Nedal Katib1, Shannon D Thomas2, Andrew F Lennox3, Jia-Lin Yang4, Ramon L Varcoe5. 1. Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia. 2. Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia. 3. Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia. 4. Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia Adult Cancer Program, Lowy Cancer Research Centre, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia. 5. Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia r.varcoe@unsw.edu.au.
Abstract
PURPOSE: To evaluate the effect of a shift to a primary endovascular revascularization (ER) strategy for patients presenting with critical limb ischemia (CLI) after a change in staff at our center in 2008 altered our revascularization strategy. METHODS: Between 2004 and 2012, 344 critically ischemic limbs were treated in 279 patients (mean age 74.0±11.4 years; 179 men) during 546 separate hospital admissions. Limbs were analyzed according to (1) their principal revascularization strategy and (2) their date of presentation [early (2004-2008) or late (2008-2012)]. RESULTS: Compared with the open revascularization (OR) and no revascularization (NR) groups, the ER group had an increased freedom from major amputation (92.3% vs 80.0% OR vs 69.3% NR, p<0.001), reduced hospital stay (15.2 vs OR 31.6 vs NR 25.9 days, p<0.001), intensive care unit (ICU) stay (2.3 vs OR 23.7 vs NR 7.2 hours, p=0.033), and operating time for ER vs OR (157.9 vs 316.8 minutes, respectively; p<0.0001). There was also a significant decrease in limbs requiring minor amputations (23.2% vs OR 29.3% vs NR 37.6%, p=0.041) and mean number of admissions/limb compared to OR (1.5 vs OR 1.9 vs NR 1.5, p=0.007). The late era saw the treatment of a larger number of limbs (223 vs 121) compared with the earlier time period. This institutional shift resulted in increased freedom from major amputation (87.4% vs 74.4%, p<0.01), reduced ICU stay (3.45 vs 16.98 hours, p<0.01), and shorter length of stay (20.9 vs 31.5 days, p<0.01) between the 2 eras, respectively. CONCLUSION: A shift to an endovascular-first treatment strategy is associated with fewer major amputations and shorter length of stay.
PURPOSE: To evaluate the effect of a shift to a primary endovascular revascularization (ER) strategy for patients presenting with critical limb ischemia (CLI) after a change in staff at our center in 2008 altered our revascularization strategy. METHODS: Between 2004 and 2012, 344 critically ischemic limbs were treated in 279 patients (mean age 74.0±11.4 years; 179 men) during 546 separate hospital admissions. Limbs were analyzed according to (1) their principal revascularization strategy and (2) their date of presentation [early (2004-2008) or late (2008-2012)]. RESULTS: Compared with the open revascularization (OR) and no revascularization (NR) groups, the ER group had an increased freedom from major amputation (92.3% vs 80.0% OR vs 69.3% NR, p<0.001), reduced hospital stay (15.2 vs OR 31.6 vs NR 25.9 days, p<0.001), intensive care unit (ICU) stay (2.3 vs OR 23.7 vs NR 7.2 hours, p=0.033), and operating time for ER vs OR (157.9 vs 316.8 minutes, respectively; p<0.0001). There was also a significant decrease in limbs requiring minor amputations (23.2% vs OR 29.3% vs NR 37.6%, p=0.041) and mean number of admissions/limb compared to OR (1.5 vs OR 1.9 vs NR 1.5, p=0.007). The late era saw the treatment of a larger number of limbs (223 vs 121) compared with the earlier time period. This institutional shift resulted in increased freedom from major amputation (87.4% vs 74.4%, p<0.01), reduced ICU stay (3.45 vs 16.98 hours, p<0.01), and shorter length of stay (20.9 vs 31.5 days, p<0.01) between the 2 eras, respectively. CONCLUSION: A shift to an endovascular-first treatment strategy is associated with fewer major amputations and shorter length of stay.
Authors: Maria Teresa B Abola; Jonathan Golledge; Tetsuro Miyata; Seung-Woon Rha; Bryan P Yan; Timothy C Dy; Marie Simonette V Ganzon; Pankaj Kumar Handa; Salim Harris; Jiang Zhisheng; Ramakrishna Pinjala; Peter Ashley Robless; Hiroyoshi Yokoi; Elaine B Alajar; April Ann Bermudez-Delos Santos; Elmer Jasper B Llanes; Gay Marjorie Obrado-Nabablit; Noemi S Pestaño; Felix Eduardo Punzalan; Bernadette Tumanan-Mendoza Journal: J Atheroscler Thromb Date: 2020-07-04 Impact factor: 4.928
Authors: Jihad Mustapha; William Gray; Brad J Martinsen; Ryan W Bolduan; George L Adams; Gary Ansel; Michael R Jaff Journal: J Endovasc Ther Date: 2019-02-06 Impact factor: 3.487
Authors: Michiel A Schreve; Michael Lichtenberg; Çagdas Ünlü; Daniela Branzan; Andrej Schmidt; Daniel A F van den Heuvel; Erwin Blessing; Marianne Brodmann; Vincent Cabane; William Tan Qing Lin; Steven Kum Journal: CVIR Endovasc Date: 2019-07-31