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Performance of Computed Tomography Angiography Before Revascularization Is Associated With Higher Amputation-Free Survival in Rutherford IIb Acute Lower Limb Ischaemia

Saphir, Ebba ; Svensson-Björk, Robert LU orcid and Acosta, Stefan LU orcid (2021) In Frontiers in surgery 8.
Abstract

Background: Acute lower limb ischemia with a motor deficit (Rutherford IIb) needs urgent revascularization to avoid major amputation and mortality. It is unclear whether immediate revascularization without performing CT angiography (CTA) prior to revascularization in Rutherford IIb acute lower limb ischemia (ALI) is associated with better outcomes. Methods: Retrospective observational study of Rutherford IIb ALI patients treated between 2006 and 2018. A propensity score adjusted analysis was performed to compare outcomes after the performance of CTA examination or not. Results: Among 681 patients, 260 had Rutherford IIb ALI. CTA prior to revascularization was performed in 131 (50.4%) and increased (p < 0.001) throughout the study... (More)

Background: Acute lower limb ischemia with a motor deficit (Rutherford IIb) needs urgent revascularization to avoid major amputation and mortality. It is unclear whether immediate revascularization without performing CT angiography (CTA) prior to revascularization in Rutherford IIb acute lower limb ischemia (ALI) is associated with better outcomes. Methods: Retrospective observational study of Rutherford IIb ALI patients treated between 2006 and 2018. A propensity score adjusted analysis was performed to compare outcomes after the performance of CTA examination or not. Results: Among 681 patients, 260 had Rutherford IIb ALI. CTA prior to revascularization was performed in 131 (50.4%) and increased (p < 0.001) throughout the study period. Open vascular and endovascular surgery was first performed in 147 (56.5%) and 113 (43.5%) patients, respectively. The proportion of endovascular treatment increased while the open vascular surgery decreased during the study period (p = 0.031). In the propensity score adjusted analysis, the performance of CTA was associated with decreased risk of combined major amputation /mortality (odds ratio 0.52, 95% confidence interval 0.27-0.99; p = 0.046) at 1 year. Conclusion: Performance of CTA was associated with a higher amputation-free survival in revascularized patients with Rutherford IIb ALI. CTA seem to provide guidance in selecting the most appropriate candidates for revascularization and choice of technique.

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author
; and
organization
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type
Contribution to journal
publication status
published
subject
in
Frontiers in surgery
volume
8
article number
744721
publisher
Frontiers Media S. A.
external identifiers
  • pmid:34760919
  • scopus:85118743974
ISSN
2296-875X
DOI
10.3389/fsurg.2021.744721
language
English
LU publication?
yes
additional info
Copyright © 2021 Saphir, Svensson-Björk and Acosta.
id
28dad0f1-6de7-4501-9f22-8feb15540478
date added to LUP
2021-11-18 10:00:00
date last changed
2025-01-13 17:51:36
@article{28dad0f1-6de7-4501-9f22-8feb15540478,
  abstract     = {{<p>Background: Acute lower limb ischemia with a motor deficit (Rutherford IIb) needs urgent revascularization to avoid major amputation and mortality. It is unclear whether immediate revascularization without performing CT angiography (CTA) prior to revascularization in Rutherford IIb acute lower limb ischemia (ALI) is associated with better outcomes. Methods: Retrospective observational study of Rutherford IIb ALI patients treated between 2006 and 2018. A propensity score adjusted analysis was performed to compare outcomes after the performance of CTA examination or not. Results: Among 681 patients, 260 had Rutherford IIb ALI. CTA prior to revascularization was performed in 131 (50.4%) and increased (p &lt; 0.001) throughout the study period. Open vascular and endovascular surgery was first performed in 147 (56.5%) and 113 (43.5%) patients, respectively. The proportion of endovascular treatment increased while the open vascular surgery decreased during the study period (p = 0.031). In the propensity score adjusted analysis, the performance of CTA was associated with decreased risk of combined major amputation /mortality (odds ratio 0.52, 95% confidence interval 0.27-0.99; p = 0.046) at 1 year. Conclusion: Performance of CTA was associated with a higher amputation-free survival in revascularized patients with Rutherford IIb ALI. CTA seem to provide guidance in selecting the most appropriate candidates for revascularization and choice of technique.</p>}},
  author       = {{Saphir, Ebba and Svensson-Björk, Robert and Acosta, Stefan}},
  issn         = {{2296-875X}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in surgery}},
  title        = {{Performance of Computed Tomography Angiography Before Revascularization Is Associated With Higher Amputation-Free Survival in Rutherford IIb Acute Lower Limb Ischaemia}},
  url          = {{http://dx.doi.org/10.3389/fsurg.2021.744721}},
  doi          = {{10.3389/fsurg.2021.744721}},
  volume       = {{8}},
  year         = {{2021}},
}