PMID- 32027986
OWN - NLM
STAT- MEDLINE
DCOM- 20200928
LR  - 20221207
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 66
DP  - 2020 Jul
TI  - Predictors of Major Adverse Limb Events after Open Forefoot Amputation in 
      Patients with Chronic Limb-Threatening Ischemia.
PG  - 614-620
LID - S0890-5096(20)30155-2 [pii]
LID - 10.1016/j.avsg.2020.01.099 [doi]
AB  - BACKGROUND: Management of patients with chronic limb-threatening ischemia (CLTI) 
      and extensive foot necrosis presents a challenge for limb salvage. Our study 
      evaluates preoperative risk factors that contributed to durability and efficacy 
      of limb salvage after open transmetatarsal amputation (TMA) in patients with 
      critical limb-threatening ischemia. METHODS: We abstracted data from patients who 
      underwent open TMA at Los Angeles County-University of Southern California 
      Medical Center and Keck Hospital of University of Southern California from 2009 
      to 2018. Multivariable logistic regression analysis, adjusting for preoperative 
      risk factors, was used to examine predictors of major adverse limb events (MALE). 
      The aim was to evaluate outcomes following open TMA with MALE as the primary 
      outcome. Our hypotheses were that outcomes would be worse for patients with foot 
      infections and renal failure. RESULTS: Forty-three open TMAs were done in 39 
      patients during the study period. The cohort had a mean age of 63 +/- 11.6 years, 
      89% had a history of diabetes, 95% hypertension (HTN), 54% had end-stage renal 
      disease (ESRD), and 26% were current smokers. MALE occurred in 39% of the cohort. 
      Sex, race, indication, HTN, smoking status, and history of prior ipsilateral 
      revascularization or minor amputations were not associated with MALE (P > 0.05). 
      Multivariate logistic regression found ESRD to be an independent predictor of 
      MALE (odds ratio 7.43, 95% confidence interval 1.12-49.17, P = 0.038) after 
      adjusting for clinically significant covariates. CONCLUSIONS: Open TMA provides 
      acceptable rates of limb salvage for complex patients with CLTI. ESRD is an 
      independent risk factor for MALE following open TMA in these patients. Vigilant 
      follow-up is essential for this morbid patient population given poorer outcomes 
      after forefoot amputation.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Zhang, Louis L
AU  - Zhang LL
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA. Electronic address: Louis.Zhang@med.usc.edu.
FAU - Saldana-Ruiz, Nallely
AU  - Saldana-Ruiz N
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
FAU - Elsayed, Ramsey S
AU  - Elsayed RS
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
FAU - Armstrong, David G
AU  - Armstrong DG
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
FAU - Shin, Laura
AU  - Shin L
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
FAU - Magee, Gregory A
AU  - Magee GA
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
FAU - Woods, Aria C
AU  - Woods AC
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
FAU - Clavijo, Leonardo C
AU  - Clavijo LC
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
FAU - Rowe, Vincent L
AU  - Rowe VL
AD  - Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of 
      USC, Los Angeles, CA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20200204
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Aged
MH  - Amputation, Surgical/*adverse effects
MH  - Chronic Disease
MH  - Female
MH  - Forefoot, Human/*blood supply/*surgery
MH  - Humans
MH  - Ischemia/diagnostic imaging/physiopathology/*surgery
MH  - Limb Salvage
MH  - Los Angeles
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/physiopathology/*surgery
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2020/02/07 06:00
MHDA- 2020/09/29 06:00
CRDT- 2020/02/07 06:00
PHST- 2019/06/19 00:00 [received]
PHST- 2020/01/15 00:00 [revised]
PHST- 2020/01/26 00:00 [accepted]
PHST- 2020/02/07 06:00 [pubmed]
PHST- 2020/09/29 06:00 [medline]
PHST- 2020/02/07 06:00 [entrez]
AID - S0890-5096(20)30155-2 [pii]
AID - 10.1016/j.avsg.2020.01.099 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2020 Jul;66:614-620. doi: 10.1016/j.avsg.2020.01.099. Epub 2020 
      Feb 4.