PMID- 19747609
OWN - NLM
STAT- MEDLINE
DCOM- 20091124
LR  - 20221207
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 23
IP  - 5
DP  - 2009 Sep-Oct
TI  - Morbidity and mortality caused by cardiac adverse events after revascularization 
      for critical limb ischemia.
PG  - 583-97
LID - 10.1016/j.avsg.2009.06.012 [doi]
AB  - BACKGROUND: We assessed cardiac adverse events (AEs) after primary lower 
      extremity arterial revascularization (LEAR) for critical lower limb ischemia 
      (CLI) in order to evaluate the impact of cardiac AEs on the clinical outcome. We 
      created an optimized care protocol concerning CLI patients' preoperative work-up 
      as well as intra- and postoperative surveillance according to recent important 
      literature and guidelines. METHODS: We conducted a prospective analysis of 
      clinical outcome after LEAR using patient-related risk factors, comorbidity, 
      surgical therapy, and AEs. This cohort was divided into patients with and without 
      AEs. AEs were categorized according to predefined standards: minor, surgical, 
      failed revascularization, and systemic. The consequences of AEs were reoperation, 
      additional medication, irreversible physical damage, and early death. RESULTS: 
      There were 106 patients (Fontaine III n=49, 46%, and Fontaine IV n=57, 56%) who 
      underwent primary revascularization by bypass graft procedure (n=67, 63%) or 
      balloon angioplasty (n=39, 37%). No difference in comorbidity was registered 
      between the two groups. Eighty-four AEs were registered in 34 patients (32%). 
      Patients experiencing AEs had significantly less antiplatelet agents (without AEs 
      n=63, 88%, vs. with AEs n=18, 53%; p=0.000) and/or beta-blockers (without AEs 
      n=66, 92%, vs. with AEs n=16, 47%; p=0.000) compared to patients without AEs. The 
      two most harmful consequences of AEs were irreversible physical damage (n=3) and 
      early death (n=8). Sixty percent (n=9) of systemic AEs were heart-related. The 
      postprocedural mortality rate was 7.5%, with a 75% (n=6) heart-related cause of 
      death. CONCLUSION: AEs occur in >30% of CLI patients after LEAR. The most harmful 
      AEs on the clinical outcome of CLI patients were heart-related, causing increased 
      morbidity and death. Significant correlations between prescription of 
      beta-blockers and antiplatelet agents and prevention of AEs were observed. A 
      persistent focus on the prevention of systemic AEs in order to ameliorate the 
      outcome after LEAR for limb salvage remains of utmost importance. Therefore, we 
      advise the implementation of an optimized care protocol by discussing patients in 
      a strict manner according to a predetermined protocol, to optimize and 
      standardize the preoperative work-up as well as intra- and postoperative patient 
      surveillance.
FAU - Flu, H C
AU  - Flu HC
AD  - Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
FAU - Lardenoye, J H P
AU  - Lardenoye JH
FAU - Veen, E J
AU  - Veen EJ
FAU - Aquarius, A E
AU  - Aquarius AE
FAU - Van Berge Henegouwen, D P
AU  - Van Berge Henegouwen DP
FAU - Hamming, J F
AU  - Hamming JF
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Angioplasty, Balloon/*adverse effects/mortality
MH  - Arterial Occlusive Diseases/complications/mortality/surgery/*therapy
MH  - Clinical Protocols
MH  - Critical Illness
MH  - Female
MH  - Heart Diseases/*etiology/mortality/prevention & control
MH  - Humans
MH  - Interdisciplinary Communication
MH  - Ischemia/etiology/mortality/surgery/*therapy
MH  - Limb Salvage
MH  - Lower Extremity/*blood supply
MH  - Male
MH  - Middle Aged
MH  - Patient Care Team
MH  - Patient Selection
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Prospective Studies
MH  - Registries
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/*adverse effects/mortality
EDAT- 2009/09/15 06:00
MHDA- 2009/12/16 06:00
CRDT- 2009/09/15 06:00
PHST- 2008/12/03 00:00 [received]
PHST- 2009/02/27 00:00 [revised]
PHST- 2009/06/08 00:00 [accepted]
PHST- 2009/09/15 06:00 [entrez]
PHST- 2009/09/15 06:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - S0890-5096(09)00138-1 [pii]
AID - 10.1016/j.avsg.2009.06.012 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2009 Sep-Oct;23(5):583-97. doi: 10.1016/j.avsg.2009.06.012.