Life Expectancy and Outcome of Different Treatment Strategies for Critical Limb Ischemia in the Elderly Patients

Klaphake, Sanne; Leur, Kevin de; Mulder, Paul; Ho, Gwan H.; Groot, Hans G.W. de; Veen, Eelco J.; Laan, Lijckle van der

doi:10.1016/j.avsg.2017.06.141

Cited by 29 publications

(22 citation statements)

References 17 publications

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“…25 Patients' age is also a significant risk factor influencing the long-term clinical outcomes in patients with CLI. 26,27 According to our findings, the high comorbidity burden taking into account the age factor (Age-CCI > 5) was associated with the negative clinical dynamics one year after SCS. Furthermore, clinical manifestations of CLI by the time SCS is performed also have an effect on the long-term outcomes.…”

Section: Discussionmentioning

confidence: 54%

The Clinical Outcomes in Patients with Critical Limb Ischemia One Year after Spinal Cord Stimulation

Клинкова

Kamenskaya

Ashurkov

et al. 2020

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 54%

The Clinical Outcomes in Patients with Critical Limb Ischemia One Year after Spinal Cord Stimulation

Клинкова

Kamenskaya

Ashurkov

et al. 2020

Annals of Vascular Surgery

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“…Major limb amputation was defined as an amputation above the level of the ankle. 8 Amputations of the foot or digiti were classified as minor limb amputations.…”

Section: Outcome Measurementsmentioning

confidence: 99%

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

Schuivens

Buijs

Winter

et al. 2020

Annals of Vascular Surgery

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Background: The aim of this study is to investigate the impact of the coronavirus disease 2019 (COVID-19) lockdown period on the number and type of vascular procedures performed in the operating theater. Methods: A total of 38 patients who underwent 46 vascular procedures during the lockdown period of March 16th until April 30th, 2020, were included. The control groups consisted of 29 patients in 2019 and 54 patients in 2018 who underwent 36 and 66 vascular procedures, respectively, in the same time period. Data were analyzed using SPSS Statistics. Results: Our study shows that the lockdown during the COVID-19 pandemic resulted in a significant increase in the number of major amputations (42% in 2020 vs. 18% and 15% in 2019 and 2020, respectively; P-value 0.019). Furthermore, we observed a statistically significant difference in the degree of tissue loss as categorized by the Rutherford classification (P-value 0.007). During the lockdown period, patients presented with more extensive ischemic damage when than previous years. We observed no difference in vascular surgical care for patients with an aortic aneurysm. Conclusions: Measurements taken during the lockdown period have a significant effect on noneCOVID-19 vascular patient care, which leads to an increased severe morbidity. In the future, policy makers should be aware of the impact of their measurements on vulnerable patient groups such as those with peripheral arterial occlusive disease. For these patients, medical care should be easily accessible and adequate.

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“…Conservative treatment or primary amputation are accepted treatment modalities in patients with poor pre-operative living status, and extensive comorbidities 1 , 4 , 8 , 14 , 15 , 20. Due to a significantly reduced life expectancy, increase in subjectively measures QoL is an important parameter for frail elderly patients in the last phase of their life and transcend traditional outcome measurements such as mortality and patency 3. Substantial differences between QoL and HS were observed in conservatively treated patients as these patients did not exhibit a significant increase in their physical HS, although their physical QoL had significantly improved at 6 months and 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…However, this prospective study gives a clear view of the differences between HS and QoL in the treatments used for CLI patients in the current clinical practice. These results should be combined with the traditional outcome rates to select the optimal treatment, because of the known high mortality (19–49%) and limb salvage rates (74–85%) in elderly CLI patients 3 , 16 , 23. Also, wound healing in Rutherford five-sixths patients could potentially influence QoL.…”

Section: Discussionmentioning

confidence: 99%

“…Reports on patient-reported outcome measures (PROMS) appear to be an important primary endpoint in addition to traditional outcome results. Especially in elderly patients with limited life expectancy, these PROMS offer important information regarding the success of treatment from a patient’s perspective and could help in shared decision-making 2 , 3…”

Section: Introductionmentioning

confidence: 99%

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<p>Important differences between quality of life and health status in elderly patients suffering from critical limb ischemia</p>

Vries

Raats

Verbogt

et al. 2019

CIA

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Introduction Critical limb ischemia (CLI) patients are often of advanced age with reduced health status (HS) and quality of life (QoL) at baseline. Physical health is considered as the most affected domain due to reduced mobility and ischemic pain. QoL and HS are often used interchangeably in the current literature. HS refers to objectively perceived physical, psychological, and social functioning and in assessing QoL, change is measured subjectively and can only be determined by the individual since it concerns patients’ evaluation of their functioning. It is important to distinguish between QoL and HS, especially in the concept of shared decision-making when the opinion of the patient is key. Goal of this study was to examine and compare QoL and HS in elderly CLI patients in relation to the used therapy, with a special interest in conservatively treated patients. Methods Patients suffering from CLI and ≥70 years old were included in a prospective study with a follow-up period of 1 year. Patients were divided into three groups; endovascular revascularization, surgical revascularization, and conservative therapy. The WHOQoL-Bref was used to determine QoL, and the 12-Item Short Form Health Survey was used to evaluate HS at baseline, 5–7 days, 6 weeks, 6 months, and 1 year. Results Physical QoL of endovascularly and surgically treated patients showed immediate significant improvement during follow-up in contrast to delayed increased physical HS at 6 weeks and 6 months ( P <0.001). Conservatively treated patients showed significantly improved physical QoL at 6 and 12 months ( P =0.02) in contrast to no significant improvement in physical HS. Conclusion This study demonstrates that QoL and HS are indeed not identical concepts and that differentiating between these two concepts could influence the choice of treatment in elderly CLI patients. Discriminating between QoL and HS is, therefore, of major importance for clinical practice, especially to achieve shared decision-making.

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Life Expectancy and Outcome of Different Treatment Strategies for Critical Limb Ischemia in the Elderly Patients

Cited by 29 publications

References 17 publications

The Clinical Outcomes in Patients with Critical Limb Ischemia One Year after Spinal Cord Stimulation

The Clinical Outcomes in Patients with Critical Limb Ischemia One Year after Spinal Cord Stimulation

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

<p>Important differences between quality of life and health status in elderly patients suffering from critical limb ischemia</p>

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