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1.
Georgian Med News ; (316-317): 10-16, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34511436

RESUMO

Aim - analyze the results of surgical treatment of patients with diabetes mellitus (DM) with chronic critical lower limb ischemia (CCLLI) against the background of the combined stenotic-occlusive lesions (SOL) of the femoral arterial segment (FAS) and popliteo-tibial arterial segment (PTAS), considering the data of the intraoperative debitometry (ID). The results of surgical treatment of 97 patients with diabetes mellitus with CCLLI caused by combined SOL of FAS and PTAS arteries after 1 month and 12 months of treatment were analyzed. All patients were treated at the Vascular Surgery Center of the Clinical Hospital "Feofania" of State Directorate for Affairs, Kiev, Ukraine during 2014 - 2018yrs. All patients underwent femoro-popliteal bypass grafting without intervention on arteries of PTAS.According to the obtained results of the ID, the patients were divided into groups: group 1 - 32 patients with a debit of the shunt (SD) greater than 60 ml/min, group 2 - 35 patients with SD 30-60 ml/min, group 3 - 30 patients with SD lesser than 30 ml/min. In case of the femoro-popliteal shunt (FPS) thrombosis, performed repeated surgery as a hybrid revascularization (HR) - thrombectomy from the shunt and endovascular balloon angioplasty of the arteries of PTAS. The primary patency of the arterial reconstruction zone of the patients from group 1 after 1 month was 93.75% (30 of 32), after 12 months - 78.13% (25 of 32); group 2 - after 1 month it was 82.8% (29 out of 35), after 12 months - 68.57% (24 out of 35); group 3 - after 1 month it was 46.66% (14 out of 30), after 12 months - 23.33% (7 out of 30). Thrombosis of the femoropopliteal shunt (FPS) within 12 months was diagnosed in 41 (42.27%) of 97 patients, within these patients 1 month after primary shunting in 26 (63.41%), and during the next 11 months in 15 (36.59 %)cases.With repeated intervention on thrombosis ofFPSin form ofHR, secondary patency within 12 months was 78.05% (32 of 41 patients).Restoration of the outflow from the popliteal artery in one of the tibial arteries by HR was possible in 28 of 41 (68.29%) patients, within 12 months rethrombosis of the arterial reconstruction zone occurred in 8 patients (28.57%) - with secondary patency after 12 months of 71.43% (20 of 28 patients). The restoration of the outflow from the popliteal artery into two tibial arteries by HR was possible in 13 of 41 (31.71%) patients, from them rethrombosis of the FPS within 12 months occurred in 1 patient (7.69%) - the secondary patency within 12 months was 92.31% (12 of 13 patients). In the case of combined SOL of FAS and arteries of PTAS, reconstruction of FAS without intervention on the arteries of PTAS requires performing of ID with determining of SD. Performing of ID with determining of SD is an effective diagnostic technique that allows to formulate a differentiated approach to the tactics of surgical treatment of patients with diabetes mellitus with CCLLI, caused by the SOL of FAS and PTAS. The indicator which allows to restore the patency of FAS without intervention on the arteries of the PTAS is SD>60 ml/min; with SD 30-60 ml/min, the reconstruction of the arteries of the PTAS after the restoration of the patency of FAS can be delayed and performed as elective surgery at the second stage; with SD<30 ml/min, simultaneous reconstruction of FAS and PTAS arteries is required by performing HR or two-stage open arterial reconstruction. The HR is an effective method of blood circulation restoration in patients with diabetes mellitus with CCLLI, caused by a combined SOL of FAS and PTAS, and according to the results: the patency of the FPS within 12 months is 78.05% and does not significantly differ from the results of FAS reconstruction in 1st group of patients with SD>60 ml/min - where patency of the FPS within 12 months is 78.13% (p>0.05). In case of thrombosis of the FPS, thrombectomy from the shunt, supplemented by the restoration of the magistral blood flow from the popliteal artery into two tibial arteriesby the method of balloon angioplasty, demonstrates reliably better secondary patency of the femoropopliteal shunt after 12 months - 92.31% in comparison with the secondary patency of the FPS within 12 months after restoration of the magistral blood flow from the popliteal artery into one tibial artery - 71.43% (p<0.05).


Assuntos
Diabetes Mellitus , Artéria Poplítea , Humanos , Isquemia/cirurgia , Extremidade Inferior/cirurgia , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
2.
Angiol Sosud Khir ; 27(3): 54-65, 2021.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-34528589

RESUMO

Described in the article is a clinical case report regarding complete endovascular arterialization of deep crural and pedal veins in a male patient with accompanying pathology and impossibility of intraluminal restoration of the arterial bed. Peculiarities of the presented case report consisted in creation of an arteriovenous anastomosis in the upper third of the crus using an endovascular technique. During treatment, a repeat intervention was required, i. e., balloon angioplasty of veins and implantation of an additional stent graft due to reocclusion of veins because of long-term local treatment of wounds and cytostatic therapy for background diseases (chronic myeloleukaemia and rheumatoid arthritis). The performed treatment resulted in a clear trend towards healing of the wounds on the foot and limb salvage.


Assuntos
Procedimentos Endovasculares , Isquemia , Amputação , , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Perna (Membro) , Salvamento de Membro , Masculino , Resultado do Tratamento , Veias/cirurgia
3.
Angiol Sosud Khir ; 27(3): 173-179, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528603

RESUMO

The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound. Also discussed herein are the problems of terminology, indications for, techniques and results of treatment, providing a historical background, followed by analysing problem spots of using this technique and trends of development.


Assuntos
Isquemia , Extremidade Inferior , Artérias , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Salvamento de Membro , Extremidade Inferior/cirurgia , Resultado do Tratamento
5.
J Pak Med Assoc ; 71(7): 1885-1888, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34410267

RESUMO

A study was conducted to assess the number of limbs salvaged among diabetic patients with chronic limb-threatening ischaemia after infra-inguinal bypass surgeries at a low- to middle-income country (LMIC) hospital. It was a retrospective chart review of diabetic patients who underwent infra-inguinal bypass for lower leg revascularisation for chronic limb-threatening ischaemia at the Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) from January 2008 till April 2019. Diabetic patients with chronic limb-threatening ischaemia had a salvage rate of 90.5%(29/32) after infra-inguinal bypass surgery in our set up which is comparable to those described in the literature.


Assuntos
Diabetes Mellitus , Doença Arterial Periférica , Amputação , Diabetes Mellitus/epidemiologia , Humanos , Isquemia/cirurgia , Salvamento de Membro , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
BMC Surg ; 21(1): 313, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266428

RESUMO

BACKGROUND: This study aimed to compare the clinical efficacy of digital subtraction angiography (DSA) combined arterial thrombectomy versus simple arterial thrombectomy in the treatment of acute lower limb ischemia (ALI). METHODS: This retrospective cohort study collected the clinical data from 124 patients (128 affected lower limbs) with ALI who underwent emergency surgery from March 2010 to November 2019. Patients were consecutively divided into Group A and Group B. Patients in Group A underwent simple arterial thrombectomy via the Fogarty catheterization. Patients in Group B underwent arterial thrombectomy, and the DSA was performed during the surgery. The differences in the success rate of primary surgery, the second intervention rate, and the amputation/mortality rate within 30-days after surgery were compared. RESULTS: In Group A, 4 of 70 limbs (5.7%) were amputated, 54 of 70 limbs (77.1%) had improved blood flow, 14 of 70 limbs (20.0%) received a second intervention, and 3 of 68 patients (4.4%) died within 30 days. In Group B, 1 of 58 limbs (1.7%) was amputated, 56 of 58 limbs (96.6%) had improved blood flow, 3 of 58 limbs (5.2%) received a second intervention, and 2 of 56 patients (3.5%) died within 30-days. The success rate of primary surgery, the second intervention rate, and the amputation rate of Group B were significantly lower than Group A (P < 0.05). CONCLUSION: Arterial thrombectomy combined with DSA may effectively improve the clinical efficacy of patients with ALI.


Assuntos
Arteriopatias Oclusivas , Isquemia , Angiografia Digital , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Extremidade Inferior , Estudos Retrospectivos , Trombectomia , Resultado do Tratamento
9.
J Clin Neurosci ; 90: 36-38, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275576

RESUMO

Ischaemic neuropathy is a rare phenomenon given the rich arterial collateral supply afforded to peripheral nerves by the vasa nervorum. We report an unusual case of unilateral foot drop secondary to long-segment popliteal artery occlusion. Without expedient vessel imaging and revascularisation of the occluded artery, this reversible cause of neurological deficit would likely have resulted in a poor functional outcome for our patient.


Assuntos
Neuropatias Fibulares/etiologia , Artéria Poplítea/patologia , Doenças Vasculares/complicações , Humanos , Isquemia/complicações , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/patologia , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
10.
J Wound Care ; 30(7): 562-567, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34256601

RESUMO

OBJECTIVE: Local intramuscular transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilised peripheral blood mononuclear cells (PB-MNC) has been shown to be effective for treating patients with no-option critical limb ischaemia (CLI) who are not considered suitable to undergo surgical bypass or percutaneous transluminal angioplasty. The aim of this study was to investigate the effectiveness and safety of PB-MNCs as a treatment for no-option CLI patients. METHOD: This prospective cohort study was conducted between April 2013 and December 2017. Patients with no-option CLI were treated with G-CSF 5-10 µg/kg/day for 3 days. PB-MNCs (7.1±2.2×1010) with CD34+ cells (2.1±1.2×108) were collected by blood cell separator and then injected into the calf or thigh of ischaemic limbs. Ankle-brachial index, toe-brachial index and transcutaneous oxygen tension were recorded at 1 and 3 months after injection. The amputation rate and the wound healing rate were also recorded. RESULTS: Eight patients took part in the study. Two patients experienced rest pain relief 1 month after PB-MNC therapy. Five patients had healed ulcer at 6 months after PB-MNC therapy. Limb ischaemia did not improve after PB-MNC therapy in one patient. Below-knee amputation was performed in that patient due to extension of gangrene. Two patients required reinjection of PB-MNCs because of recurrence of ischaemic ulcer. The limb salvage rate after 1 year was 87.5%. CONCLUSION: Local intramuscular transplantation of G-CSF-mobilised PB-MNCs might be a safe and effective treatment for no-option CLI patients.


Assuntos
Leucócitos Mononucleares , Doenças Vasculares Periféricas , Amputação , Humanos , Isquemia/cirurgia , Salvamento de Membro , Estudos Prospectivos , Transplante Autólogo , Resultado do Tratamento
11.
J Endovasc Ther ; 28(5): 716-725, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34137657

RESUMO

PURPOSE: Revascularization of both endovascular therapy (EVT) and surgical reconstruction improve clinical outcomes of patients with critical limb ischemia (CLI); however, treatment of dialysis-dependent patients with CLI is still challenging. This study aimed to investigate the impact of dialysis-related parameters on the risk of mortality in dialysis-dependent patients undergoing revascularization for CLI. MATERIALS AND METHODS: We retrospectively identified 274 dialysis-dependent patients with CLI (196 males; mean age 71 years), who underwent revascularization, from the clinical database of the surgical reconstruction vs peripheral intervention in patients with critical limb ischemia (SPINACH) study, which was a prospective, multicenter, observational study. Of these patients, 175 patients underwent EVT and 99 patients received surgical reconstruction. The current study evaluated the impact of dialysis vintage and renal biomarkers on the mortality rate of dialysis-dependent patients with CLI undergoing revascularization. RESULTS: During a mean follow-up period of 1.7 ± 1.1 years, 147 deaths were observed. The 3-year overall survival rate and its standard error were estimated to be 40.5% ± 8.1% using the Kaplan-Meier method. A Cox proportional hazard analysis revealed that dialysis vintage ≥4 years, serum creatinine levels <4.7 mg/dL, serum urea nitrogen ≥88 mg/dL, and calcium-phosphate product ≥62.6 mg2/dL2 were independent risk factors for mortality after adjustment for the detailed mortality risk score developed in the SPINACH study. Adding these parameters to the original mortality risk score slightly, but not significantly, increased the area under the time-dependent receiver operating characteristics curve from 0.74 (95% CI, 0.67 to 0.81) to 0.77 (0.71 to 0.84) (p=0.084), whereas continuous net reclassification improvement reached 0.75 (0.12 to 0.90) (p=0.027). CONCLUSION: We found that long dialysis vintage, low serum creatinine, high serum urea nitrogen, and high calcium-phosphate product were independently associated with the increased risk of mortality in dialysis-dependent patients with CLI undergoing revascularization.


Assuntos
Procedimentos Endovasculares , Isquemia , Idoso , Amputação , Biomarcadores , Estado Terminal , Procedimentos Endovasculares/efeitos adversos , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Estimativa de Kaplan-Meier , Salvamento de Membro , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
12.
BMJ Case Rep ; 14(6)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162612

RESUMO

Internal hernias due to mesenteric defects are a rare cause of bowel obstruction, but once present their complications are associated with a high morbidity and mortality. We present the case of a 24-year-old patient who presented to the emergency department with a 6-hour history of abdominal pain. Initial surgical review, taking into consideration the patient's clinical, biochemical and radiological findings, led to the patient being taken for immediate surgical exploration. Operative findings included a very mobile caecum and proximal ascending colon which had herniated through a defect in the small bowel mesentery, the sigmoid colon had subsequently become incarcerated by the caecum and small bowel too. Both the ascending and sigmoid colon had become ischaemic. Due to the early decision for surgical intervention, we were able to consider a number of surgical strategies, and the surgery led to a positive outcome for our patient.


Assuntos
Hérnia Abdominal , Obstrução Intestinal , Adulto , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/cirurgia , Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/cirurgia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/cirurgia , Mesentério/diagnóstico por imagem , Mesentério/cirurgia , Adulto Jovem
13.
Eur J Vasc Endovasc Surg ; 62(2): 304-311, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34088615

RESUMO

OBJECTIVE: Amputation level decision making in patients with chronic limb threatening ischaemia is challenging. Currently, evidence relies on published average population risks rather than individual patient risks. The result is significant variation in the distribution of amputation levels across health systems, geographical regions, and time. Clinical decision support has been shown to enhance decision making, especially complex decision making. The goal of this study was to translate the previously validated AMPREDICT prediction models by developing and testing the usability of the AMPREDICT Decision Support Tool (DST), a novel, web based, clinical DST that calculates individual one year post-operative risk of death, re-amputation, and probability of achieving independent mobility by amputation level. METHODS: A mixed methods approach was used. Previously validated prediction models were translated into a web based DST with additional content and format developed by an expert panel. Tool usability was assessed using the Post-Study System Usability Questionnaire (PSSUQ; a 16 item scale with scores ranging from 1 to 7, where lower scores indicate greater usability) by 10 clinician end users from diverse specialties, sex, geography, and clinical experience. Think aloud, semi-structured, qualitative interviews evaluated the AMPREDICT DST's look and feel, user friendliness, readability, functionality, and potential implementation challenges. RESULTS: The PSSUQ overall and subscale scores were favourable, with a mean overall total score of 1.57 (standard deviation [SD] 0.69) and a range from 1.00 to 3.21. The potential clinical utility of the DST included (1) assistance in counselling patients on amputation level decisions, (2) setting outcome expectations, and (3) use as a tool in the academic environment to facilitate understanding of factors that contribute to various outcome risks. CONCLUSION: After extensive iterative development and testing, the AMPREDICT DST was found to demonstrate strong usability characteristics and clinical relevance. Further evaluation will benefit from integration into an electronic health record with assessment of its impact on physician and patient shared amputation level decision making.


Assuntos
Amputação , Sistemas de Apoio a Decisões Clínicas , Isquemia/cirurgia , Extremidade Inferior/cirurgia , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Tomada de Decisão Compartilhada , Técnicas de Apoio para a Decisão , Aconselhamento Diretivo , Feminino , Humanos , Internet , Entrevistas como Assunto , Isquemia/complicações , Extremidade Inferior/irrigação sanguínea , Masculino , Medição de Risco/métodos , Inquéritos e Questionários
14.
Eur J Vasc Endovasc Surg ; 62(2): 225-232, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34090781

RESUMO

OBJECTIVE: The aim of this study was to provide long term survival and limb salvage rates for patients with non-revascularisable (NR) chronic limb threatening ischaemia (CLTI). METHODS: This was a retrospective review of prospectively collected data, derived from a randomised controlled trial (JUVENTAS) investigating the use of a regenerative cell therapy. Survival and limb salvage of the index limb in CLTI patients without viable options for revascularisation at inclusion were analysed retrospectively. The primary outcome was amputation free survival, a composite of survival and limb salvage, at five years after inclusion in the original trial. RESULTS: In 150 patients with NR-CLTI, amputation free survival was 43% five years after inclusion. This outcome was driven by an equal rate of all cause mortality (35%) and amputation (33%). Amputation occurred predominantly in the first year. Furthermore, 33% of those with amputation subsequently died within the investigated period, with a median interval of 291 days. CONCLUSION: Five years after the initial need for revascularisation, about half of the CLTI patients who were deemed non-revascularisable survived with salvage of the index limb. Although the prospects for these high risk patients are still poor, under optimal medical care, amputation free survival seems comparable with that of revascularisable CLTI patients, while the major amputation rate within one year, especially among NR-CLTI patients with ischaemic tissue loss, is very high.


Assuntos
Amputação/estatística & dados numéricos , Isquemia/terapia , Salvamento de Membro/estatística & dados numéricos , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Fatores Etários , Idoso , HDL-Colesterol/sangue , Doença Crônica , Feminino , Humanos , Claudicação Intermitente/etiologia , Isquemia/etiologia , Isquemia/cirurgia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Modelos de Riscos Proporcionais , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Gestão de Riscos , Índice de Gravidade de Doença , Taxa de Sobrevida , Fatores de Tempo
15.
Ann Vasc Surg ; 75: 140-143, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34044096

RESUMO

The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a self-isolation condition. The occurrence of Acute limb ischemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications.


Assuntos
COVID-19/complicações , Diagnóstico Tardio , Erros de Diagnóstico , Isquemia/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Amputação , Anticoagulantes/uso terapêutico , Implante de Prótese Vascular , COVID-19/diagnóstico , COVID-19/terapia , Embolectomia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Masculino , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/cirurgia , Valor Preditivo dos Testes , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Resultado do Tratamento
16.
Int Angiol ; 40(4): 323-334, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34008931

RESUMO

BACKGROUND: Critical limb-threatening ischemia (CLTI) and type 2 diabetes (T2D) frequently co-exist and often with less favorable outcome after revascularization. The objective was to evaluate the effects of revascularization on muscle function, perfusion and mitochondrial respiration in patients with combined CLTI and T2D. METHODS: A prospective translational observational study. Two groups of patients facing unilateral peripheral revascularization was included: Patients suffering from combined disease with CLTI+T2D (N.=14) and patients suffering from CLTI (N.=15). During pedal exercise testing, calf muscle perfusion was monitored with near-infrared spectroscopy (NIRS) and leg arterial volume flow in the common femoral artery with duplex ultrasound. Calf muscle biopsy and subsequent assessment of mitochondrial respiratory capacity on isolated muscle fibers was performed. Tests was performed before and six weeks after revascularization. RESULTS: After revascularization, patients CLTI+T2D improved in muscle force from 8.48 kg (CI: 7.49-9.46) to 13.11 kg (CI: 11.58-14.63), (P<0.001). Conversely, muscle force in patients suffering from non-diabetic CLTI decreased from 10.03 kg (CI: 9.1-10.96) to 9.73 kg (CI: 8.77-10.69), (P=0.042). Muscle oxygenation during exercise improved more in the CLTI+T2D group (6.36 µM/kg/s [CI: 5.71-7.01] compared to 2.11 µM/kg/s [CI:1.38-2.83] in the CLTI group; P=0.002). No improvement or difference between groups regarding mitochondrial function was detected. CONCLUSIONS: Patients with combined CLTI+T2D, had an unsuspected better effect of revascularization compared to patients with non-diabetic CLTI, in terms of increased muscle force and improved muscle perfusion. Further studies are needed to elucidate the apparent interaction of the CLTI and T2D syndromes.


Assuntos
Diabetes Mellitus Tipo 2 , Procedimentos Endovasculares , Doença Arterial Periférica , Doença Crônica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Salvamento de Membro , Extremidade Inferior/cirurgia , Músculos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Vasa ; 50(5): 363-371, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33973817

RESUMO

Background: This study aimed to evaluate the differences between the outcomes of patients with intermittent claudication (IC) and chronic limb threatening ischemia (CLTI) who underwent a hybrid procedure comprising common femoral artery endarterectomy and endovascular therapy. Patients and methods: This was a retrospective single-center study of all patients with peripheral arterial occlusive disease (PAD) who underwent the hybrid procedure between March 2007 and August 2018. The primary endpoint was primary patency after 7 years. The secondary endpoints were primary-assisted patency, secondary patency, limb salvage, and survival. Results: During the follow-up period, 427 limbs in 409 patients were treated. A total of 267 and 160 patients presented with clinical signs of IC and CLTI, respectively. The 30-day mortality was 1.4% (IC: 0% vs. CLTI: 3.8%, p=0.001). The overall 30-day major amputation rate was 1.6% (IC: 0% vs. CLTI: 4.4, p=0.001). The rates of primary and secondary patency after 7 years were 63% and 94%, respectively, in the IC group and 57% and 88%, respectively, in the CLTI group; the difference was not significant. Limb salvage (94% vs. 82%, p=0.000) and survival (58% vs. 29%, p=0.000) were significantly higher in the IC group. In a multivariate analysis, CLTI was the only risk factor for major amputation. CLTI and single vessel run-off were risk factors for death. Statin therapy was a protective factor. Conclusions: The hybrid procedure provides excellent results as a treatment option for multilevel lesions in patients with PAD. However, patients with CLTI had a shorter long-term survival and lower limb salvage rate.


Assuntos
Arteriopatias Oclusivas , Doença Arterial Periférica , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/cirurgia , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
Cardiovasc Intervent Radiol ; 44(7): 1017-1027, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33948700

RESUMO

PURPOSE: Restenosis remains a limitation of endovascular angioplasty with a patency of 30% in BTK at 12 months. Several studies on drug-coated balloons have not demonstrated any improvements in terms of patency and target lesions revascularization in BTK lesions. This prospective single-centre cohort study evaluates the safety and efficacy of a new generation low-dose drug-coated balloon (DCB) with a reduced crystalline structure to treat below the knee (BTK) lesions in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: Between November 2016 and November 2017, 30 consecutive patients (mean 68.8 ± 12.7 years, 6 female) with BTK lesions and CLI were included in this single-centre, prospective non-randomized cohort study. All patients with rest pain and/or ischemic wound associated with BTK lesions were included in the study. Mean lesion length was 133.6 ± 94.5 mm and 18(60%) were chronic total occlusions. The primary safety outcome parameter was a composite of all-cause mortality and major amputation at 6 months. The primary efficacy outcome parameter was the primary angiographic patency at 6 months (defined as freedom from clinically driven target lesion revascularization and the absence of significant restenosis (> 50%) as determined by core laboratory angiography assessment. Immediate technical success, late lumen loss (LLL), clinical target lesion revascularization (TLR) and ulcer healing rates at 12 months were also evaluated. RESULTS: Immediate technical success was 97%(29/30): one patient had an acute thrombosis at the completion of index procedure. Primary safety outcome parameter was 94%(28/30): one patient underwent major amputation and one patient died of other comorbidities at 2 months. Another patient had a major amputation at 7.5 months. Angiographic follow-up was available in 20 patients. Primary angiographic patency was 57%(12/21 lesions), and LLL was 0.99 ± 0.68 mm at 6 months. Freedom from TLR was 89% at 12 months. The rate of ulcer healing was 76% at 12 months. CONCLUSION: Ranger DCB balloons to treat CLI patients demonstrated a positive trend with good safety outcomes parameters. Further randomized studies are needed to understand the usefulness compared to POBA.


Assuntos
Angioplastia com Balão/métodos , Materiais Revestidos Biocompatíveis , Isquemia/cirurgia , Salvamento de Membro/métodos , Paclitaxel/farmacologia , Artéria Poplítea/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Antineoplásicos Fitogênicos/farmacologia , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
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