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Impact of Preoperative Symptoms and Revascularized Arterial Segment in Patients With Chronic Limb-Threatening Ischemia
Ryhov Cty Hosp, Sweden; Gothenburg Univ, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
Statisticon AB, Sweden.
Gothenburg Univ, Sweden.
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2019 (English)In: Vascular and Endovascular Surgery, ISSN 1538-5744, E-ISSN 1938-9116, Vol. 53, no 5, p. 365-372Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC , 2019. Vol. 53, no 5, p. 365-372
Keywords [en]
arterial occlusive diseases; peripheral arterial disease; atherosclerosis; mortality; amputations
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-158853DOI: 10.1177/1538574419834765ISI: 000471722300001PubMedID: 30879396OAI: oai:DiVA.org:liu-158853DiVA, id: diva2:1337641
Note

Funding Agencies|Vastra Gotaland Region [ALFGBG-218331]; Futurum - Academy for health and care, Jonkoping County, Sweden

Available from: 2019-07-16 Created: 2019-07-16 Last updated: 2019-07-16

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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health Sciences
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