PMID- 33227462
OWN - NLM
STAT- MEDLINE
DCOM- 20210802
LR  - 20210802
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 72
DP  - 2021 Apr
TI  - Multiple Reinterventions for Claudication are Associated with Progression to 
      Chronic Limb-Threatening Ischemia.
PG  - 166-174
LID - S0890-5096(20)30948-1 [pii]
LID - 10.1016/j.avsg.2020.10.004 [doi]
AB  - BACKGROUND: Claudication has a relatively benign natural history, associated with 
      a low risk of limb loss. However, rates of progression to chronic 
      limb-threatening ischemia (CLTI) following lower extremity revascularization 
      (LER) for claudication remain unclear. This study examines the long-term outcomes 
      and risk factors associated with progression to CLTI after LER for claudication. 
      METHODS: A single-center retrospective review of patients undergoing LER for 
      claudication was performed from 2013-2016. Patients were stratified based on 
      whether they progressed to CLTI or not. RESULTS: There were 448 patients (502 
      limbs) treated for claudication, and 57 (12.7%) progressed to CLTI with a mean 
      follow up time of 3.7 +/- 1.5 years. Among patients who progressed, 23 (5.1%) 
      developed tissue loss, 34 (7.6%) developed rest pain, and 6 (1.2%) underwent 
      major amputation. The mean time of progression to CLTI was 1.6 +/- 1.5 years after 
      index LER. Patients who progressed to CLTI were more likely to have a history of 
      congestive heart failure and prior open revascularizations compared with those 
      who did not progress. There was no difference in type or level of index 
      revascularization between the two groups and no difference in perioperative 
      complications. Patients who developed CLTI had significantly higher rates of 
      reinterventions and a mean number of reinterventions after index LER prior to 
      developing CLTI compared to those who did not progress. Multivariable logistic 
      regression demonstrated that history of congestive heart failure (OR = 2.8 
      [1.2-6.6]), stroke (OR = 2.6 [1.1-6.1]), prior open procedure (OR = 2.8 
      [1.3-5.9]) and increasing number of reinterventions after index LER (OR = 2.9 
      [1.5-5.7]) were independently associated with disease progression to CLTI. 
      CONCLUSIONS: Multiple reinterventions and previous open revascularization are 
      associated with progression to CLTI following LER for claudication. Patients with 
      atherosclerosis in the coronary and cerebrovascular beds are also more likely to 
      have a progression of claudication to CLTI after LER.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Kim, Tanner I
AU  - Kim TI
AD  - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New 
      Haven, CT.
FAU - Kiwan, Gathe
AU  - Kiwan G
AD  - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New 
      Haven, CT.
FAU - Mohamedali, Alaa
AU  - Mohamedali A
AD  - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New 
      Haven, CT.
FAU - Zhang, Yawei
AU  - Zhang Y
AD  - Department of Surgery, Yale School of Medicine, Department of Environmental 
      Health Sciences, Yale School of Public Health, New Haven, CT.
FAU - Dardik, Alan
AU  - Dardik A
AD  - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New 
      Haven, CT.
FAU - Guzman, Raul J
AU  - Guzman RJ
AD  - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New 
      Haven, CT.
FAU - Ochoa Chaar, Cassius Iyad
AU  - Ochoa Chaar CI
AD  - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New 
      Haven, CT. Electronic address: Cassius.chaar@yale.edu.
LA  - eng
PT  - Journal Article
DEP - 20201121
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Aged
MH  - Chronic Disease
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Intermittent Claudication/diagnostic imaging/physiopathology/*therapy
MH  - Ischemia/diagnostic imaging/physiopathology/*therapy
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/physiopathology/*therapy
MH  - Retreatment
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2020/11/24 06:00
MHDA- 2021/08/03 06:00
CRDT- 2020/11/23 20:09
PHST- 2020/08/11 00:00 [received]
PHST- 2020/09/27 00:00 [revised]
PHST- 2020/10/06 00:00 [accepted]
PHST- 2020/11/24 06:00 [pubmed]
PHST- 2021/08/03 06:00 [medline]
PHST- 2020/11/23 20:09 [entrez]
AID - S0890-5096(20)30948-1 [pii]
AID - 10.1016/j.avsg.2020.10.004 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2021 Apr;72:166-174. doi: 10.1016/j.avsg.2020.10.004. Epub 2020 
      Nov 21.