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1.
J Vasc Surg ; 79(3): 632-641.e3, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37939747

RESUMO

OBJECTIVE: There is no established consensus or guidelines for wound management after revascularization for patients with chronic limb-threatening ischemia (CLTI) without severe infection. This study is designed to evaluate the clinical effect of the wound management strategy on toe wounds after revascularization for CLTI. METHODS: This retrospective cohort study was performed at eight institutions affiliated with Keio University School of Medicine in Japan and included 261 patients who underwent revascularization for CLTI between April 2019 and July 2021. We identified 132 patients with toe wounds from the database who had restored in-line blood flow to the foot. Patients were divided into two groups by the timing of toe resection after revascularization, which dictated the wound management policy. Group A (62 patients) underwent early toe amputation for suspected osteomyelitis, whereas group B (70 patients) underwent watchful waiting. The primary outcome was wound healing after revascularization; the secondary outcome was major amputation. We compared outcomes between groups A and B after propensity score matching. RESULTS: Using propensity score matching, each patient in group A (33 patients) was matched with a patient in group B (33 patients). Wound healing in matched group A was significantly better than that in matched group B (respectively: 1-year wound healing rate: 90.0% vs 68.2%, P < .001; median wound healing time: 65 days vs 258 days, P < .01). Although five major amputations were necessary in matched group B, none were required in matched group A (P = .05). The high rate of major amputations in group B was attributed to the sudden exacerbation of infection. Limb salvage rate in matched group A exceeded matched group B (100.0% vs 90.5%: 1-year limb salvage rate, P = .02). CONCLUSIONS: Early toe amputation for highly suspected osteomyelitis in patients with CLTI with toe wounds may expedite wound healing compared with watchful waiting, potentially avoiding unnecessary major amputation. Considering the wound management strategy is crucial when evaluating wound healing outcomes in patients with CLTI with revascularization.


Assuntos
Procedimentos Endovasculares , Osteomielite , Doença Arterial Periférica , Humanos , Isquemia Crônica Crítica de Membro , Estudos Retrospectivos , Resultado do Tratamento , Fatores de Risco , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Salvamento de Membro/efeitos adversos , Doença Crônica , Procedimentos Endovasculares/efeitos adversos
2.
Gan To Kagaku Ryoho ; 46(5): 953-955, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31189824

RESUMO

A 73-year-old man underwent laparoscopic sigmoidectomy for sigmoid colon cancer. Two years after the operation, multiple lung metastasis was diagnosed and chemotherapy with bevacizumab, irinotecan, and TS-1®was started in the patient. However, epigastric pain developed 73 days after the initial course of chemotherapy. Abdominal CT revealed duodenal perforation and generalized peritonitis. Emergency operation with omental patch closure was immediately performed. The patient was discharged 15 days after the emergency operation without any complication. This is an extremely rare case of bevacizu- mab-related duodenal perforation.


Assuntos
Bevacizumab/efeitos adversos , Úlcera Duodenal , Perfuração Intestinal , Neoplasias do Colo Sigmoide , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Colo Sigmoide , Humanos , Masculino , Neoplasias do Colo Sigmoide/terapia
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