Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

Abstract

BackgroundContemporary data on patients presenting with acute limb ischemia (ALI), who are selected for treatment with endovascular peripheral vascular interventions (PVI), are limited. Our study examined outcomes following endovascular PVI in patients with ALI by comparing with patients treated for chronic critical limb ischemia using a regional quality improvement registry.Methods and ResultsOf the 11 035 patients in the Vascular Study Group of New England PVI database (2010–2014), we identified 365 patients treated for lower extremity ALI who were 5:1 frequency matched (by procedure year and arterial segments treated) to 1808 patients treated for critical limb ischemia. ALI patients treated with PVI had high burden of atherosclerotic risk factors and were more likely to have had prior ipsilateral revascularizations. ALI patients were less likely to be treated with self‐expanding stents and more likely to undergo thrombolysis than patients with critical limb ischemia. In multivariable analysis, ALI was associated with higher technical failure (odds ratio 1.7, 95% confidence interval, 1.1%–2.5%), increased rate of distal embolization (odds ratio 2.7, 95% confidence interval, 1.5%–4.9%), longer length of stay (means ratio 1.6, 95% confidence interval, 1.4%–1.8%), and higher in‐hospital mortality (odds ratio 2.8, 95% confidence interval, 1.3%–5.9%). ALI was not associated with risk of major amputation or mortality at 1 year.ConclusionsIn a multicenter cohort of patients treated with PVI, we found that ALI patients selected for treatment with endovascular techniques experienced greater short‐term adverse events but similar long‐term outcomes as their critical limb ischemia counterparts. Further studies are needed to refine the selection of ALI patients who are best served by PVI.

Redox RegulationviaGlutaredoxin-1 and ProteinS-Glutathionylation

“…PAD is associated with atherosclerosis and is potentiated by other risk factors such as age, smoking, and diabetes. The pathogenesis involving impaired angiogenesis and reduced microcirculation in the skeletal muscle accelerates to intractable limb ischemia in PAD pa-tients (81). Various therapeutic approaches to improve vascularization with angiogenic factors, including vascular endothelial growth factor (VEGF), have shown promising effects in animal models (164) but failed in clinical trials (154).…”

An Observational Study on Patients with Acute Limb Ischemia and SARS-CoV-2 Infection: Early and Late Results in Limb Salvage Rate

“…In patients without SARS-CoV-2, amputation rates following acute limb ischemia are between 6% and 23% [36,37]. In this study, the presence of SARS-CoV-2 infection did not influence the amputation-free survival rate: it was only the risk factor for the arterial thrombosis and the trigger for the acute ischemic event.…”

Predictors of poor outcomes after lower extremity revascularization for acute limb ischemia

“…9 In contrary, analysis by Fagundes et al 12 showed that gender was not a prognostic factor for 30-day amputation in patients treated for ALI. Inagaki et al 23 reported that female sex was independently associated with increased odds of in-hospital adverse events following interventions for ALI, but not specifically increased the risk of limb loss. Several studies have ascertained some other features that increase risk of amputation in patients with ALI that were not seen in our cohort, such as race, age, history of heart failure and malignancy, higher Rutherford class of ischemia, failed previous revascularization procedures, and technical failure of primary interventions.…”