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Kulezic A, Acosta S, Ekberg O, Lehti L. Extravascular incidental findings in computed tomography angiography are associated with lower amputation-free survival in patients with acute lower limb ischaemia. Vascular 2024; 32:126-131. [PMID: 36268567 DOI: 10.1177/17085381221135272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emergency computed tomography angiography (CTA) is the most important imaging modality to visualize arterial occlusions in patients with acute lower limb ischaemia (ALI). Extravascular incidental findings (EVIFs) have received less attention. PURPOSE The aims of this study were to evaluate the incidence of EVIFs of immediate clinical relevance in patients with ALI undergoing CTA and evaluate the association between EVIFs and emergency revascularization and amputation-free survival at 1 year. METHODS Retrospective cohort study. Emergency CTA in patients with ALI between 2015 and 2018 were independently scrutinized by two senior radiologists. EVIFs were classified into immediate (category I), potential (category II) or no clinical relevance (category III). Multi-variable binary logistic regression analysis was expressed in Odds ratios (OR) with 95% confidence intervals (CI). RESULTS The intra-class correlation (ICC) coefficient for EVIF category I between the raters was 0.94 (95% CI 0.92-0.96). Among 118 patients with ALI, 78 patients underwent emergency revascularization. Forty-six EVIFs (34 patients) were category I, of which 63% were found in the chest, including pleural effusion (n = 12), pneumonia (n = 8) and cardiac thrombus (n = 4). Ascites (n = 4) and cancer disease (n = 4) were other category I findings. Category I EVIFs were associated with reduced rate of emergency revascularization (OR 0.26, 95% CI 0.10-0.66) and increased rate of combined major amputation/mortality at 1 year (OR 2.9, 95% CI 1.1-8.2) in adjusted analysis. CONCLUSION It is important to evaluate EVIFs in emergency CTA in patients with ALI since these findings are both common and associated with reduced emergency revascularization and amputation-free survival at 1 year.
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Affiliation(s)
- Andrea Kulezic
- Department of Clinical Sciences, Malmö Lund University, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö Lund University, Malmö, Sweden
- Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Olle Ekberg
- Division of Medical Radiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Leena Lehti
- Department of Clinical Sciences, Malmö Lund University, Malmö, Sweden
- Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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Manu CA, Slim H, Huang D, Wilkins CJ, Vas PRJ, Rashid H, Winkley K, Edmonds M. Isolated low toe-brachial index is associated with increased mortality and morbidity: a retrospective cohort study. J Wound Care 2021; 30:65-73. [PMID: 33439082 DOI: 10.12968/jowc.2021.30.1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim was to assess the prognostic impact of perfusion assessments including ankle-brachial Index (ABI) and toe-brachial Index (TBI) on survival of patients who present with diabetic foot ulceration and to analyse clinical outcomes when patients are categorised into three levels of limb ischaemia. METHOD This was a retrospective cohort analysis of consecutive patients presenting with foot ulceration. Patients continued with their standard of care, after having baseline assessments of limb perfusion. Patients were retrospectively categorised into three groups according to baseline ABI and TBI: Group 1 (n=31) non-ischaemic (TBI≥0.75, ABI≥0.9), Group 2 (n=67) isolated low TBI with foot ischaemia (TBI<0.75, ABI≥0.90) and Group 3 (n=30) foot-leg ischaemia (TBI<0.75, ABI<0.90). RESULTS A total of 128 patients took part in the study. Low TBI was associated with a significant decrease in patient survival (42±20 versus 51±16 months, p=0.011). There was a progressive and significant decline in mean patient survival time (51±16 versus 44±20 versus 39±22 months, respectively, for ANOVA across the three groups, p=0.04). Patients with isolated low TBI had angioplasty and bypass at a rate similar to that of patients in Group 3 (low ABI and low TBI). The proportion of angioplasties was significantly higher in the isolated low TBI (19.4% (13/67) versus the non-ischaemic 3.2% (1/31), p=0.033). Such revascularisation resulted in ulcer healing within the foot ischaemic group that was similar to the non-ischaemic group (68% versus 60% over 12 months, p=0.454). CONCLUSION Regardless of ABI level, measurement of TBI identifies patients with isolated low TBI who require specialised care pathways and revascularisation to achieve ulcer healing that is similar to non-ischaemic patients.
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Affiliation(s)
- Chris Adusei Manu
- Diabetes Department, King's College Hospital, Denmark Hill, London, UK
| | - Hani Slim
- Vascular Surgery Department, King's College Hospital, Denmark Hill, London, UK
| | - Dean Huang
- Interventional Radiology Department, King's College Hospital, Denmark Hill, London, UK
| | | | | | - Hisham Rashid
- Vascular Surgery Department, King's College Hospital, Denmark Hill, London, UK
| | - Kirsty Winkley
- Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK
| | - Michael Edmonds
- Diabetes Department, King's College Hospital, Denmark Hill, London, UK
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Scatena A, Petruzzi P, Maioli F, Lucaroni F, Ambrosone C, Ventoruzzo G, Liistro F, Tacconi D, Di Filippi M, Attempati N, Palombi L, Ercolini L, Bolognese L. Autologous Peripheral Blood Mononuclear Cells for Limb Salvage in Diabetic Foot Patients with No-Option Critical Limb Ischemia. J Clin Med 2021; 10:2213. [PMID: 34065278 DOI: 10.3390/jcm10102213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
Peripheral blood mononuclear cells (PBMNCs) are reported to prevent major amputation and healing in no-option critical limb ischemia (NO-CLI). The aim of this study is to evaluate PBMNC treatment in comparison to standard treatment in NO-CLI patients with diabetic foot ulcers (DFUs). The study included 76 NO-CLI patients admitted to our centers because of CLI with DFUs. All patients were treated with the same standard care (control group), but 38 patients were also treated with autologous PBMNC implants. Major amputations, overall mortality, and number of healed patients were evaluated as the primary endpoint. Only 4 out 38 amputations (10.5%) were observed in the PBMNC group, while 15 out of 38 amputations (39.5%) were recorded in the control group (p = 0.0037). The Kaplan-Meier curves and the log-rank test results showed a significantly lower amputation rate in the PBMNCs group vs. the control group (p = 0.000). At two years follow-up, nearly 80% of the PBMNCs group was still alive vs. only 20% of the control group (p = 0.000). In the PBMNC group, 33 patients healed (86.6%) while only one patient healed in the control group (p = 0.000). PBMNCs showed a positive clinical outcome at two years follow-up in patients with DFUs and NO-CLI, significantly reducing the amputation rate and improving survival and wound healing. According to our study results, intramuscular and peri-lesional injection of autologous PBMNCs could prevent amputations in NO-CLI diabetic patients.
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Choy OS, Manewell S, Rajendran S, Aitken SJ. Variation in treatment and outcomes for patients with chronic limb-threatening ischaemia in New South Wales, Australia. ANZ J Surg 2021; 91:1211-1219. [PMID: 33908162 DOI: 10.1111/ans.16886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic limb-threatening ischaemia (CLTI) carries significant amputation and mortality risks. Australian population-based outcomes for CLTI are inadequately known. This study aimed to distinguish factors associated with outcomes in the first 2 years after CLTI surgery. METHODS By linking routinely collected health administrative and mortality data from New South Wales, this population-based cohort study identified patients with ischaemic rest pain, gangrene or ulceration undergoing vascular surgery in public hospitals between 2010 and 2012. The primary outcome was 2-year amputation-free survival (AFS), and secondary outcomes included readmission and reoperation rates. Multivariable regression analysis identified prognostic factors adjusted for patient, hospital and geographic factors. RESULTS Primary CLTI surgery was performed on 4898 patients. Almost half the cohort had minor amputations without concurrent revascularization (2398, 49%), and the remaining patients had open (652, 13%) or endovascular (1848, 38%) surgery. At 2-years, the AFS rate was 72%. Significant disparity was seen between age groups, with the 2-year AFS 71% in patients aged 75 years or older, compared to 95% in patients aged less than 75 years (P < 0.001). Place of residence or hospital training status did not significantly influence AFS or readmission, but non-training hospitals had higher rates of reoperation. CONCLUSION This population-based cohort study demonstrated variable outcomes for patients with CLTI, particularly with respect to older age, admission acuity and comorbidity. Results may guide service improvements however further research is needed into how population-wide health initiatives can address age-related disparities in CLTI.
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Affiliation(s)
- Oh Sung Choy
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Nepean Hospital, Sydney, New South Wales, Australia
| | - Sarah Manewell
- Podiatry Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Saissan Rajendran
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord Institute of Academic Surgery, Vascular Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Sarah J Aitken
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord Institute of Academic Surgery, Vascular Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Totić D, Ðurović Sarajlić V, Vranić H, Hadžimehmedagić A, Rustempašić N, Djedović M, Vukas H, Ahmetašević A. Endovascular or open surgical treatment of high-risk patients with infrainguinal peripheral arterial disease and critical limb ischemia. Med Glas (Zenica) 2020; 17:477-84. [PMID: 32602301 DOI: 10.17392/1143-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/21/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022]
Abstract
Aim To determine preferable type of treatment in our clinical circumstances by following two groups of patients with critical limb ischemia (CLI), who were treated endovascularly and surgically. Methods Research was carried out in the form of a prospective study of 80 patients with CLI and Trans-Atlantic Inter-Society Consensus (TASC) C or D type of arterial disease, with American Society of Anesthesiology (ASA) class III risk, who were randomly divided in two groups as per the treatment they received, surgical and endovascular. Patients were followed during 28 months using clinical examination and Duplex Ultrasound (DUS) in accordance with prescheduled control visits. Results There was a statistical difference between surgical and endovascular group in two years patency (82.5% vs. 55%; p=0.022) but it did not result in the difference in amputation free survival (AFS) (95% vs. 85%; p=0.171) or two-year freedom from major adverse limb events (MALE) (87.5 vs. 77.5; p=0.254). Also, there was no difference in the overall survival of patients (100% vs. 97.5%; p=0.317). Conclusion Initial endovascular treatment is a preferred form of the treatment for selected patient population.
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Kazakov YI, Lukin IB, Sokolova NY, Ivanova OV, Bakulina AV. [Outcomes of revascularizing operations on lower-limb arteries in patients with critical ischaemia and multifocal atherosclerosis]. Angiol Sosud Khir 2019; 25:114-121. [PMID: 31503255 DOI: 10.33529/angio2019317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to evaluate the amputation-free survival rate and predictors of major adverse cardiovascular events (extracardiac and cardiac mortality, non-fatal myocardial infarction, non-fatal stroke) in patients with atherosclerotic occlusive-stenotic lesions of the femoropopliteal-tibial segment and critical ischaemia. We analysed the results of treating a total of 122 patients with atherosclerotic lesions of the superficial femoral artery and lower limb critical ischaemia. Of these, 35 patients had no lesions of other arterial basins, 24 patients presented with a concomitant lesion of the carotid basin, 41 subjects had lesions of the coronary basin, and 22 had lesions of the coronary and carotid basins. The patients were subjected to either bypass graft operation (n=75) or endovascular intervention (n=47). The evaluated outcome measures were amputation-free survival and the frequency of major adverse cardiovascular events. The average duration of follow up amounted to 38.2±4.3 months. The carried out multivariate logistic regression analysis demonstrated that the factors associated with lower limb amputation and the development of major adverse cardiovascular events were as follows: a concomitant lesion of the coronary (p=0.044) and coronary-carotid (p<0.05) basins, a history of endured myocardial infarction (p=0.003), a C-reactive protein level not less than 17.0 mg/l (p<0.05) and the value of the apolipoprotein B/A1 ratio above 1.0 (p=0.004).
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Affiliation(s)
- Yu I Kazakov
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - I B Lukin
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - N Yu Sokolova
- Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - O V Ivanova
- Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - A V Bakulina
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
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Iida O, Takahara M, Soga Y, Kodama A, Terashi H, Azuma N. Three-Year Outcomes of Surgical Versus Endovascular Revascularization for Critical Limb Ischemia: The SPINACH Study (Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischemia). Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005531. [PMID: 29246911 PMCID: PMC5753823 DOI: 10.1161/circinterventions.117.005531] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/03/2017] [Indexed: 01/09/2023]
Abstract
Supplemental Digital Content is available in the text. Background— The aim of this study was to compare clinical outcomes between surgical reconstruction and endovascular therapy (EVT) for critical limb ischemia (CLI) in today’s real-world settings. Methods and Results— This multicenter, prospective, observational study registered and followed 548 Japanese CLI patients. The registration was in advance of revascularization; 197 patients were scheduled to receive surgical reconstruction, and the remaining 351 were scheduled to receive EVT. The primary end point was 3-year amputation-free survival, compared between the 2 treatments in an intention-to-treat manner, using propensity score matching. Interaction analysis was additionally performed to explore which subgroups had better outcomes with surgical reconstruction or EVT. After propensity score matching, the 3-year amputation-free survival was not significantly different between the 2 groups (52% [95% confidence interval, 43%–60%] and 52% [95% confidence interval, 44–60%]; P=0.26). Subsequent interaction analysis identified (1) Wound, Ischemia, and foot Infection (WIfI) classification W-3, (2) fI-2/3, (3) history of ipsilateral minor amputation, (4) history of revascularization after CLI onset, and (5) bilateral CLI as the factors more favorable for surgical reconstruction, whereas (1) diabetes mellitus, (2) renal failure, (3) anemia, (4) history of nonadherence to cardiovascular risk management, and (5) contralateral major amputation were as those less favorable for surgical reconstruction. Conclusions— The 3-year amputation-free survival was not different between surgical reconstruction and EVT in the overall CLI population. The subsequent interaction analysis suggested that there would be a subgroup more suited for surgical reconstruction and another benefiting more from EVT. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/. Unique identifier: UMIN000007050.
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Affiliation(s)
- Osamu Iida
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.).
| | - Mitsuyoshi Takahara
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Yoshimitsu Soga
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Akio Kodama
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Hiroto Terashi
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Nobuyoshi Azuma
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
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Johner F, Clemens R, Husmann M, Thalhammer C, Seifert B, Amann-Vesti B. Long-term follow-up after endovascular revascularisation for acute limb ischaemia--a retrospective single-centre cohort. VASA 2016; 45:247-52. [PMID: 27129071 DOI: 10.1024/0301-1526/a000532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We evaluated the long-term outcome after endovascular revascularisation for acute limb ischaemia (ALI). PATIENTS AND METHODS From a prospectively maintained database, 318 endovascular interventions for ALI were identified between 2004 and 2010. Event history and survival were analysed using the Kaplan-Meier method and Cox regression. Endpoints were target vessel revascularisation (TVR), non-target extremity revascularisation (NTER), amputation, major vascular events, coronary artery revascularisation and amputation-free survival. RESULTS Follow-up data of 303 patients (mean age 68.5 ± 12.7 years, 40% female) were available. The mean follow-up time was 38.7 ± 26.2 months. TVR was performed in 40.1 ± 2.9% at 1 year and 66.5 ± 3.8% at 5 years. NTER at 1 and 5 years were 7.1 ± 1.5% and 29.2 ± 4%, respectively. The proportion of patients who needed major or minor amputation was 4.3 ± 1.2% after 1 year and 9 ± 2.1% after 5 years. Amputation-free survival at 1 year was 90.3 ± 1.8% and 74.8 ± 3.2% at 5 years. Coronary artery disease (HR 2.22, 95% CI 1.33 to 3.7, p = 0.002) and atrial fibrillation (HR 2.56, % CI 1.3 to 5.04, p = 0.007) were independently associated with a worse amputation-free survival. The cumulative proportion surviving one year following acute limb ischemia was 95.4 ± 1.2% and 79.7 ± 3.1% after 5 years. CONCLUSIONS Long-term amputation-free survival after successful revascularisation for ALI is high; negative predictors are coronary artery disease and atrial fibrillation.
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Affiliation(s)
- Fabian Johner
- 1 Clinic for Angiology, University Hospital Zurich, Switzerland
| | - Robert Clemens
- 1 Clinic for Angiology, University Hospital Zurich, Switzerland
| | - Marc Husmann
- 1 Clinic for Angiology, University Hospital Zurich, Switzerland
| | | | - Burkhardt Seifert
- 2 Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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Affiliation(s)
- Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Abstract
PURPOSE To determine the 1-year survival rate, 1-year amputation-free survival rate and the risk factors of amputation for patients with diabetic foot ulcers. MATERIALS AND METHODS One hundred seventy-three patients with diabetic foot ulcers were included in our study. Mean patient age was 67.5 (range, 29 to 87, SD ±11.4) years. 74% of the patients were male. Time from study entry to amputation and time to death were evaluated separately as censored event times by Kaplan-Meier curves and log-rank tests. A multivariate Cox proportional hazards regression analysis was carried out for determining the risk factors of amputation. RESULTS The survival rate and amputation-free survival rate were 96.5% (n=167), 65.9% (n=114), respectively, over one year study period. Severity of ulcer was the strongest significant risk factor of amputation [hazard ratio (HR): 7.99; confidence interval (CI): 3.12 to 20.47]. Peripheral artery disease was also independent risk factor of amputation (HR: 2.64; CI: 1.52 to 4.59). CONCLUSION In assessing the prognosis of diabetic foot ulcers, clinicians should consider the severity of ulcer and presence of peripheral artery disease. Our study provides important insights into clinical practice and supplementary information for both physicians and patients.
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Affiliation(s)
- Sung Hun Won
- Department of Orthopaedic Surgery, Armed Force Hampyeong Hospital, Hampyeong, Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeseung Lee
- Department of Vascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Seung Yeol Lee
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Tae Gyun Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
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