PMID- 30879396
OWN - NLM
STAT- MEDLINE
DCOM- 20190626
LR  - 20221207
IS  - 1938-9116 (Electronic)
IS  - 1538-5744 (Linking)
VI  - 53
IP  - 5
DP  - 2019 Jul
TI  - Impact of Preoperative Symptoms and Revascularized Arterial Segment in Patients 
      With Chronic Limb-Threatening Ischemia.
PG  - 365-372
LID - 10.1177/1538574419834765 [doi]
AB  - 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.
FAU - Baubeta Fridh, Erik
AU  - Baubeta Fridh E
AUID- ORCID: 0000-0001-9177-7322
AD  - 1 Department of Radiology, Ryhov County Hospital, Jonkoping, Sweden.
AD  - 2 Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, 
      Gothenburg University, Gothenburg, Sweden.
FAU - Andersson, Manne
AU  - Andersson M
AD  - 3 Department of Vascular Surgery, Ryhov County Hospital, Jonkoping, Sweden.
AD  - 4 Department of Clinical and Experimental Medicine, Faculty of Health Sciences, 
      Linkoping University, Linkoping, Sweden.
FAU - Thuresson, Marcus
AU  - Thuresson M
AD  - 5 Statisticon AB, Uppsala, Sweden.
FAU - Nordanstig, Joakim
AU  - Nordanstig J
AD  - 6 Department of Vascular Surgery and Department of Molecular and Clinical 
      Medicine, Institute of Medicine, Sahlgrenska University Hospital and Sahlgrenska 
      Academy, Gothenburg University, Gothenburg, Sweden.
FAU - Falkenberg, Marten
AU  - Falkenberg M
AD  - 2 Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, 
      Gothenburg University, Gothenburg, Sweden.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20190317
PL  - United States
TA  - Vasc Endovascular Surg
JT  - Vascular and endovascular surgery
JID - 101136421
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - Female
MH  - Gangrene
MH  - Humans
MH  - Intermittent Claudication/diagnosis/mortality/physiopathology/*surgery
MH  - Ischemia/diagnosis/mortality/physiopathology/*surgery
MH  - Limb Salvage
MH  - Lower Extremity/*blood supply/pathology
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnosis/mortality/physiopathology
MH  - Registries
MH  - Risk Assessment
MH  - Risk Factors
MH  - Sweden
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Vascular Surgical Procedures/adverse effects/mortality
OTO - NOTNLM
OT  - amputations
OT  - arterial occlusive diseases
OT  - atherosclerosis
OT  - mortality
OT  - peripheral arterial disease
EDAT- 2019/03/19 06:00
MHDA- 2019/06/27 06:00
CRDT- 2019/03/19 06:00
PHST- 2019/03/19 06:00 [pubmed]
PHST- 2019/06/27 06:00 [medline]
PHST- 2019/03/19 06:00 [entrez]
AID - 10.1177/1538574419834765 [doi]
PST - ppublish
SO  - Vasc Endovascular Surg. 2019 Jul;53(5):365-372. doi: 10.1177/1538574419834765. 
      Epub 2019 Mar 17.