Predictors for Distal Revascularization Following Femoral Endarterectomy in Chronic Limb-Threatening Ischemia Patients.
Objective: This study aims to identify the clinical variables which are predictive for the benefit of concomitant distal revascularization (DR) to prevent Chronic limb-threatening ischemia (CLTI) progression and the need for major limb amputation. Methods: This is a retrospective cohort study of pat...
| Publicado en: | Vascular & Endovascular Surgery Vol. 57; no. 6; pp. 564 - 574 |
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| Autores principales: | , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Aug2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=164485167&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 164485167 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15385744 JG4 jtl: Vascular & Endovascular Surgery issn: 15385744 maglogo: Y pubinfo: dt: Aug2023 vid: 57 iid: 6 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 164485167 162098500 164485167 164485167 10.1177/15385744231154084 164485167 ppf: 564 ppct: 10 formats: tig: atl: Predictors for Distal Revascularization Following Femoral Endarterectomy in Chronic Limb-Threatening Ischemia Patients. aug: au: Alnahhal, Khaled I. Dehaini, Hassan Sorour, Ahmed A Vyas, Priyam Chumakova, Maryana Bena, James Kirksey, Lee affil: 2569 Department of Vascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH, USA sug: subj: Revascularization Endarterectomy Femoral Artery Surgery Chronic Limb-Threatening Ischemia Surgery Disease Progression Prevention and Control Amputation Needs Assessment Risk Assessment Postoperative Complications Risk Factors Human Retrospective Design Prospective Studies Length of Stay Chronic Limb-Threatening Ischemia Mortality Readmission Reoperation Surgical Wound Infection Descriptive Statistics Multivariate Analysis Clinical Assessment Tools Cox Proportional Hazards Model Intermittent Claudication Surgery Peripheral Vascular Diseases Surgery Health Status Indicators Record Review Chi Square Test Fisher's Exact Test One-Way Analysis of Variance Kruskal-Wallis Test Mann-Whitney U Test Post Hoc Analysis Data Analysis Software Male Female Middle Age Aged Survival Analysis Chronic Limb-Threatening Ischemia Prognosis Survival Rate Hyperlipidemia Funding Source Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Objective: This study aims to identify the clinical variables which are predictive for the benefit of concomitant distal revascularization (DR) to prevent Chronic limb-threatening ischemia (CLTI) progression and the need for major limb amputation. Methods: This is a retrospective cohort study of patients who presented with lower limb ischemia and required at least femoral endarterectomy (FEA), recruited over a period of 15 years (2002-2016). The patient cohort was divided into three groups based on the type of intervention: A (FEA alone), B (FEA + catheter-based intervention/(CBI)), and C (FEA + surgical bypass (SB)). The primary endpoint was to identify independent predictors for the use of concomitant DR (CBI or SB). Secondary endpoints were amputation rate, length of stay, mortality rate, postoperative ankle-brachial index and complications, readmission rate, re-intervention rate, resolution of symptoms and wound status. Results: A total of 400 patients were included, 68.0% were males. Most presenting limbs were at Rutherford class (RC) III and WIfI stage 2, with an ankle-brachial index (ABI) of.47 ±.21 and a TASC II class C lesion. No significant differences were found in the primary-assisted and secondary patency rates between the three groups (P >.05, in all). In the multivariate analyses, clinical variables associated with DR were hyperlipidemia (hazard ratio (HR) 2.1-2.2), TASC II D (HR 2.62), Rutherford class 4 (HR 2.3) and 5 (HR 3.7), as well as WIfI stage ≥3 (HR 1.48). Conclusions: Femoral endarterectomy is sufficient to treat intermittent claudication. However, patients in whom rest pain, tissue loss or TASC II D anatomic lesion severity are present may benefit from concomitant distal revascularization. Taking into consideration the overall assessment of operative risk factors for each individual patient, proceduralists should have a lower threshold for performing early or concomitant distal revascularization to reduce CLTI progression including additional tissue loss and/or major limb amputation. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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