Young patients without prior vascular disease are at increased risk of limb loss and reintervention after acute limb ischemia

Andraska, Elizabeth; Phillips, Amanda R.; Reitz, Katherine M.; Asaadi, Sina; Ho, Jonathan; McDonald, Mackenzie M.; Madigan, Michael; Liang, Nathan L.; Eslami, Mohammad H.; Sridharan, Natalie

doi:10.1016/j.jvs.2022.04.052

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Older age (30 d: aHR 1.17; 180 d: 1.27) and an extended grade of ALI (30 d: TASC IIa aHR 3.29, TASC IIb aHR 3.93, TASC III aHR 7.79; 180 d: TASC IIa aHR 1.97, TASC IIb aHR 2.43, TASC III aHR 4.2), were associated with significantly worse outcomes in the multivariate analysis (Figures 3 and 4). In contrary to our results, Andraska et al [32] identified female sex to be associated with worse outcomes after ALI regardless of treatment modality in a cohort of 232 patients.…”

Section: Discussioncontrasting

confidence: 99%

Patients with Acute Limb Ischemia Might Benefit from Endovascular Therapy—A 17-Year Retrospective Single-Center Series of 985 Patients

Stoklasa,

Sieber,

Naher

et al. 2023

JCM

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Acute lower limb ischemia (ALI) is a common vascular emergency, requiring urgent revascularization by open or endovascular means. The aim of this retrospective study was to evaluate patient demographics, treatment and periprocedural variables affecting the outcome in ALI patients in a consecutive cohort in a tertiary referral center. Primary outcome events (POE) were 30-day (safety) and 180-day (efficacy) combined mortality and major amputation rates, respectively. Secondary outcomes were perioperative medical and surgical leg-related complications and the 5-year combined mortality and major amputation rate. Statistical analysis used descriptive and uni- and multivariable Cox regression analysis. In 985 patients (71 ± 9 years, 56% men) from 2004 to 2020, the 30-day and 180-day combined mortality and major amputation rates were 15% and 27%. Upon multivariable analysis, older age (30 d: aHR 1.17; 180 d: 1.27) and advanced Rutherford ischemia stage significantly worsened the safety and efficacy POE (30 d: TASC IIa aHR 3.29, TASC IIb aHR 3.93, TASC III aHR 7.79; 180 d: TASC IIa aHR 1.97, TASC IIb aHR 2.43, TASC III aHR 4.2), while endovascular treatment was associated with significant improved POE after 30 days (aHR 0.35) and 180 days (aHR 0.39), respectively. Looking at five consecutive patient quintiles, a significant increase in endovascular procedures especially in the last quintile could be observed (17.5% to 39.5%, p < 0.001). Simultaneously, the re-occlusion rate as well as the number of patients with any previous revascularization increased. In conclusion, despite a slightly increasing early re-occlusion rate, endovascular treatment might, if possible, be favorable in ALI treatment.

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Section: Discussioncontrasting

confidence: 99%

Patients with Acute Limb Ischemia Might Benefit from Endovascular Therapy—A 17-Year Retrospective Single-Center Series of 985 Patients

Stoklasa,

Sieber,

Naher

et al. 2023

JCM

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show abstract

“…The incidence of acute limb ischemia is ~1.5 cases per 10,000 persons per year [2]. Diagnostic errors and delays in treatment may lead to the loss of limbs, related to the lack of sufficient time for new blood vessel growth to compensate for the loss of perfusion, or even loss 2 of 15 of life [3]. According to previous studies, 15-20% of patients die within the first year after acute lower extremity ischemia, and most of these deaths occur in the peri-operative period.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Predictors of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically

Myrcha

Kozak

Myrcha³

et al. 2023

IJERPH

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Background: Acute peripheral arterial ischemia is a rapidly developing loss of perfusion, resulting in ischemic clinical manifestations. This study aimed to assess the incidence of cardiovascular mortality in patients with acute peripheral arterial ischemia and either atrial fibrillation (AF) or sinus rhythm (SR). Methods: This observational study involved patients with acute peripheral ischemia treated surgically. Patients were followed-up to assess cardiovascular mortality and its predictors. Results: The study group included 200 patients with acute peripheral arterial ischemia and either AF (n = 67) or SR (n = 133). No cardiovascular mortality differences between the AF and SR groups were observed. AF patients who died of cardiovascular causes had a higher prevalence of peripheral arterial disease (58.3% vs. 31.6%, p = 0.048) and hypercholesterolemia (31.2% vs. 5.3%, p = 0.028) than those who did not die of such causes. Patients with SR who died of cardiovascular causes more frequently had a GFR <60 mL/min/1.73 m2 (47.8% vs. 25.0%, p = 0.03) and were older than those with SR who did not die of such causes. The multivariable analysis shows that hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was the predisposing factor for such mortality. Conclusions: Cardiovascular mortality of patients with acute ischemia did not differ between patients with AF and SR. Hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was a predisposing factor for such mortality.

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Percutaneous thrombectomy for acute limb ischemia is associated with equivalent limb and mortality outcomes compared with open thrombectomy

Jarosinski,

Kennedy,

Khamzina

et al. 2024

Journal of Vascular Surgery

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Young patients without prior vascular disease are at increased risk of limb loss and reintervention after acute limb ischemia

Cited by 3 publications

References 25 publications

Patients with Acute Limb Ischemia Might Benefit from Endovascular Therapy—A 17-Year Retrospective Single-Center Series of 985 Patients

Patients with Acute Limb Ischemia Might Benefit from Endovascular Therapy—A 17-Year Retrospective Single-Center Series of 985 Patients

Clinical Characteristics and Predictors of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically

Percutaneous thrombectomy for acute limb ischemia is associated with equivalent limb and mortality outcomes compared with open thrombectomy

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