Critical Limb Ischemia—Need to Look Beyond Limb Salvage

Kumar, Bharath N.; Gambhir, Raghvinder

doi:10.1016/j.avsg.2011.05.020

Cited by 14 publications

(12 citation statements)

References 17 publications

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“…In previous researches [ 19 – 22 ], revascularization procedure (surgery and angioplasty/stenting) could have a determined better prognosis than conservative therapy. However, procedure percentage (48.8%) is relative low for CLI patients in our institution, especially in group B (GNRI<90, 36.4%).…”

Section: Discussionmentioning

confidence: 99%

Geriatric Nutritional Risk Index (GNRI) Independently Predicts Amputation Inchronic Criticallimb Ischemia (CLI)

et al. 2016

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ObjectiveGeneral malnutrition usually occurs in critical limb ischemia (CLI) patients because of shortness of appetite and sleeplessness leaded by chronic pain. And amputation frequently is end-point of CLI patients. So the aim of this study was to assess the predictive ability of Geriatric nutritional risk index (GNRI) for predicting amputation in patients with CLI.MethodsA retrospective study was designed. Demographics, history, comorbidity, and risk factors for peripheral vascular disease of admitted patients, and laboratory study were documented. Patients’ height, weight and BMI were recorded. Amputation was identified as end-point during follow-up. Patients’ amputation-free survival (AFS) was recorded.Result172 patients were identified, with mean age 71.98±3.12. Geriatric nutritional risk index (GNRI) = 90 was taken as cutoff value of high risk of amputation for CLI patients via using receiver operating characteristic (ROC) curve. Span of follow-up was 12–48 months. During follow-up, 60 patients (36.04%) received amputation surgery. And analyzed by Cox proportional hazards model, it is found that GNRI was the independent predictive factor for amputation in long term.ConclusionThis study revealed that GNRI was a reliable and effective predictive marker for AFS. GNRI could identify patients with high risk for amputation in early time.

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Section: Discussionmentioning

confidence: 99%

Geriatric Nutritional Risk Index (GNRI) Independently Predicts Amputation Inchronic Criticallimb Ischemia (CLI)

et al. 2016

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“…28,29 Thus, there has been a recent shift toward inclusion of patient-centered outcomes in research analyses performed in CLI cohorts, both in the United States 30,31 and globally. 32 The opinions expressed in the focus groups of vascular amputees highlight the importance of QOL in defining a “successful treatment outcome” for CLI. In our discussions, functionality and life quality remained the paramount topics raised by patients, not target lesion revascularization or residual stenosis.…”

Section: Discussionmentioning

confidence: 99%

Domains that Determine Quality of Life in Vascular Amputees

Suckow

Goodney

Nolan

et al. 2015

Annals of Vascular Surgery

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Background Although patients with critical limb ischemia (CLI) commonly undergo major limb amputation, the quality of life (QOL) of this group remains poorly described. Therefore, we sought to describe which domains vascular amputees consider important in determining their health-related QOL. Methods We performed 4 focus groups in patients who had major lower extremity amputations resulting from CLI. They were conducted at 4 distinct centers across the United States to ensure broad geographic, socioeconomic, and ethnic representation. Results Of 26 patients (mean age, 64 years), 19 (73%) were Caucasian, 6 (23%) were African American, and 1 (4%) was Native American. Nearly, three-quarter of patients were men (n = 19, 73%) and had a high-school education or more (n = 19, 73%). Overall, 8 (31%) were double amputees and 17 (65%) had diabetes. Time since amputation varied across patients and ranged from 3 months to more than 27 years (mean, 4.3 years). Patients stated that their current QOL was determined by impaired mobility (65%), pain (60%), progression of disease in the remaining limb (55%), and depression/frustration (54%). Across 26 patients, more than half (n = 16, 62%) described multiple prior revascularization procedures. Although most felt that their physician did his/her best to salvage the affected leg (85%), a sizable minority would have preferred an amputation earlier in their CLI treatment course (27%). Furthermore, when asked how their care might have been improved, patients reported that facilitating peer support (88%), more extensive rehabilitation and prosthetist involvement (71%), earlier mention of amputation as a possible outcome (54%), and the early discontinuation of narcotics (54%) were potential areas of improvement. Conclusions Although QOL in vascular amputees seems primarily determined by mobility impairment, pain, and emotional perturbation, our focus groups identified that physician-controlled factors such as the timing of amputation, informed decision making, and postamputation support may also play an important role. The assessment of patient preferences regarding maintenance of mobility at the cost of increased pain versus relief of pain with amputation at a cost of diminished mobility is central to shared decision making in CLI treatment.

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“…First, we did not consider functional or patient-oriented outcomes that have recently been emphasized as critical in evaluating optimal management of CLI. 7,25,28,41 Second, since BMI, lipid profiles, and serum albumin levels are merely 3 facets of nutritional status, it will be important to evaluate additional markers to develop a more useful predictive model for outcomes. Finally, we did not investigate mechanisms underlying the effect of poor nutrition and AF on CLI.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors of Long-Term Outcomes in Patients With Critical Limb Ischemia Who have Undergone Endovascular Therapy

et al. 2013

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Clinical predictors of long-term outcomes in patients with critical limb ischemia (CLI) treated with endovascular therapy (EVT) remain unclear. In this study, clinical predictors of long-term outcomes in EVT-treated patients with CLI were investigated. In this prospective, observational study, we analyzed a total of 253 Taiwanese patients with CLI with 314 limbs who underwent EVT between 2005 and 2012. Cox models were used to estimate hazard ratios of death, limb loss, and sustained clinical success (SCS). Multivariate analysis showed that age, atrial fibrillation (AF), end-stage renal disease (ESRD), and albumin were significant predictors of mortality. Patients with coronary artery disease and low albumin levels had a significant risk of major limb amputation, while AF, ESRD, and albumin were significant, independent predictors of SCS. In addition to previously reported predictors, we showed that AF and malnutrition can be used to predict long-term outcome in EVT-treated patients with CLI.

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Critical Limb Ischemia—Need to Look Beyond Limb Salvage

Cited by 14 publications

References 17 publications

Geriatric Nutritional Risk Index (GNRI) Independently Predicts Amputation Inchronic Criticallimb Ischemia (CLI)

Geriatric Nutritional Risk Index (GNRI) Independently Predicts Amputation Inchronic Criticallimb Ischemia (CLI)

Domains that Determine Quality of Life in Vascular Amputees

Clinical Predictors of Long-Term Outcomes in Patients With Critical Limb Ischemia Who have Undergone Endovascular Therapy

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