Evaluation of the BASIL Survival Prediction Model in Patients Undergoing Infrapopliteal Interventions for Critical Limb Ischemia

Cury, Marcus Vinícius Martins; Neto, Francisco Cardoso Brochado; Matielo, Marcelo Fernando; Soares, Rafael de Athayde; Póvoa, Rui; Melo, Larissa Soares Bezerra Santos Torres de; Pecego, Christiano Stchelkunoff; Sacilotto, Roberto

doi:10.1016/j.avsg.2018.06.007

Cited by 6 publications

(20 citation statements)

References 23 publications

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“…groups. 60 Two studies found no statistical difference between endovascular and open groups 53,55 and 1 study reported increased rates of limb salvage in the endovascular group at a mean follow-up time of 18 months (Endo: 88%, Open: 73%, p = 0.01). 44 Amputation-free survival was reported in 3 retrospective studies.…”

Section: Of 16mentioning

confidence: 98%

“…The 11 studies comparing endovascular and open procedures included 28,182 participants who underwent an endovascular procedure and 9515 who underwent an open procedure (Supplementary Table S2). 44,[53][54][55][56][57][58][59][60][61][62] One study reported the inclusion of hybrid procedures affecting 4.9% of participants undergoing open revascularisation. Ten of the studies were retrospective cohort studies, 44,[53][54][55][57][58][59][60][61][62] and one was a randomised controlled trial 56 60 and endovascular and open procedures in people with diabetes and tissue loss, gangrene, or rest pain 61 .…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…DFU healing was reported in 3 studies, 54,55,62 one study reported healing post minor amputation (transmetatarsal amputation) and one study reported minor amputation as an outcome. 62 Seven studies reported on major amputation, 54,[57][58][59][60][61][62] 4 studies reported on limb salvage 44,53,55,60 and 3 studies reported on amputation-free survival,. 44,55,58 Survival was reported in 4 studies 44,53,55,57 and mortality in 4 studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…62 Seven studies reported on major amputation, 54,[57][58][59][60][61][62] 4 studies reported on limb salvage 44,53,55,60 and 3 studies reported on amputation-free survival,. 44,55,58 Survival was reported in 4 studies 44,53,55,57 and mortality in 4 studies. [58][59][60]62 The randomised controlled trial 56 reported the composite outcome of major adverse limb event or death.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Effectiveness of revascularisation for the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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IntroductionPeripheral artery disease (PAD) is associated with an increased likelihood of delayed or non‐healing of a diabetes‐related foot ulcer, gangrene, and amputation. The selection of the most effective surgical technique for revascularisation of the lower limb in this population is challenging and there is a lack of conclusive evidence to support the choice of intervention. This systematic review aimed to determine, in people with diabetes and tissue loss, if direct revascularisation is superior to indirect revascularisation and if endovascular revascularisation is superior to open revascularisation for the outcomes of wound healing, minor or major amputation, and adverse events including mortality.MethodsTitle and abstract searches of Medline, Embase, PubMed, and EBSCO were conducted from 1980 to 30th November 2022. Cohort and case‐control studies and randomised controlled trials reporting comparative outcomes of direct (angiosome) revascularisation (DR) and indirect revascularisation (IR) or the comparative outcomes of endovascular revascularisation and open or hybrid revascularisation for the outcomes of healing, minor amputation, and major amputation in people with diabetes, PAD and tissue loss (including foot ulcer and/or gangrene) were eligible. Methodological quality was assessed using the Cochrane risk‐of‐bias tool for randomised trials, the ROBINS‐I tool for non‐randomised studies, and Newcastle‐Ottawa Scale for observational and cohort studies where details regarding the allocation to intervention groups were not provided.ResultsFrom a total 7086 abstracts retrieved, 26 studies met the inclusion criteria for the comparison of direct angiosome revascularisation (DR) and indirect revascularisation (IR), and 11 studies met the inclusion criteria for the comparison of endovascular and open revascularisation. One study was included in both comparisons. Of the included studies, 35 were observational (31 retrospective and 4 prospective cohorts) and 1 was a randomised controlled trial. Cohort study quality was variable and generally low, with common sources of bias related to heterogeneous participant populations and interventions and lack of reporting of or adjusting for confounding factors. The randomised controlled trial had a low risk of bias. For studies of DR and IR, results were variable, and it is uncertain if one technique is superior to the other for healing, prevention of minor or major amputation, or mortality. However, the majority of studies reported that a greater proportion of participants receiving DR healed compared with IR, and that IR with collaterals may have similar outcomes to DR for wound healing. For patients with diabetes, infrainguinal PAD, and an adequate great saphenous vein available for use as a bypass conduit who were deemed suitable for either surgical procedure, an open revascularisation first approach was superior to endovascular therapy to prevent a major adverse limb event or death (Hazard Ratio: 0.72; 95% CI 0.61–0.86). For other studies of open and endovascular approaches, there was generally no difference in outcomes between the interventions.ConclusionsThe majority of available evidence for the effectiveness of DR and IR and open and endovascular revascularisation for wound healing and prevention of minor and major amputation and adverse events including mortality in people with diabetes, PAD and tissue loss is inconclusive, and the certainty of evidence is very low. Data from one high quality randomised controlled trial supports the use of open over endovascular revascularisation to prevent a major limb event and death in people with diabetes, infrainguinal disease and tissue loss who have an adequate great saphenous vein available and who are deemed suitable for either approach.

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Section: Of 16mentioning

confidence: 98%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of revascularisation for the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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“…Much work has been undertaken to look at patient outcomes for PAD, but less common is work on CLTI-related amputation (Monaro, 2018). Studies exploring the impact of PAD (Bosma, Vahl, & Wisselink, 2013;Brothers, Rios, Robison, & Elliott, 1999;Cury et al, 2018;Donker et al, 2016) have largely focused on surgical interventions and used end-points of graft patency and limb salvage that contribute little to understandings of the experience of CLTI and amputation. While these finding provides clinician-centred outcomes, the perspective of the patient in terms of what matters to them is lacking.…”

Section: Backg Rou N Dmentioning

confidence: 99%

The body with chronic limb‐threatening ischaemia: A phenomenologically derived understanding

Monaro

West

Gullick

2020

Journal of Clinical Nursing

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Aims and Objectives To explore person and family lifeworld narratives of chronic limb‐threatening ischaemia (CLTI) after major amputation has been offered as a treatment option. Background Chronic limb‐threatening ischaemia manifests as ischaemic pain, ulceration and/or gangrene and is receiving heightened attention due to the increasing health system burden from associated complex wounds and hospitalisations for repeat procedures. The patient and family impact of these manifestations is not well‐reported: current studies largely seek to measure treatment outcomes. Patient‐reported outcome measurements need to be developed but should be underpinned by rigorous qualitative research. Design Prospective, longitudinal, qualitative design using interpretive phenomenology. Methods The journeys of 19 people with CLTI were explored via 42 semi‐structured interviews with 14 patient and 13 family participants. The initial interview was conducted soon after the advice of the need for major amputation, and where amputation followed, participants were invited for a second interview 6 months postprocedure. Hermeneutic phenomenological analysis was guided by Merleau‐Ponty's philosophy of embodiment. Results People with embodied CTLI faced an existential crisis due to the catastrophic impact of creeping decay of their flesh and vascular system, relentless pain and a sense of spreading poison from gangrene, infection and drugs, which disrupted the interleaving of the physical and existential body. Consequent to the creeping decay and surgery, participants also experienced shifting body boundaries and an unreliable body. Conclusions The lifeworld of the patient and family living with CTLI is irrevocably altered through the disruption of a spontaneous and reliable body. This shapes subsequent therapeutic relationships and discourse. Relevance to Clinical Practice People facing CLTI require early patient‐ and family‐centred discussions about the possibility for major amputation and its potential to arrest the further decline of the body and to support the body's existential expression.

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