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Limb ischemia risk score

Cosmin Caraşca, Angela Borda, Alexandru Incze, Emilian Caraşca, Attila Frigy, HoraŢiu Suciu
We present the case of a 55-year-old male with mild hypertension and brief episodes of paroxysmal self-limiting atrial fibrillation (AF) since 2010. Despite a small cardioembolic risk score, CHA2DS2-Vasc=1 (Congestive heart failure, Hypertension, Age=75, Diabetes melitus, prior Stroke), the patient is effectively anticoagulated using acenocumarol. In December 2014, he showed signs of plantar transitory ischemia, for which he did not address the doctor. In early January 2015, he urgently presented at the hospital with left renal pain, caused by a renal infarction, diagnosed by computed tomography (CT) angiography...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Stavros Spiliopoulos, Dimitrios Karnabatidis, Konstantinos Katsanos, Athanasios Diamantopoulos, Tariq Ali, Panagiotis Kitrou, Alessandro Cannavale, Miltiadis Krokidis
PURPOSE: The purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease. MATERIALS AND METHODS: This was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals...
August 1, 2016: Cardiovascular and Interventional Radiology
Walter Dorigo, Gabriele Piffaretti, Raffaele Pulli, Patrizio Castelli, Carlo Pratesi
AIM OF THE STUDY: To retrospectively create a predictive score for estimating amputation-free survival (AFS) in patients with critical limb ischemia (CLI) operated on with the use of a heparin-bonded expanded polytetrafluoroethylene (ePTFE) bypass graft (Hb-ePTFE). METHODS: Over a 13-year period, ending in March 2015, a Hb-ePTFE graft was implanted in 683 patients undergoing below-knee revascularization for CLI in seven Italian vascular hospitals. Data concerning these interventions were retrospectively collected in a multicenter registry with a dedicated database...
July 29, 2016: World Journal of Surgery
Gwang Sil Kim, Jae-Sun Uhm, Tae-Hoon Kim, Hancheol Lee, Junbeom Park, Jin-Kyu Park, Boyoung Joung, Hui-Nam Pak, Moon-Hyoung Lee
BACKGROUND: This study aimed to determine the risk of thromboembolic events in patients with junctional bradycardia(JB). METHODS: We retrospectively reviewed electrocardiograms(ECGs) for 380,682 patients. Those with JB on an ECG at least twice over a ≥3-month interval were included for analysis. We additionally included 138 CHADS2 score-matched patients(age, 68.4 ± 15.7 years; male, 52.2%) in sinus rhythm as a control group. Between the JB patients(with or without retrograde P wave) and controls, we compared incidences of ischemic stroke and a composite of ischemic stroke, renal infarction, ischemic colitis, acute limb ischemia, and pulmonary embolism...
2016: BMC Neurology
In Sook Kang, Wonkyung Lee, Byoung Wook Choi, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, Young-Guk Ko
OBJECTIVE: Tibial artery calcification (TAC) is associated with increased risk of amputation and mortality in peripheral artery disease. We sought to investigate whether the severity of TAC based on semiquantitative analysis of computed tomography angiography (CTA) can predict outcomes of endovascular therapy in patients with critical limb ischemia. METHODS: We reviewed medical records of 124 patients who underwent lower extremity CTA before intervention. Based on CTA, TAC severity was categorized into three groups: minimal calcification (MC; n = 43), intermediate calcification (IC; n = 36), or extensive calcification (EC; n = 45)...
July 15, 2016: Journal of Vascular Surgery
Terri Chiong, Esther S H Cheow, Chin C Woo, Xiao Y Lin, Lay W Khin, Chuen N Lee, Mikael Hartman, Siu K Sze, Vitaly A Sorokin
AIMS: The SYNTAX score correlate with major cardiovascular events post-revascularization, although the histopathological basis is unclear. We aim to evaluate the association between syntax score and extracellular matrix histological characteristics of aortic punch tissue obtained during coronary artery bypass surgery (CABG). This analysis compares coronary artery bypass surgery patients with High and Low syntax score which were followed up for one year period. METHODS AND RESULTS: Patients with High (score ≥ 33, (n=77)) and Low Syntax Scores (score ≤ 22, (n=71)) undergoing elective CABG were recruited prospectively...
2016: Open Cardiovascular Medicine Journal
Paul P Heideman, Mohammad Reza Rajebi, Michael A McKusick, Haraldur Bjarnason, Gustavo S Oderich, Jeremy L Friese, Mark D Fleming, Andrew H Stockland, William S Harmsen, Jay Mandrekar, Sanjay Misra
PURPOSE: To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. MATERIALS AND METHODS: A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267)...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
Yoshio Tanaka, Tetsuji Uemura, Shinobu Ayabe, Tomohiro Hirao, Tomohisa Nagasao
Background The purpose of this study was to investigate the efficacy of introducing microsurgical techniques to distal bypass surgery for critical limb ischemia. Methods Datasets of 83 consecutive microsurgical distal bypasses in a multicenter (SKY) study were compared with the results of the PREVENT III (PIII) study regarding the following: (1) patients' characteristics, (2) clinical severity according to the PIII risk score, (3) conduits and procedures for revascularization, (4) proximal and distal anastomosis sites, and (5) primary patency and amputation-free survival (AFS) rates at 1 year...
June 15, 2016: Journal of Reconstructive Microsurgery
Andrew J Meltzer, Art Sedrakyan, Abby Isaacs, Peter H Connolly, Darren B Schneider
OBJECTIVE: In this study, the effectiveness of peripheral vascular intervention (PVI) was compared with surgical bypass grafting (BPG) for critical limb ischemia (CLI) in the Vascular Study Group of Greater New York (VSGGNY). METHODS: Patients undergoing BPG or PVI for CLI at VSGGNY centers (2011-2013) were included. The Society for Vascular Surgery objective performance goals for CLI were used to directly compare the safety and effectiveness of PVI and BPG. Propensity score matching was used for risk-adjusted comparisons of PVI with BPG...
May 27, 2016: Journal of Vascular Surgery
Monica Reed Chase, Howard S Friedman, Prakash Navaratnam, Kim Heithoff, Ross J Simpson
BACKGROUND: There is growing concern about appropriate disease management for peripheral artery disease (PAD) because of the rapidly expanding population at risk for PAD and the high burden of illness associated with symptomatic PAD. A better understanding of the potential economic impact of symptomatic PAD relative to a matched control population may help improve care management for these patients. OBJECTIVE: To compare the medical resource utilization, costs, and medication use for patients with symptomatic PAD relative to a matched control population...
June 2016: Journal of Managed Care & Specialty Pharmacy
Emrah Şişli, Ali Aycan Kavala, Mustafa Mavi, Osman Nejat Sarıosmanoğlu, Öztekin Oto
OBJECTIVE: To elucidate the risk factors associated with amputation in cases with combat-related vascular injury (CRVI). MATERIAL AND METHODS: This retrospective study included 90 cases with CRVI treated between May 2011 and July 2013. The patients were divided into group I (n=69), in which the limb was salvaged and group II (n=21), in which the patients received amputation. RESULTS: The overall and the secondary amputation rates were 23% and 18%, respectively...
September 2016: Injury
Marlin W Causey, Ayman Ahmed, Bian Wu, Warren J Gasper, Alex Reyzelman, Shant M Vartanian, Jade S Hiramoto, Michael S Conte
OBJECTIVE: Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization...
June 2016: Journal of Vascular Surgery
George L Adams, Jihad Mustapha, William Gray, Nick J Hargus, Brad J Martinsen, Gary Ansel, Michael R Jaff
BACKGROUND: Most peripheral artery disease (PAD) clinical device trials are supported by commercial manufacturers and designed for regulatory device approval, with extensive inclusion/exclusion criteria to support homogeneous patient populations. High-risk patients with advanced disease, including critical limb ischemia (CLI), are often excluded leading to difficulty in translating trial results into real-world clinical practice. As a result, physicians have no direct guidance regarding the use of endovascular devices...
April 2016: American Heart Journal
Efthymios Beropoulis, Konstantinos Stavroulakis, Arne Schwindt, Arne Stachmann, Giovanni Torsello, Theodosios Bisdas
BACKGROUND: The Society for Vascular Surgery Lower Extremity Guidelines Committee developed the Wound, Ischemia, foot Infection (WIfI) a classification system to predict the amputation risk in patients with critical limb ischemia (CLI). A number of published studies have already evaluated its prognostic value. However, most of the included patients were diabetic, and the validation was done independent of the revascularization procedure. This single-center study evaluated the prognostic value of WIfI stages in nondiabetic patients treated by endovascular means...
July 2016: Journal of Vascular Surgery
Surbhi Leekha, Brian D Lahr, Rodney L Thompson, Priya Sampathkumar, Audra A Duncan, Robert Orenstein
OBJECTIVE: The objective of this study was to develop a surgical site infection (SSI) prediction score for risk assessment before elective vascular surgery. METHODS: We conducted a nested case-control study among patients who underwent elective vascular (abdominal aortic and peripheral arterial) surgery from January 1, 2003, to December 31, 2007, at Mayo Clinic (Rochester, Minn) an academic tertiary surgical center. Cases were patients with SSI requiring hospitalization; controls (one or two per case) were matched on type of procedure and date of surgery...
July 2016: Journal of Vascular Surgery
Tzu-Yen Chang, Shyh-Jou Shieh
The estimated prevalence of diabetes is 9.78% in Taiwan. The lifetime risk for patients with diabetes to have foot ulcers might be as high as 25%. About 15% of these patients require major limb amputation because of ischemia and infection. Peripheral artery disease is still a major problem involved in diabetic foot disease and the cause for major amputation despite an increase in the prevalence of revascularization surgery and new revascularization techniques over the past 20 years. We investigated the major limb amputation rates in patients with diabetic foot and critical limb ischemia who had undergone revascularization surgery in our hospital...
March 2016: Annals of Plastic Surgery
Liming Wei, Yueqi Zhu, Fang Liu, Peilei Zhang, Xiaocong Li, Jungong Zhao, Haitao Lu
PURPOSE: To investigate factors predictive of thromboembolic occlusions and evaluate the efficacy of percutaneous aspiration thrombectomy (PAT) for infrainguinal thromboembolic occlusions in patients undergoing endovascular recanalization (EVR). MATERIALS AND METHODS: In this single-center retrospective study, 23 patients who underwent PAT for thromboembolism during EVR and 237 patients who underwent successful EVR without thromboembolic occlusions (control group) were enrolled...
March 2016: Journal of Vascular and Interventional Radiology: JVIR
Luca Naldi, Margherita Bernetti, Francesca Baroni, Maria Boddi
The ankle-brachial index (ABI) obtained by the ankle/brachial blood pressure ratio is the gold standard for the diagnosis of peripheral arterial disease (PAD): ≤0.9 is the cut-off value for PAD diagnosis and ≤0.4 for the diagnosis of acute or chronic critical limb ischemia. Recently, the ABI has been proposed as an independent marker of cardiovascular (CV) risk, but its role remains debated. According to some authors, ABI improves CV risk scoring when added to traditional scores, such as the Framingham risk score, in both primary and secondary prevention: an ABI of ≤0...
December 2015: Giornale Italiano di Cardiologia
Hosam El-Sayed, Matthew E Bennett, Thomas M Loh, Mark G Davies
BACKGROUND: Endovascular revascularization is an established approach for limb salvage in the setting of critical limb ischemia. However, failure rate of antegrade recanalization in complex femoropopliteal to infrapopliteal occlusions is as high as 20%. We report a series of 21 patients who underwent retrograde pedal access and recanalization of below-the-knee chronic total occlusions after failed antegrade attempts. METHODS: This is a retrospective review of prospectively maintained data for all patients who underwent ultrasound-guided percutaneous pedal access for retrograde endovascular treatment of advanced tibial vessel disease between 2011 and 2014...
February 2016: Annals of Vascular Surgery
Jessica P Simons, Philip P Goodney, Julie Flahive, Andrew W Hoel, John W Hallett, Larry W Kraiss, Andres Schanzer
BACKGROUND: Providing patients and payers with publicly reported risk-adjusted quality metrics for the purpose of benchmarking physicians and institutions has become a national priority. Several prediction models have been developed to estimate outcomes after lower extremity revascularization for critical limb ischemia, but the optimal model to use in contemporary practice has not been defined. We sought to identify the highest-performing risk-adjustment model for amputation-free survival (AFS) at 1 year after lower extremity bypass (LEB)...
April 2016: Journal of Vascular Surgery
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