The natural history of patients with claudication with toe pressures of 40 mm Hg or less

Bowers, Benjamin L.; Valentine, R. James; Myers, Stuart I.; Chervu, Arun; Clagett, G. Patrick

doi:10.1016/0741-5214(93)90269-r

Cited by 37 publications

(10 citation statements)

References 9 publications

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“…1–3 Of these, about 20% will undergo major lower extremity amputation within 1 year of diagnosis, 4,5 whereas even higher amputation rates have been reported in certain high-risk patient subsets. 6–10 Although the number of endovascular and surgical interventions for CLI has dramatically increased over the last decade, trends suggest that the number of amputations in CLI patients is only modestly declining if not remaining constant. 11,12 Furthermore, amputation is greatly feared by patients, 13 and the incidence of limb loss (or conversely–limb salvage) has been incorporated into society-endorsed outcome guidelines as an important measure of lower extremity revascularization quality and performance.…”

Section: Introductionmentioning

confidence: 99%

Domains that Determine Quality of Life in Vascular Amputees

Suckow

Goodney

Nolan

et al. 2015

Annals of Vascular Surgery

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Background Although patients with critical limb ischemia (CLI) commonly undergo major limb amputation, the quality of life (QOL) of this group remains poorly described. Therefore, we sought to describe which domains vascular amputees consider important in determining their health-related QOL. Methods We performed 4 focus groups in patients who had major lower extremity amputations resulting from CLI. They were conducted at 4 distinct centers across the United States to ensure broad geographic, socioeconomic, and ethnic representation. Results Of 26 patients (mean age, 64 years), 19 (73%) were Caucasian, 6 (23%) were African American, and 1 (4%) was Native American. Nearly, three-quarter of patients were men (n = 19, 73%) and had a high-school education or more (n = 19, 73%). Overall, 8 (31%) were double amputees and 17 (65%) had diabetes. Time since amputation varied across patients and ranged from 3 months to more than 27 years (mean, 4.3 years). Patients stated that their current QOL was determined by impaired mobility (65%), pain (60%), progression of disease in the remaining limb (55%), and depression/frustration (54%). Across 26 patients, more than half (n = 16, 62%) described multiple prior revascularization procedures. Although most felt that their physician did his/her best to salvage the affected leg (85%), a sizable minority would have preferred an amputation earlier in their CLI treatment course (27%). Furthermore, when asked how their care might have been improved, patients reported that facilitating peer support (88%), more extensive rehabilitation and prosthetist involvement (71%), earlier mention of amputation as a possible outcome (54%), and the early discontinuation of narcotics (54%) were potential areas of improvement. Conclusions Although QOL in vascular amputees seems primarily determined by mobility impairment, pain, and emotional perturbation, our focus groups identified that physician-controlled factors such as the timing of amputation, informed decision making, and postamputation support may also play an important role. The assessment of patient preferences regarding maintenance of mobility at the cost of increased pain versus relief of pain with amputation at a cost of diminished mobility is central to shared decision making in CLI treatment.

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Section: Introductionmentioning

confidence: 99%

Domains that Determine Quality of Life in Vascular Amputees

Suckow

Goodney

Nolan

et al. 2015

Annals of Vascular Surgery

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“…Unlike smoking status, diabetes, considered the other major risk factor for PAD, 34,36 affects mostly smaller vessels. With postexercise ABI change used as a progression criterion, an earlier study did not find significant progression related to diabetes.…”

Section: Aboyans Et Al Risk Factors For Pad Progression 2625mentioning

confidence: 99%

Risk Factors for Progression of Peripheral Arterial Disease in Large and Small Vessels

et al. 2006

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Background-Data on the natural history of peripheral arterial disease (PAD) are scarce and are focused primarily on clinical symptoms. Using noninvasive tests, we assessed the role of traditional and novel risk factors on PAD progression. We hypothesized that the risk factors for large-vessel PAD (LV-PAD) progression might differ from small-vessel PAD (SV-PAD). Methods and Results-Between 1990 and 1994, patients seen during the prior 10 years in our vascular laboratories were invited for a new vascular examination. The first assessment provided baseline data, with follow-up data obtained at this study. The highest decile of decline was considered major progression, which was a Ϫ0.30 ankle brachial index decrease for LV-PAD and a Ϫ0.27 toe brachial index decrease for SV-PAD progression. In addition to traditional risk factors, the roles of high-sensitivity C-reactive protein, serum amyloid-A, lipoprotein(a), and homocysteine were assessed. Over the average follow-up interval of 4.6Ϯ2.5 years, the 403 patients showed a significant ankle brachial index and toe brachial index deterioration. In multivariable analysis, current smoking, ratio of total to HDL cholesterol, lipoprotein(a), and high-sensitivity C-reactive protein were related to LV-PAD progression, whereas only diabetes was associated with SV-PAD progression. Conclusions-Risk

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“…1,2 Toe pressures and TBI are utilized frequently to adequately assess perfusion to the lower extremity especially in the PAD and diabetic population, while tri-phasic ankle waveforms indicate sufficient blood flow distally. 7 The Eastern Association for the Surgery of Trauma (EAST) guideline statement on lower extremity trauma management has endorsed the use of CTA as a primary diagnostic tool for evaluation of lower extremity vascular trauma. 5 A number of trauma centers in the USA now utilize CTA as a primary diagnostic tool as patients with mangled extremities may present with orthopedic, neurological, and soft tissue injury that may be best assessed by CTA.…”

Section: Discussionmentioning

confidence: 99%