PMID- 26560838 OWN - NLM STAT- MEDLINE DCOM- 20161031 LR - 20221207 IS - 1615-5947 (Electronic) IS - 0890-5096 (Print) IS - 0890-5096 (Linking) VI - 30 DP - 2016 Jan TI - Risk Factors for Long-Term Mortality and Amputation after Open and Endovascular Treatment of Acute Limb Ischemia. PG - 82-92 LID - S0890-5096(15)00778-5 [pii] LID - 10.1016/j.avsg.2015.10.004 [doi] AB - BACKGROUND: Acute limb ischemia (ALI) is a highly morbid and fatal vascular emergency with little known about contemporary, long-term patient outcomes. The goal was to determine predictors of long-term mortality and amputation after open and endovascular treatment of ALI. METHODS: A retrospective review of ALI patients at a single institution from 2005 to 2011 was performed to determine the impact of revascularization technique on 5-year mortality and amputation. For each main outcome 2 multivariable models were developed; the first adjusted for preoperative clinical presentation and procedure type, the second also adjusted for postoperative adverse events (AEs). RESULTS: A total of 445 limbs in 411 patients were treated for ALI. Interventions included surgical thrombectomy (48%), emergent bypass (18%), and endovascular revascularization (34%). Mean age was 68 +/- 15 years, 54% were male, and 23% had cancer. Most patients presented with Rutherford classification IIa (54%) or IIb (39%). The etiology of ALI included embolism (27%), in situ thrombosis (28%), thrombosed bypass grafts (32%), and thrombosed stents (13%). Patients treated with open procedures had significantly more advanced ischemia and higher rates of postoperative respiratory failure, whereas patients undergoing endovascular interventions had higher rates of technical failure. Rates of postprocedural bleeding and cardiac events were similar between both treatments. Excluding Rutherford class III patients (n = 12), overall 5-year mortality was 54% (stratified by treatment, 65% for thrombectomy, 63% for bypass, and 36% for endovascular, P < 0.001); 5-year amputation was 28% (stratified by treatment, 18% for thrombectomy, 27% for bypass, and 17% for endovascular, P = 0.042). Adjusting for comorbidities, patient presentation, AEs, and treatment method, the risk of mortality increased with age (hazard ratio [HR] = 1.04, P < 0.001), female gender (HR = 1.50, P = 0.031), cancer (HR = 2.19, P < 0.001), fasciotomy (HR = 1.69, P = 0.204) in situ thrombosis or embolic etiology (HR = 1.73, P = 0.007), cardiac AEs (HR = 2.25, P < 0.001), respiratory failure (HR = 2.72, P < 0.001), renal failure (HR = 4.70, P < 0.001), and hemorrhagic events (HR = 2.25, P = 0.003). Risk of amputation increased with advanced ischemia (Rutherford IIb compared with IIa, HR = 2.57, P < 0.001), thrombosed bypass etiology (HR = 3.53, P = 0.002), open revascularization (OR; HR = 1.95, P = 0.022), and technical failure of primary intervention (HR = 6.01, P < 0.001). CONCLUSIONS: After the treatment of ALI, long-term mortality and amputation rates were greater in patients treated with open techniques; OR patients presented with a higher number of comorbidities and advanced ischemia, while also experiencing a higher rate of major postoperative complications. Overall, mortality rates remained high and were most strongly associated with baseline comorbidities, acuity of presentation, and perioperative AEs, particularly respiratory failure. Comparatively, amputation risk was most highly associated with advanced ischemia, thrombosed bypass, and failure of the initial revascularization procedure. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Genovese, Elizabeth A AU - Genovese EA AD - Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: genovesee@upmc.edu. FAU - Chaer, Rabih A AU - Chaer RA AD - Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Taha, Ashraf G AU - Taha AG AD - Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Vascular Surgery, Assiut University, Assiut, Egypt. FAU - Marone, Luke K AU - Marone LK AD - Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Avgerinos, Efthymios AU - Avgerinos E AD - Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Makaroun, Michel S AU - Makaroun MS AD - Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Baril, Donald T AU - Baril DT AD - Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. LA - eng GR - T32 HL098036/HL/NHLBI NIH HHS/United States GR - 5T32HL098036-05/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20151110 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 SB - IM MH - Acute Disease MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Amputation, Surgical MH - Endovascular Procedures MH - Female MH - Humans MH - Ischemia/*mortality/*surgery MH - Lower Extremity/*blood supply MH - Male MH - Middle Aged MH - Peripheral Vascular Diseases/*mortality/*surgery MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - Vascular Patency MH - Young Adult PMC - PMC4698794 MID - NIHMS741520 EDAT- 2015/11/13 06:00 MHDA- 2016/11/01 06:00 PMCR- 2017/01/01 CRDT- 2015/11/13 06:00 PHST- 2015/06/23 00:00 [received] PHST- 2015/10/01 00:00 [revised] PHST- 2015/10/27 00:00 [accepted] PHST- 2015/11/13 06:00 [entrez] PHST- 2015/11/13 06:00 [pubmed] PHST- 2016/11/01 06:00 [medline] PHST- 2017/01/01 00:00 [pmc-release] AID - S0890-5096(15)00778-5 [pii] AID - 10.1016/j.avsg.2015.10.004 [doi] PST - ppublish SO - Ann Vasc Surg. 2016 Jan;30:82-92. doi: 10.1016/j.avsg.2015.10.004. Epub 2015 Nov 10.