 amputations are performed in the United States each year. What remains to be determined is the association between how physicians manage patients with PAD (ie, process of care) and the development of adverse limb outcomes. Determining the association of the management of PAD with adverse limb outcomes will highlight those areas in which to focus to improve the quality of care for patients with this disease. Understanding the relationship between risk factors, process of care, and outcomes will be of importance to patients, clinicians, and policy makers. The purpose of this article is to review the burden of PAD and to discuss the association of process of care with adverse limb outcomes in patients with PAD.
Collapse
Affiliation(s)
- Tracie C Collins
- Houston Center for Quality of Care and Utilization Studies, Houston, Texas 77030, USA
| | | |
Collapse
|
36
|
Abstract
Lipoprotein(a) is a cholesterol-enriched lipoprotein, consisting of a covalent linkage joining the unique and highly polymorphic apolipoprotein(a) to apolipoprotein B100, the main protein moiety of low-density lipoproteins. Although the concentration of lipoprotein(a) in humans is mostly genetically determined, acquired disorders might influence synthesis and catabolism of the particle. Raised concentration of lipoprotein(a) has been acknowledged as a leading inherited risk factor for both premature and advanced atherosclerosis at different vascular sites. The strong structural homologies with plasminogen and low-density lipoproteins suggest that lipoprotein(a) might represent the ideal bridge between the fields of atherosclerosis and thrombosis in the pathogenesis of vascular occlusive disorders. Unfortunately, the exact mechanisms by which lipoprotein(a) promotes, accelerates, and complicates atherosclerosis are only partially understood. In some clinical settings, such as in patients at exceptionally low risk for cardiovascular disease, the potential regenerative and antineoplastic properties of lipoprotein(a) might paradoxically counterbalance its athero-thrombogenicity, as attested by the compatibility between raised plasma lipoprotein(a) levels and longevity.
Collapse
Affiliation(s)
- Giuseppe Lippi
- Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologiche e Biomediche, Università degli Studi di Verona, Verona, Italy
| | | |
Collapse
|
37
|
Siskin GP, Englander M, Roddy S, Dowling K, Dolen EG, Quarfordt S, Hughes T, Mandato K. Results of iliac artery stent placement in patients younger than 50 years of age. J Vasc Interv Radiol 2002; 13:785-90. [PMID: 12171981 DOI: 10.1016/s1051-0443(07)61986-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine long-term outcome in patients 50 years of age or younger treated with iliac artery stent placement. MATERIALS AND METHODS The records of 412 patients who underwent iliac artery stent placement during a 62-month study period were reviewed retrospectively. Forty-two patients younger than age 50 (mean age = 45 y) at the time of stent placement were included in the study population. Presenting symptoms included claudication (47%), rest pain (17%), ulceration/tissue loss (31%), and blue toe syndrome (5%). Anatomic, hemodynamic, and clinical success rates of the stent placement procedure were assessed. Stent patency rates were calculated by life-table methods. RESULTS Fifty-nine iliac lesions were treated with stents; 62% of patients underwent treatment of a single lesion whereas 38% had multiple lesions treated. Thirty-one percent were treated after a failed angioplasty procedure and 69% were treated with stent placement primarily. After stent placement, 34 patients (82%) experienced symptomatic relief, although eight of these patients (19%) underwent a planned ipsilateral infrainguinal bypass procedure during the same hospitalization. During follow-up, five patients (12%) required a bypass procedure as a result of stent failure and two patients (5%) required below-knee amputation. Seven patients (17%) required endovascular stent revision, with none requiring additional surgery. At 1, 2, and 3 years, the primary patency rates were 86%, 72%, and 65%, and the secondary patency rates were 90%, 88%, and 88%, respectively. CONCLUSIONS Iliac stent placement successfully addresses the presenting symptoms of young patients with peripheral vascular disease and results in patency rates that are similar to those reported in a more general population. With appropriate postprocedural surveillance, restenosis can be addressed in many patients with use of endovascular techniques, limiting the need for surgical revision.
Collapse
Affiliation(s)
- Gary P Siskin
- Institute for Vascular Health and Disease, Albany Medical College, A-113, 47 New Scotland Avenue, Albany, New York 12208, USA.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Best IM, Vansandani G, Rust G, Bumpers HL. Recurrent Ischemia in a Young Man with the Antiphospholipid Syndrome. Am Surg 2002. [DOI: 10.1177/000313480206800708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recurrent thromboses, cerebral disease, miscarriages, and antiphospholipid antibodies are characteristic of the antiphospholipid syndrome. A 31-year-old man presented with limb ischemic and isolated right ventricular failure. Antiphospholipid syndrome was suspected and limb salvage was accomplished by anticoagulation and tibial- to-plantar artery bypass surgery. However, recurrent ischemic episodes were successfully treated with thrombolytic therapy and anticoagulants. The surgeon should be aware that patients with antiphospholipid antibodies and lupus anticoagulant antibodies have a high propensity for recurrent arterial thromboses and should use multiple therapeutic approaches to effect successful long-term limb salvage.
Collapse
Affiliation(s)
- Irwin M. Best
- Departments of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | | | - George Rust
- Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Harvey L. Bumpers
- Departments of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| |
Collapse
|
39
|
Porto-Rodríguez J, Gesto-Castromil R. Resultados de la revascularización de miembros inferiores en el paciente arteriosclerótico joven. ANGIOLOGIA 2002. [DOI: 10.1016/s0003-3170(02)74744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Corominas-Roura C, Plaza-Martínez A, Díaz López M, Riera-Vázquez R, Cordobés-Gual J. Tratamiento médico de la claudicación intermitente. ANGIOLOGIA 2002. [DOI: 10.1016/s0003-3170(02)74741-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|