Acute Arterial Occlusions in COVID-19 Times: A Comparison Study Among Patients with Acute Limb Ischemia With or Without COVID-19 Infection.

BACKGROUND: To determine the impact of coronavirus (COVID-19) infection in patients with acute limb ischemia (ALI), mainly the limb salvage estimates the rate and the overall survival rate. METHODS: This was a prospective, consecutive cohort study of ALI patients with or without COVID-19 infection. Two groups of patients were identified: patients with ALI and COVID-19 infection and patients with ALI and without COVID-19 infection. The comparisons among the 2 groups were performed with proper statistical analysis methods. RESULTS: Two groups of patients were identified: ALI and COVID-19 infection with 23 patients and ALI without COVID-19 infection with 49 patients. The overall mortality rate (OMR) was 20.8% (15 patients) in total cohort within the first 30 days. COVID-19 group had a higher OMR than non-COVID-19 group (30.4% vs. 16.7%, P = 0.04). The limb salvage rate at 30 days was 79.1% in total cohort; however, non-COVID-19 infection group had higher limb salvage rates than COVID-19 infection group (89.7% vs. 60.8%, P = 0.01). A univariate and multivariate logistic regression was performed to test the factors related to a major amputation rate. Among the factors evaluated, the following were related to limb loss: D-dimer > 1,000 mg/mL (hazards ratio [HR] = 3.76, P = 0.027, CI = 1.85-5.89) and COVID-19 infection (HR = 1.38, P = 0.035, CI = 1.03-4.75). Moreover, a univariate and multivariate logistic regression analysis was performed to analyze the factors related to overall mortality. Among the factors evaluated, the following were related to OMR: D-dimer > 1,000 mg/dL (HR = 2.28, P = 0.038, CI: 1.94-6.52), COVID-19 infection (HR = 1.8, P = 0.018, CI = 1.01-4.01), and pharmacomechanical thrombectomy >150 cycles (HR = 2.01, P = 0.002, CI = 1.005-6.781). CONCLUSIONS: COVID-19 has a worse prognosis among patients with ALI, with higher rates of limb loss and overall mortality relative to non-COVID patients. The main factors related to overall mortality were D-dimer > 1,000 mg/dL, COVID-19 infection, and pharmacomechanical thrombectomy >150 cycles. The factors related to limb loss were D-dimer > 1,000 mg/mL and COVID-19 infection.

The Incidence, Risk Factors, and Outcomes of Contrast-Induced Nephropathy In Patients With Critical Limb Ischemia Following Lower Limb Angiography.

Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves. Overall, there was a predominance of males (57%), with a mean age of 70.5 (10.7) years. The incidence of CIN was 35.5%, and chronic kidney failure was the only factor associated with elevated risk of this condition (relative risk [RR] = 1.9; 95% confidence interval = 1.17-3.09; P = .017). The median follow-up was 645 days, and in 720-day analyses, patients who experienced CIN had worse HI (81.2% vs 96.3%; P = .0107) and OS (49.5% vs 66.3%; P = .0463). The current study found a high incidence of CIN in patients with CLI after DSA. This renal impairment was associated with a worse prognosis in terms of survival.

A anquilose tíbio-társica e sua importância na insuficiência venosa crônica / Ankle ankylosis and its importance in chronic venous insufficiency

CONTEXTO: O desenvolvimento de anquilose em pacientes com insuficiência venosa crônica (IVC) pode ser evidenciado em diversos estágios da patologia através de medidas da amplitude de movimento da articulação do tornozelo tomadas com a utilização de um goniômetro. OBJETIVO: Relacionar a diminuição da amplitude de movimento da articulação tíbio-társica na IVC dos membros inferiores (MMII) medida por goniometria com a gravidade da IVC, utilizando-se a classificação CEAP. MÉTODOS: No período de março de 2003 a agosto de 2004, 86 pacientes (67 mulheres e 19 homens) com média de idade de 50,6 anos foram submetidos à goniometria do tornozelo. Os indivíduos foram divididos conforme a gravidade da IVC de seus MMII (121 avaliados) de acordo com a classificação CEAP. Quarenta membros foram caracterizados como C0 (grupo-controle), 40 como C3, e 41 como C4. As medidas obtidas nos diferentes grupos foram comparadas entre si. RESULTADOS: A média da amplitude de movimento da articulação tíbio-társica do grupo C0 foi de 42,4º (variação de 26-54); a do grupo C3 foi de 37,9º (variação de 10-61); e a do grupo C4 foi de 24,5º (variação de 8-50). A diferença das médias de C4 e C3 foi de 36 por cento, e a de C3 comparada com o grupo-controle (C0), de 11 por cento, caracterizando a maior diferença entre C3 e C4. CONCLUSÃO: A goniometria do tornozelo auxilia a graduar a hipertensão venosa crônica, pois demonstra a existência de correlação entre a gravidade da anquilose e a severidade da IVC.

BACKGROUND: Development of ankylosis in patients with chronic venous insufficiency (CVI) can be observed in different stages of the disease as the ankle range of motion is measured by a goniometer. OBJECTIVE: To relate a reduced ankle range of motion in patients with CVI of the lower limbs measured by goniometry and the severity of CVI according to the CEAP classification. METHODS: From March 2003 to August 2004, 86 patients (67 females and 19 males) with a mean age of 50.6 years had their ankles assessed by a goniometer. Patients were classified into three groups according to the severity of the CVI of the lower limbs (121 were assessed) using the CEAP classification. There were 40 limbs classified as C0 (control group), 40 limbs as C3 and 41 limbs as C4. Measurements of all groups were compared. RESULTS: The average ankle range of motion was 42.4º (from 26º to 54º) in C0 group, 37.9º (from 10º to 61º) in C3 group and 24.5º (from 8º to 50º) in group C4. The difference between C4 and C3 average values was 36 percent and that between C3 and the control group (C0) was 11 percent; thus, the contrast between C3 and C4 was more significant. CONCLUSION: Ankle goniometry may be used to assess chronic venous hypertension, as it reveals a correlation between the severity of ankylosis and the severity of CVI.