Endovascular Therapy in an “All-Comers” Risk Group for Chronic Limb-Threatening Ischemia Demonstrates Safety and Efficacy When Compared with the Established Performance Criteria Proposed by the Society for Vascular Surgery

Montero-Baker, Miguel; Zulbaran-Rojas, Alejandro; Chung, Jayer; Barshes, Neal R.; Elizondo-Adamchik, Hector; Shahbazi, Mohammad; Ross, Jeffrey A.; Rahemi, Hadi; Najafi, Bijan; Mills, Joseph L.

doi:10.1016/j.avsg.2020.03.008

Cited by 4 publications

(6 citation statements)

References 36 publications

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“…More recently, to integrate frailty screening as a component of routine preoperative assessment, the focus has shifted toward developing a quick and objective assessment tool to evaluate physical frailty based on a single frailty phenotype. Grip strength, which is often associated with sarcopenia (weight loss phenotype) and reduced muscle strength (weakness phenotype), has been shown to be a robust surrogate measure of frailty, 21,22 predicting disability, morbidity, and mortality 22,29,30 as well as high cardiovascular risk 31 36,37 especially in frail patients. 38 In our study, 4 patients (2.6%) died and 9 patients (5.9%) had limb loss within 30 days of revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…The mean (SD) FI also was not significantly different between patients with open (0.26 [0.13]) and endovascular (0.28 [0.14]) revascularizations. Previous studies have shown that patients with CLTI have higher mortality 35 and increased risk of an amputation following a revascularization 36,37 especially in frail patients. 38 In our study, 4 patients (2.6%) died and 9 patients (5.9%) had limb loss within 30 days of revascularization.…”

Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

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Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

et al. 2020

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IMPORTANCE Physical frailty is a key risk factor associated with higher rates of major adverse events (MAEs) after surgery. Assessing physical frailty is often challenging among patients with chronic limb-threatening ischemia (CLTI) who are often unable to perform gait-based assessments because of the presence of plantar wounds. OBJECTIVE To test a frailty meter (FM) that does not rely on gait to determine the risk of occurrence of MAEs after revascularization for patients with CLTI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 184 consecutively recruited patients with CLTI at 2 tertiary care centers. After 32 individuals were excluded, 152 participants were included in the study. Data collection was conducted between May 2018 and June 2019. EXPOSURES Physical frailty measurement within 1 week before limb revascularization and incidence of MAEs for as long as 1 month after surgery. MAIN OUTCOMES AND MEASURES The FM works by quantifying weakness, slowness, rigidity, and exhaustion during a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. The FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of physical frailty. RESULTS Of 152 eligible participants (mean [SD] age, 67.0 [11.8] years; 59 [38.8%] women), 119 (78.2%) were unable to perform the gait test, while all could perform the FM test. Overall, 53 (34.9%), 58 (38.1%), and 41 (27.0%) were classified as robust (FI <0.20), prefrail (FI Ն0.20 to <0.35), or frail (FI Ն0.35), respectively. Within 30 days after surgery, 24 (15.7%) developed MAEs, either major adverse cardiovascular events (MACE; 8 [5.2%]) or major adverse limb events (MALE; 16 [10.5%]). Baseline demographic characteristics were not significantly different between frailty groups. In contrast, the FI was approximately 30% higher in the group that developed MAEs (mean [SD] score, 0.36 [0.14]) than those who were MAE free (mean [SD] score, 0.26 [0.13]; P = .001), with observed MAE rates of 4 patients (7.5%), 7 patients (12.1%), and 13 patients (31.7%) in the robust, prefrail and frail groups, respectively (P = .004). The FI distinguished individuals who developed MACE and MALE from those who were MAE free (MACE: mean [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; P = .004) after adjusting by body mass index. CONCLUSIONS AND RELEVANCE In this cohort study, measuring physical frailty using a wrist-worn sensor during a short upper extremity test was a practical method for stratifying the risk of MAEs following revascularization for CLTI when the administration of gait-based tests is often challenging.

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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

et al. 2020

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“…Therefore, therapy dosage might be needed to adjust for vascular deficiencies, or in worse cases, revascularization. 38 …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, therapy dosage might be needed to adjust for vascular deficiencies, or in worse cases, revascularization. 38 Another speculation is E-Stim may be more effective to improve tissue perfusion depending on severity of disease. This hypothesis is supported by the significant increase and maintenance of SatO2 in the sub-group of patients with moderate to severe PAD.…”

Section: Discussionmentioning

confidence: 99%

Home-Based Electrical Stimulation to Accelerate Wound Healing—A Double-Blinded Randomized Control Trial

Zulbaran-Rojas

Park

El-Refaei

et al. 2021

J Diabetes Sci Technol

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Background: Electrical stimulation (E-Stim) may offer a unique adjunctive treatment to heal complicated diabetic foot ulcers (DFU). Our primary goal is to examine the effectiveness of daily home-based E-Stim therapy to speed-up wound healing. Methods: Patients with chronic DFUs and mild to severe peripheral arterial disease (PAD) were recruited and randomized to either control (CG) or intervention (IG) groups. The IG received 1-hour home-based E-Stim therapy on daily basis for 4 weeks (4W). E-Stim was delivered through electrical pads placed above the ankle joint using a bio-electric stimulation technology (BEST®) platform (Tennant Biomodulator® PRO). The CG was provided with an identical but non-functional device for the same period. The primary outcome included wound area reduction at 4W from baseline (BL). Results: Thirty-eight patients were recruited and 5 were removed due to non-compliance or infection, leaving 33 participants (IG, n = 16; CG, n =17). At 4W, the IG showed a significant wound area reduction of 22% (BL: 7.4 ± 8.5 cm2 vs 4W: 5.8 ± 8.0 cm2, P = 0.002). Average of wound area was unchanged in the CG ( P = 0.982). The self-report adherence to daily home-therapy was 93.9%. Conclusions: Daily home-based E-Stim provides early results on the feasibility, acceptability, and effectiveness of E-Stim as an adjunctive therapy to speed up wound healings in patients with chronic DFU and mild to severe PAD.

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“…The importance of intensive and close follow-up, including regular podiatric care, debridement, access to vascular in-hospital intervention to maximize the likelihood of limb salvage, is critical. 90 …”

Section: Standard Wound Care and Adjunctive Prevention And Treatment ...mentioning

confidence: 99%

Debridement of Diabetic Foot Ulcers

Dayya

O'Neill

Huedo‐Medina

et al. 2022

Advances in Wound Care

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Diabetic foot ulcerations have devastating complications, including amputations, poor quality of life, and life-threatening infections. Diabetic wounds can be protracted, take significant time to heal, and can recur after healing. They are costly consuming health care resources. These consequences have serious public health and clinical implications. Debridement is often used as a standard of care. Debridement consists of both nonmechanical (autolytic, enzymatic) and mechanical methods (sharp/surgical, wet to dry debridement, aqueous high-pressure lavage, ultrasound, and biosurgery/maggot debridement therapy). It is used to remove nonviable tissue, to facilitate wound healing, and help prevent these serious outcomes. What are the various forms and rationale behind debridement? This article comprehensively reviews cutting-edge methods and the science behind debridement and diabetic foot ulcers.

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Endovascular Therapy in an “All-Comers” Risk Group for Chronic Limb-Threatening Ischemia Demonstrates Safety and Efficacy When Compared with the Established Performance Criteria Proposed by the Society for Vascular Surgery

Cited by 4 publications

References 36 publications

Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

Home-Based Electrical Stimulation to Accelerate Wound Healing—A Double-Blinded Randomized Control Trial

Debridement of Diabetic Foot Ulcers

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