Acute leg ischaemia in Gloucestershire

Davies, B.; Braithwaite, B. D.; Birch, P. A.; Poskitt, K. R.; Heather, B. P.; Earnshaw, J. J.

doi:10.1046/j.1365-2168.1997.02601.x

Cited by 18 publications

(12 citation statements)

References 10 publications

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“…Extremity rescue ratio of our patients was 91% with 21 patients. Extremity rescue rate in literature is indicated between 84-94 percent [5,6]. In our patient group, only 2 patients 8.7% were reported with major amputation in the first month.…”

Section: Discussionmentioning

confidence: 64%

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Outcomes of intravenous thrombolytic and adjuvant surgery in acute limb ischemia: Review of 23 patients

Demir¹,

Kahraman²

2019

Journal of Surgery and Medicine

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How to cite / Atıf için: Demir D, Kahraman N. Outcomes of intravenous thrombolytic and adjuvant surgery in acute limb ischemia: Review of 23 patients. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND 4.0) where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. AbstractAim: Today, combined thrombolytic and surgical adjuvant embolectomy is known to have positive results in acute limb ischemia (ALI) treatment. In thrombolytic therapy, the intra-arterial method is generally used. In our study, we performed an intravenous thrombolytic and / or adjuvant surgical embolectomy in patients with failed bypass or diffuse aorta vascular disease who were unable to perform catheter directed thrombolytic therapy (CDT) due to technical difficulties. We evaluated the mortality and morbidity results of the patients. Methods: Retrospective cohort study was planned. This study consists of patients treated for ALI between January 2014 and September 2018. First, the intravenous thrombolytic treatment was performed. The patients who failed this treatment were additionally treated with surgical embolectomy. The patients were in Rutherford Class IIa and IIb. Results: A total of 23 ALI patients were included in the study. Thrombolytic treatment was performed on all of the patients. Twelve (52%) patients who failed thrombolytic treatment were also treated with surgical adjuvant embolectomy. In the first month, two patients (8.7%) required major amputation. In follow-up period of one year, a total three patients (13%) required major amputation and one patient (4.3%) had intracranial hemorrhage. Conclusions: ALI, despite all the developments in its treatment, is still a life threatening disease. This study suggests that our rate of amputation, hemorrhage and extremity rescue are similar or a little lower than the large series of intraarterial thrombolytic treatments in the literature. Today, the thrombolytic treatment methods have one thing in common which is the use of intra-arterial route. Yet we reckon that as in our study; the patients who cannot be treated with intraarterial catheterization the intravenous thrombolytic therapy and/or surgical adjuvant embolectomy can be helpful in rescuing those patient's life and extremity.

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Section: Discussionmentioning

confidence: 64%

“…The amputation rate in the 90s was reported as 6-16 percent. Yet again in the same era, the 30day mortality rate was reported as 16-22 percent [5,6]. In a wider study made on ALI patients in 2000s showed that amputation rates were 13-14 percent and mortality rates were 9-12 percent [7].…”

Section: Discussionmentioning

confidence: 97%

Outcomes of intravenous thrombolytic and adjuvant surgery in acute limb ischemia: Review of 23 patients

Demir¹,

Kahraman²

2019

Journal of Surgery and Medicine

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“…In 1994, in Gloucestershire, UK, 24% of individuals with ALI did not undergo a revascularisation attempt. 22 However, these data may not reflect contemporary practice, and it may be questioned whether they are still valid. Decisions about care need to be made in a compassionate and sympathetic way but based on available clinical evidence, and after discussion with patients and their relatives.…”

Section: Epidemiologymentioning

confidence: 99%

“…For example, in a small series of patients who developed ALI while in hospital with other medical conditions, none survived active treatment. 22 The elderly may tolerate an embolectomy but not do so well if a distal bypass is needed to save the limb. The benefit of revascularisation in nonagenarians with lower limb ischaemia is limited by high mortality at one year.…”

Section: Epidemiologymentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

338

222

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“…Our study also showed increased serum levels of lipopolysaccharide-binding protein in patients with all stages of TBI compared to normal controls. Like serum amyloid A and C-reactive protein, lipopolysaccharide-binding protein is also recognized as a non-specific marker of inflammation [22].…”

Section: Discussionmentioning

confidence: 99%

Panel of serum protein biomarkers to grade the severity of traumatic brain injury

et al. 2018

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The Glasgow Coma Scale (GCS), which classifies patients into mild, moderate or severe traumatic brain injury (TBI), is a system used to prioritize treatment and prognosticate the severity of head injury. In this study, sera of patients with various stages of TBI, as well as control subjects, were analyzed to screen for proteins that may be used to complement the GCS system. By subjecting pooled serum samples to iTRAQ analysis for quantitative comparison of protein abundance, and attesting their altered levels using ELISA, we have detected increased levels of serum amyloid A, C-reactive protein, leucine-rich alpha-2-glycoprotein, lipopolysaccharide-binding protein, fibronectin, vitronectin and alpha-1-antichymotrypsin in patients across all strata of TBI relative to the controls. However, kininogen was decreased only in moderate and severe TBI, whereas apolipoprotein E and zinc-alpha-2-glycoprotein were only increased in severe TBI. Hence, we propose a panel of serum biomarkers, which if analyzed within 24 h of the injury, can be used to diagnose patients with TBI into mild, moderate or severe stratification objectively, thus complementing the traditional GCS.

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Acute leg ischaemia in Gloucestershire

Abstract: In Gloucestershire almost all cases of acute leg ischaemia are managed by, or discussed with vascular surgeons. A flexible integrated policy of surgery and peripheral thrombolysis has resulted in a limb salvage rate of 78 per cent in patients suitable for active treatment.

Cited by 18 publications

References 10 publications

Outcomes of intravenous thrombolytic and adjuvant surgery in acute limb ischemia: Review of 23 patients

Outcomes of intravenous thrombolytic and adjuvant surgery in acute limb ischemia: Review of 23 patients

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Panel of serum protein biomarkers to grade the severity of traumatic brain injury

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