Impact of Preoperative Symptoms and Revascularized Arterial Segment in Patients With Chronic Limb-Threatening Ischemia
Baubeta Fridh, Erik LU
; Andersson, Manne
; Thuresson, Marcus
; Nordanstig, Joakim
and Falkenberg, Mårten
(2019)
In Vascular and Endovascular Surgery
53(5).
p.365-372
- Abstract
Background: Little is known about the relative impact of the preoperative symptoms rest pain and tissue loss, and of the arterial segment revascularized, on amputation rate and mortality in patients with chronic limb-threatening ischemia (CLTI). We wanted to investigate this topic further. Method: This population-based observational cohort study involved 10 419 patients revascularized for CLTI in Sweden, 2008 to 2013. Data were collected from health-care registries and medical records. The effect of preoperative symptoms and revascularized arteries was determined using Cox regression models. A competing risk analysis was used to determine the effect of symptoms on the combined endpoint “amputation or death”. Results: The amputation rate... (More)
Background: Little is known about the relative impact of the preoperative symptoms rest pain and tissue loss, and of the arterial segment revascularized, on amputation rate and mortality in patients with chronic limb-threatening ischemia (CLTI). We wanted to investigate this topic further. Method: This population-based observational cohort study involved 10 419 patients revascularized for CLTI in Sweden, 2008 to 2013. Data were collected from health-care registries and medical records. The effect of preoperative symptoms and revascularized arteries was determined using Cox regression models. A competing risk analysis was used to determine the effect of symptoms on the combined endpoint “amputation or death”. Results: The amputation rate during a mean follow-up of 2 years was 7.5% in patients with rest pain, 15.6% in patients with tissue loss only, and 20.1% when both symptoms were present. Mortality was 39% lower in patients with rest pain only than in those with both symptoms. Revascularizations targeted the aortoiliac, femoropopliteal, and infrapopliteal segments in 19.4%, 76.8%, and 30.6%, respectively. Distal revascularizations were associated with a higher amputation rate, but this difference disappeared after adjustment for comorbidities. Aortoiliac revascularizations were associated with high mortality. Competing risk analysis showed that mortality became the major determinant of amputation-free survival outcomes from 1 year after revascularization. Conclusions: Tissue loss implies a clearly worse prognosis compared to rest pain for patients with CLTI. Most revascularizations for CLTI are done in the femoropopliteal segment. Infrapopliteal procedures are associated with a higher amputation rate, whereas aortoiliac revascularizations are associated with higher mortality.
(Less)
- author
- Baubeta Fridh, Erik
LU
; Andersson, Manne
; Thuresson, Marcus
; Nordanstig, Joakim
and Falkenberg, Mårten
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- keywords
- amputations, arterial occlusive diseases, atherosclerosis, mortality, peripheral arterial disease
- in
- Vascular and Endovascular Surgery
- volume
- 53
- issue
- 5
- pages
- 365 - 372
- publisher
- SAGE Publications
- external identifiers
-
- scopus:85063134501
- pmid:30879396
- ISSN
- 1538-5744
- DOI
- 10.1177/1538574419834765
- language
- English
- LU publication?
- no
- additional info
- Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work was supported by a research grant from Västra Götaland Region (grant no. ALFGBG-218331 to MF). Research grants from Futurum – Academy for health and care, Jönköping County, Sweden, made the collection of data on amputation possible. Funding Information: This report was made possible by contribution of data to the Swedvasc registry by Swedish vascular surgeons and interventional radiologists. We also thank the Steering Committee of Swedvasc: L. Blomgren, K. Bj?rses, K. Djavani Gidlund, M. Jonsson, A. Daryapeyma, J. Starck, H. Lindgren, K. Mani, E. R?dstr?m, T. S?derlund, and B. Kragsterman. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work was supported by a research grant from V?stra G?taland Region (grant no. ALFGBG-218331 to MF). Research grants from Futurum ? Academy for health and care, J?nk?ping County, Sweden, made the collection of data on amputation possible. Publisher Copyright: © The Author(s) 2019.
- id
- 3c1e490c-4698-44d8-91d7-89ed417c03f7
- date added to LUP
- 2022-04-04 10:56:32
- date last changed
- 2024-05-05 11:06:03
@article{3c1e490c-4698-44d8-91d7-89ed417c03f7,
abstract = {{<p>Background: Little is known about the relative impact of the preoperative symptoms rest pain and tissue loss, and of the arterial segment revascularized, on amputation rate and mortality in patients with chronic limb-threatening ischemia (CLTI). We wanted to investigate this topic further. Method: This population-based observational cohort study involved 10 419 patients revascularized for CLTI in Sweden, 2008 to 2013. Data were collected from health-care registries and medical records. The effect of preoperative symptoms and revascularized arteries was determined using Cox regression models. A competing risk analysis was used to determine the effect of symptoms on the combined endpoint “amputation or death”. Results: The amputation rate during a mean follow-up of 2 years was 7.5% in patients with rest pain, 15.6% in patients with tissue loss only, and 20.1% when both symptoms were present. Mortality was 39% lower in patients with rest pain only than in those with both symptoms. Revascularizations targeted the aortoiliac, femoropopliteal, and infrapopliteal segments in 19.4%, 76.8%, and 30.6%, respectively. Distal revascularizations were associated with a higher amputation rate, but this difference disappeared after adjustment for comorbidities. Aortoiliac revascularizations were associated with high mortality. Competing risk analysis showed that mortality became the major determinant of amputation-free survival outcomes from 1 year after revascularization. Conclusions: Tissue loss implies a clearly worse prognosis compared to rest pain for patients with CLTI. Most revascularizations for CLTI are done in the femoropopliteal segment. Infrapopliteal procedures are associated with a higher amputation rate, whereas aortoiliac revascularizations are associated with higher mortality.</p>}},
author = {{Baubeta Fridh, Erik and Andersson, Manne and Thuresson, Marcus and Nordanstig, Joakim and Falkenberg, Mårten}},
issn = {{1538-5744}},
keywords = {{amputations; arterial occlusive diseases; atherosclerosis; mortality; peripheral arterial disease}},
language = {{eng}},
number = {{5}},
pages = {{365--372}},
publisher = {{SAGE Publications}},
series = {{Vascular and Endovascular Surgery}},
title = {{Impact of Preoperative Symptoms and Revascularized Arterial Segment in Patients With Chronic Limb-Threatening Ischemia}},
url = {{http://dx.doi.org/10.1177/1538574419834765}},
doi = {{10.1177/1538574419834765}},
volume = {{53}},
year = {{2019}},
}