Primary and Secondary Amputation in Critical Limb Ischemia Patients: Different Aspects

Paulus, Niklas; Jacobs, Michael; Greiner, Andreas

doi:10.1080/00015458.2012.11680834

Cited by 9 publications

(7 citation statements)

References 2 publications

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“…Lower extremity amputations are becoming an increasingly important topic, especially in the current demographic situation of an aging population and increasing incidence of diabetes mellitus. 3,6 In this single-center retrospective analysis of all levels of lower extremity amputation, the overall revision rate was 25.2% for patients with diabetes mellitus and PAD. Van Damme et al 12 reported a similar high revision rate for amputations in dysvascular patients with diabetes mellitus (28% for toe, 25% for transmetatarsal, and 17% for below-knee amputations).…”

Section: Discussionmentioning

confidence: 92%

“…The amputation level is defined by preexisting necrosis, gangrene, and infection and the expectation of effective wound healing, which is mainly dependent on sufficient arterial blood supply. 6 The energy required for walking increases, and the customary walking speed decreases as the amputation level moves proximally. 7,8 As a result, better functional outcomes are usually associated with joint-level preservation.…”

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confidence: 99%

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Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients

Wanivenhaus¹,

Mauler²,

Stelzer³

et al. 2016

Orthopedics

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This article reports the revision rate and possible risk factors for lower extremity amputations in patients with diabetes mellitus or peripheral arterial disease (PAD). Data were collected from 421 patients with diabetes mellitus or PAD who underwent amputations of the lower extremity at the authors' institution from 2002 to 2012. There was a 25.2% overall revision rate. Mean time from amputation to revision was 244 days (range, 2-2590 days). Patients with diabetes mellitus had a significantly higher rate of revision to a more proximal level compared with patients without diabetes mellitus (type 1: odds ratio [OR]=3.73; 95% confidence interval [CI], 1.21-11.52; P=.022; and type 2: OR=2.3; 95% CI, 1.07-4.95; P=.033). A significant increase in revision rates was observed from Fontaine stage 0 to IV (stage 0: 17.9%; stage IV, 34.7%; P=.03). Risk factors for revision were diabetic nephropathy (OR=2.26; 95% CI, 1.4-3.63; P=.001) and polyneuropathy (OR=1.68; 95% CI, 1.03-2.73; P=.037). Patients who underwent revision amputation had a significantly younger mean age than patients who did not undergo revision amputation (65.23 years [range, 40-92 years] vs 68.52 years [range, 32-96 years]; P=.013). Anticipated amputation in this patient population requires a multidisciplinary approach with optimization of the patient's health. In the authors' clinical practice, the determination of the appropriate amputation level is performed individually for each patient, considering the risk factors identified in this study and the patient's expected mobilization potential, social background, and acceptance of a more proximal primary amputation level.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients

Wanivenhaus¹,

Mauler²,

Stelzer³

et al. 2016

Orthopedics

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“…Due to the severity of the disease, hundreds of thousands of patients worldwide undergo lower limb amputations each year 1 . The prognosis after amputation is extremely poor, with a mortality rate of 30–50% and a contralateral leg amputation rate of 25% within 1 year, which is a life‐threatening condition 2,3 . Failure to revascularize following the ischemic episode is an important cause of amputation of the lower limbs.…”

Section: Introductionmentioning

confidence: 99%

“…condition. 2,3 Failure to revascularize following the ischemic episode is an important cause of amputation of the lower limbs. Generally, revascularization of the lower limbs involves endovascular treatment using catheters and bypass surgery using autologous veins or artificial blood vessels.…”

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confidence: 99%

Pre‐implantation evaluation of a small‐diameter, long vascular graft (Biotube®) for below‐knee bypass surgery in goats

et al. 2022

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There are no small-diameter, long artificial vascular grafts for below-knee bypass surgery in chronic limb-threatening ischemia. We have developed tissue-engineered vascular grafts called "Biotubes ® " using a completely autologous approach called in-body tissue architecture (iBTA). This study aimed at pre-implantation evaluation of Biotube and its in vivo preparation device, Biotube Maker, for use in below-knee bypass surgery. Forty nine makers were subcutaneously embedded into 17 goats for predetermined periods (1, 2, or 3 months). All makers produced Biotubes as designed without inflammation over all periods, with the exception of a few cases with minor defects (success rate: 94%). Small hole formation occurred in only a few cases. All Biotubes obtained had an inner diameter of 4 mm and a length of 51 to 52 cm with a wall thickness of 594 ± 97 μm. All Biotubes did not kink when completely bent under an internal pressure of 100 mmHg and did not leak without any deformation under a water pressure of 200 mmHg. Their burst strength was 2409 ± 473 mmHg, and suture retention strength was 1.75 ± 0.27 N, regardless of the embedding period, whereas tensile strength increased from 7.5 ± 1.3 N at 1 month to 9.7 ± 2.0 N at 3 months with the embedding period. The amount of water leakage from the needle holes prepared in the Biotube wall was approximately 1/7th of that in expanded polytetrafluoroethylene vascular grafts. The Biotubes could be easily connected to each other without cutting or anastomosis leaks. They could be stored for at least 1 year at room temperature. This study confirmed that even Biotubes formed 1 month after embedding of Biotube Makers had properties comparable to arteries.biotube, chronic limb-threatening ischemia, in body tissue architecture, small diameter vascular graft, tissue engineering | INTRODUCTIONPatients with chronic limb-threatening ischemia (CLTI) present with resting pain, foot ulcer, or gangrene. Due to the severity of the disease, hundreds of thousands of patients worldwide undergo lower limb amputations each year. 1 The prognosis after amputation is extremely poor, with a mortality rate of 30-50% and a contralateral leg amputation rate of 25% within 1 year, which is a life-threatening

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“…Many studies have demonstrated that the increased rate of revascularization, especially in the last decade of life, creates a significant reduction in the rate of amputation. According to the data from United States, endovascular interventions, which have increased in the last 10 years, reduced the need for amputation and open surgery by about 50% (4). Nowadays, the increasing experience of percutaneous interventional treatments has provided significant benefits for rapid, effective and total revascularization, and therefore many authors now prefer the "endo-first" approach (5).…”

Section: Introductionmentioning

confidence: 99%

Endo-first Approach for Peripheral Vascular Disease: The First Fifty Cases of a New Clinic

Yücel¹,

Ketenciler²,

Gürsoy³

et al. 2019

eamr

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In recent years, endovascular and hybrid therapies have come to the forefront in the treatment of peripheral arterial disease (PAD) instead of open surgical treatment. In this study, we aimed to present the results of endovascular and hybrid treatments performed in our newly established clinic. Methods: The data of the patients, who were diagnosed as PAD and treated with endovascular and hybrid methods, were retrospectively analyzed and 50 patients were included in the study. Patients were classified according to the Fontaine classification and patients with Fontaine 2B or higher underwent interventional or hybrid treatment. Results: The majority of the patients were male (96%) and mean age of the patients was 62.89±9.01 years. Twelve patients (24%) had ischemic ulcers (Fontaine 4), 32 patients (64%) had claudication (Fontaine 2B) and six patients (12%) had rest pain (Fontaine 3). Thirty-four patients (68%) underwent endovascular intervention and 16 (32%) underwent hybrid treatment procedures. In 38 patients (76%) with complaints of Fontaine class 2B or 3 before the intervention, symptoms regressed to Fontaine class 1 after the procedure. The mean ankle-brachial index values of the extremities with lesions increased from 0.44±0.30 to 0.85±0.17 on the first postoperative day. Conclusion: In conclusion, endovascular and hybrid interventions provide satisfactory results in high-risk patients with PAD for both the salvage of extremities and the improvement of symptoms. We believe that endovascular interventions will provide less invasive and safer revascularization in patients with higher comorbidity rates in the future.

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Primary and Secondary Amputation in Critical Limb Ischemia Patients: Different Aspects

Cited by 9 publications

References 2 publications

Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients

Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients

Pre‐implantation evaluation of a small‐diameter, long vascular graft (Biotube®) for below‐knee bypass surgery in goats

Endo-first Approach for Peripheral Vascular Disease: The First Fifty Cases of a New Clinic

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