Age-Dependent Outcome of First-Line Endovascular and Surgical Revascularization Strategies in Chronic Limb-Threatening Ischemia

Smet, Nick; Fourneau, Inge; Hilde, Roeleveld; Leandra, Boonman-de Winter; Schraepen, Cédric; Michael, Favoreel; Laan, Lijckle van der

doi:10.1016/j.avsg.2022.03.021

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…We have found advanced age over 75 years old to be a negative prognostic factor, both for 30 day and 1 year mortality. A Dutch study recently reported a similar result for 1 year mortality in advanced age, as did a Yale School of Medicine study [ 26 , 27 ].…”

Section: Discussionsupporting

confidence: 62%

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Martelli

Zamboni²,

Sotgiu

et al. 2023

JPM

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Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66–80) and 79 (71–85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.

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Section: Discussionsupporting

confidence: 62%

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Martelli

Zamboni²,

Sotgiu

et al. 2023

JPM

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“…The reasons for the increased prevalence with age may be associated with poor peripheral artery drainage and tissue loss. Previous studies showed that patients had comorbidities such as hypertension, hypercholesterolemia, chronic kidney disease, history of heart disease, COPD, and CVDs that also increase the risk of PAOD ( 38 ). In this study, we also showed that age was a risk factor for PAOD in PSO patients.…”

Section: Discussionmentioning

confidence: 99%

Association between psoriasis and peripheral artery occlusive disease: a population-based retrospective cohort study

Yeh

Yang

et al. 2023

Front. Cardiovasc. Med.

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IntroductionPsoriasis (PSO) is a chronic skin condition that affects a variety of disorders, especially the cardiovascular system. This study investigated the association between PSO and peripheral arterial disease (PAOD).MethodsA retrospective cohort study design was carried out between 2000 and 2018. The exposure subject was a newly diagnosed PSO. The diagnosis of PSO was never elaborated as a comparison subject. Balanced heterogeneity of the two groups was used by propensity score matching. The cumulative incidence of PAOD between the two groups was performed using Kaplan-Meier analysis. The Cox proportional hazard model was used to measure the risk of PAOD risk hazard ratio.ResultsAfter matching the 1: 1 propensity score, 15,696 subjects with PSO and the same number of subjects without the diagnosis of PSO were recruited. The PSO subject had a higher risk of PAOD than the non-PSO subject (adjusted HR = 1.25; 95% CI = 1.03-1.50). In the 40-64-year-old subgroup, the subject of PSO exhibited an increased risk of PAOD than the subject without PSO.ConclusionPsoriasis is associated with an increased risk of peripheral arterial disease and curative care is necessary to reduce the risk of PAOD..

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“…In this multicenter cohort study, all patients diagnosed with a first episode of CLTI between 2013 and 2018 at the Amphia Hospital (The Netherlands) and between 2016 and 2018 at University Hospitals Leuven (Belgium) were included. 8 CLTI was defined as patients presenting with rest pain and/or ischemic tissue loss, equivalent to Rutherford 4 and Rutherford 5-6, respectively. Rest pain was objectified by comprised hemodynamics: ankle <50 mm Hg or toe pressure <30 mm Hg or TcPO2 <30 mm Hg.…”

Section: Methods Patient Population and Data Collectionmentioning

confidence: 99%

Chronic Limb-Threatening Ischemia does not Enclose a Homogenous Population: Time for a More Detailed Classification

Cédric,

Lijckle,

Nick

et al. 2023

Int J Angiol

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Objective Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality. Classification methods differentiate into patients with rest pain or with ischemic ulcers. No distinction is made between the presence or absence of rest pain in patients with ischemic ulcers. Our aim is to determine any differences in outcome between these subdivisions so we can improve preoperative counseling and risk assessment. Methods This multicenter retrospective cohort study included all patients revascularized for a first episode of CLTI between 2013 and 2018. The cohort was divided in three groups: patients with solely rest pain (RP), solely ischemic ulcers (IU), and patients with both rest pain and ischemic ulcers (RP + IU). Baseline characteristics, morbidity, and mortality were analyzed. Results A total of 624 limbs in 599 patients were included: 225 (36.1%) in the rest pain group, 169 (27.1%) in the ischemic ulcers group, and 230 (36.2%) in combined group. Amputation rates were higher in the combined group at 6 months. Mortality rates were significantly higher in the ischemic ulcers group and the combined group at 6 months and 1 year. Conclusions Patients with solely rest pain have significantly lower mortality rates in comparison to patients with ischemic ulcers. Rest pain did not affect mortality rates in patients with ulcers. There was a higher amputation rate in patients with combined rest pain and ischemic ulcers because the presence of rest pain CLTI patients had a significant negative effect on amputation risk. A separate subdivision for patients with combined ulcers and rest pain is indicated.

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Age-Dependent Outcome of First-Line Endovascular and Surgical Revascularization Strategies in Chronic Limb-Threatening Ischemia

Cited by 10 publications

References 24 publications

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Association between psoriasis and peripheral artery occlusive disease: a population-based retrospective cohort study

Chronic Limb-Threatening Ischemia does not Enclose a Homogenous Population: Time for a More Detailed Classification

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