The impact of prolonged lower limb ischemia on amputation, mortality, and functional status: The FRIENDS registry

Duval, Sue; Keo, Hak Hong; Oldenburg, Niki C.; Baumgartner, Iris; Jaff, Michael R.; Peacock, James M.; Tretinyak, Alexander S.; Henry, Timothy D.; Luepker, Russell V.; Hirsch, Alan T.

doi:10.1016/j.ahj.2014.06.013

Cited by 38 publications

(32 citation statements)

References 36 publications

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“…Outcomes associated with ALI in the present study were similar to those reported in observational data sets. 17,26,27 Therefore, both in clinical trials and in the community, these events occur at a frequency similar to the frequencies of other hard ischemic end points and are associated with significant morbidity.…”

Section: Outcomes With Alimentioning

confidence: 99%

“…26 The majority of events occurred secondary to graft thrombosis; in contradistinction, observational cohorts have demonstrated embolic causes as most frequent. 26 The most likely explanation for this difference is that because of the entry criteria for the present study, the proportion of patients with atrial fibrillation, who are at heightened risk of thromboembolism, was low (≈5%, <200), as were patients with heart failure (≈10%-15%). Therefore, the identified events were more likely related to intrinsic limb disease than to thromboembolism.…”

Section: Etiologies and Predictors Of Alimentioning

confidence: 99%

“…17 One difference between acute MI and ALI is that although acute MI is predominantly an atherothrombotic event, ALI has been described as having a more diverse origin, including both embolism from the heart and proximal vessels and in situ occlusion of native vessels, stents, or grafts. 18 Although in situ arterial occlusion may primarily be atherothrombotic, the pathobiology of vein graft failure may be more complex, including adverse remodeling and intimal hyperplasia of the vessel wall after exposure to the arterial circulation, as well as inflammation and changes in flow and shear stress predisposing to thrombus formation. In addition, synthetic grafts may suffer higher rates of occlusion caused by similarly complex reasons.…”

Section: March 8 2016mentioning

confidence: 99%

“…17,[26][27][28] It is associated prolonged hospitalization and rates of limb loss ranging from 12% to 50%, with the majority of amputations requiring above-the-knee procedures, resulting in significant disability. 17,29 In the present study, all patients were hospitalized, the majority required surgery, 16% resulted in amputation, and 15% died or were unable to return home after a median of 8 days in the hospital.…”

Section: Outcomes With Alimentioning

confidence: 99%

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Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease

et al. 2016

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Background-Patients with peripheral artery disease (PAD) are at heightened risk of acute limb ischemia (ALI), a morbid event that may result in limb loss. We investigated the causes, sequelae, and predictors of ALI in a contemporary population with symptomatic PAD and whether protease-activated receptor 1 antagonism with vorapaxar reduced ALI overall and by type. Methods and Results-The Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients WithAtherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50) was a randomized, double-blind, placebocontrolled trial of vorapaxar in stable patients, including 3787 with symptomatic PAD. ALI was a prespecified adjudicated end point using a formal definition. A total of 150 ALI events occurred in 108 patients during follow-up (placebo 3-year rate, 3.9%; 1.3% annualized). For patients with symptomatic PAD, previous peripheral revascularization, smoking, and the anklebrachial index were predictive of ALI. The majority of ALI events occurred as a result of surgical graft thrombosis (56%), followed by native vessel in situ thrombosis (27%). Stent thrombosis and thromboembolism caused ALI in 13% and 5%, respectively. Amputation occurred in 17.6% presenting with ALI. Vorapaxar reduced first ALI events by 41% (hazard ratio, 0.58; 95% confidence interval, 0.39-0.86; P=0.006) and total ALI events by 41% (94 versus 56 events; risk ratio, 0.59; 95% confidence interval, 0.38-0.93; P=0.022). The efficacy of vorapaxar was consistent across types of ALI. Conclusions-In selected patients with symptomatic PAD and without atrial fibrillation, ALI occurs at a rate of 1.3%/y, is most frequently caused by acute bypass graft thrombosis or in situ thrombosis of a diseased vessel, and often results in limb loss. Vorapaxar reduces ALI in patients with symptomatic PAD with consistency across type, including PAD resulting from surgical graft thrombosis and in-situ thrombosis. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00526474.

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Section: Outcomes With Alimentioning

confidence: 99%

Section: Etiologies and Predictors Of Alimentioning

confidence: 99%

Section: March 8 2016mentioning

confidence: 99%

Section: Outcomes With Alimentioning

confidence: 99%

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Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease

et al. 2016

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“…Increased identification of these patients can lead to improvement in care and clinical outcomes by stimulating targeted quality improvement strategies. 31 This study has some limitations. First, prior research studies have noted the limited accuracy of administrative data to identify patients with some disease conditions.…”

Section: Discussionmentioning

confidence: 99%

Development of administrative data algorithms to identify patients with critical limb ischemia

et al. 2014

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Administrative data have been used to identify patients with various diseases, yet no prior study has determined the utility of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-based codes to identify CLI patients. CLI cases (n=126), adjudicated by a vascular specialist, were carefully defined and enrolled in a hospital registry. Controls were frequency matched to cases on age, sex and admission date in a 2:1 ratio. ICD-9-CM codes for all patients were extracted. Algorithms were developed using frequency distributions of these codes, risk factors and procedures prevalent in CLI. The sensitivity for each algorithm was calculated and applied within the hospital system to identify CLI patients not included in the registry. Sensitivity ranged from 0.29 to 0.92. An algorithm based on diagnosis and procedure codes exhibited the best overall performance (sensitivity of 0.92). Each algorithm had differing CLI identification characteristics based on patient location. Administrative data can be used to identify CLI patients within a health system. The algorithms, developed from these data, can serve as a tool to facilitate clinical care, research, quality improvement, and population surveillance.

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Importance of Successful Revascularization in Acute Limb Ischemia: Sub‐Analysis From the RESCUE ALI Trial

Haraguchi,

Tan,

Uchida

et al. 2024

Cathet Cardio Intervent

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BackgroundThis study aimed to assess the 1‐year clinical outcomes and predictors of technical success in acute limb ischemia (ALI) treatment.MethodsA sub‐analysis of the REtroSpective multiCenter study of endovascUlar or surgical intErvention for ALI (RESCUE ALI) study involved 185 patients with ALI and technical success (n = 131) or failure (n = 54) treated via surgical, endovascular, or hybrid revascularization between January 2015 and August 2021. The primary endpoint was 1‐year amputation‐free survival (AFS), and the secondary endpoints included preoperative complications and 1‐year reintervention.ResultsThe technical success group had a significantly higher 1‐year AFS rate than the technical failure group (79% vs. 44%, p < 0.001). Perioperative complications rate showed no significant difference between the two groups. The incidence of reintervention was lower in the technical success group (17% vs. 30%, p = 0.049). Age ≥ 80 years, time from onset ≥ 24 h, no below‐the‐knee artery runoff, and preoperative c‐reactive protein ≥ 5 mg/dL were negatively associated with technical success across all procedures. In surgical revascularization, no below‐the‐knee artery runoff was negatively associated with technical success. For endovascular revascularization, onset‐to‐treatment time ≥ 48 h was negatively related and thromboembolism in atrial fibrillation was positively related to technical success. In hybrid revascularization, supra‐ to infrapopliteal lesions were negatively associated with technical success.ConclusionsTechnical success in ALI treatment significantly enhances 1‐year AFS rates. Thus, choosing the appropriate revascularization procedure based on predictors of technical success is crucial for improving patient outcomes.

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The impact of prolonged lower limb ischemia on amputation, mortality, and functional status: The FRIENDS registry

Cited by 38 publications

References 36 publications

Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease

Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease

Development of administrative data algorithms to identify patients with critical limb ischemia

Importance of Successful Revascularization in Acute Limb Ischemia: Sub‐Analysis From the RESCUE ALI Trial

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