medigraphic.com

2013, Number 1

<< Back Next >>

Revista Cubana de Angiología y Cirugía Vascular 2013; 14 (1)

Characterization of hospitalized patients with critical ischemia of the lower limbs

Hernández SA, Cabrera ZJL, Viña CH, Hondares GMC, López DM Licort GE

Language: Spanish
References: 28
Page:
PDF size: 206.26 Kb.


ABSTRACT

Objective: to characterize the hospitalized patients with a diagnosis of critical lower limb ischemic, and the therapeutic procedure to save the extremity.
Methods: the medical histories of 65 non- diabetic patients of both sexes were analyzed. The following information was drawn: risk factors, affected arterial sectors, clinical diagnosis on admission, and surgical procedures performed. The rate of preservation of limbs was estimated.
Results: it was found that smoking was the only risk factor present in all the affected arterial sectors. The most frequent occlusive patterns were the aortic-iliac (20,0 %), the femoral-popliteal (47.7 %) and the distal (32.3 %). It was observed that 42 (64.6 %) patients were hospitalized due to ischemic lesions and 23 due to pain at rest. injuries ischemic and 35,4 % for rest pain. The most performed procedures were primary amputations (40,0 %), the derivations with prosthesis (16.9 %), and endarterectomy and lumbar sympatectomy with equal frequency (12.3 %). The first procedure was performed in the femoral-popliteal (38.7 %) and the distal (52.4 %)sectors; the second one in the aortic-iliac sectors (30.7 %) and the femoral-popliteal (22.6 %), the third one in the aortic-iliac sector (23.1 %) and the fourth one in the distal (33.3 %). The best rate of extremity preservation was seen in the aortic-iliac sector.
Conclusions: The serious advanced state of lesions indicates the need of early diagnosis in order to avoid amputation and raise the overall rate of extremity preservation.


REFERENCES

  1. Varela Casariego C, March García JR, de Haro Miralles J, Acín García F. Protocolo terapéutico de la isquemia de miembros inferiores. Medicine. 2009;10(45):3032-5.

  2. Faglia E, Clerici G, Clerissi J, Gabrielli L, Losa S, Mantero M, et al. Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care. 2009;32:8227.

  3. Paraskevas KI, Bessias N, Papas TT, Gekas CD, Andrikopoulos V, Mikhailidis DP. Do different vascular risk factors affect all arteries equally? Angiology. 2008;59(4):397-401.

  4. Fontaine R, Kim M, Kieny R. Die chirurgische benhandlung der peripheren durchblutungsstorungen. Helv Chir Acta. 1954;21;499-533.

  5. Labs KH, Dormandy JA, Jaeger KA, Stuerzebecher C, Hiatt WR. Trans-Atlantic conference on clinical trial guidelines in PAOD (Peripheral arterial occlusive disease) clinical trial methodology. Eur J Vasc Endovasc Surg. 1999;18:253-65.

  6. Andres S, Jessica M, Russell H, Dennis F, Michael S. Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation-free survival using multi-center surgical outcomes data. J Vasc Surg. 2008;48(6):146471.

  7. Reifsnyder T, Grossman JP, Leers SA. Limb loss after lower extremity bypass. Am J Surg. 1997;174:149-51.

  8. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl 1):S567.

  9. Tsiara S, Elisaf M, Mikhailidis DP. Influência do tabagismo nos preditores da Doença Vascular (review). Angiology (Brasil). 2004;1(2):43-62.

  10. Mendiz OA, Fava CM, Valdivieso LR, Lev GA. Angioplasty for treatment of isolated below-the-knee arterial stenosis in patients with critical limb ischemia. Angiology. 2011;62:359-64.

  11. de Luis-Román DA, Fernández-Ovalle H, Almaraz-Gómez A, Romero E. Descripción de factores de riesgo cardiovascular de una muestra de pacientes con isquemia crítica de miembros inferiores. Angiología. 2006;58 (5):357-68.

  12. Murabito JM, D'Agostino RB, Silvershatz H, Wilson WF. Intermittent claudication: a risk profile from the Framingham Heart Study. Circulation. 1997;96:44-9.

  13. MRC/BHF Heart Protection Study of cholesterol lowering with Simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:722.

  14. Feringa HH, Karagiannis SE, van Waning VH. The effect of intensified lipid-lowering therapy on long-term prognosis in patients with peripheral arterial disease. J Vasc Surg. 2007;45:93643.

  15. Criqui MH. Peripheral arterial disease: epidemiological aspects. Vasc Med. 2001;6:3-5.

  16. Mostaza P, Álvarez C, García M. Características clínicas y evolución intra-hospitalaria de los pacientes con isquemia crítica de miembros inferiores: Estudio ICEBERG. Med Clin (Barc). 2011;136(3):916.

  17. Bailey CM, Saha S, Magee TR, Galland RB. A one year prospective study of management and outcome of patients presenting with critical lower limb ischemic. Eur J Vasc Endovasc Surg. 2003;25:1314.

  18. Group of collaboration. Recommendations for the management of chronic critical lower limb ischemic. Audit Committee of the Vascular Society of Great Britain and Ireland. Eur J Vasc Endovasc Surg. 1996;12:131-5.

  19. Bertele V, Roncaglioni MC, Pangrazzi J, Terzian E, Tognoni EG. Clinical outcome and its predictors in 1 560 patients with critical leg ischemic. Chronic Critical Leg Ischemic Group. Eur J Vasc Endovasc Surg. 1999;18:401-10.

  20. Jozami S, Albertal M, Zaefferer P, Pfund P, Fabiani A, Nau G, et al. Tratamiento de la isquemia crítica de miembros inferiores. Rev Arg Cardiol. 2010;78:129-33.

  21. Matas-Docampo M, Royo-Serrando J, Domínguez-González JM, Arañó-Heredero C, Álvarez-García B. Cirugía endovascular del sector distal: posición contraria. Angiología. 2003;55 (Supl 1):S182-9.

  22. Bou-Zamzam AM Jr, Gomez NR, Molkara A, Banta JE, Teruya TH, Killeen JD, et al. A prospective analysis of critical limb ischemia: factors leading to major primary amputation versus revascularization. Ann Vasc Surg. 2007;21:45863.

  23. Hernández SA, Cabrera JL, Viña H, Hondares MC, López M, Licort E, et al. Endarterectomía retrógrada trans-inguinal en la isquemia crítica de los miembros inferiores. Spanish J Surg Res. 2009;12(4):149-52.

  24. Schwindt AG, Panuccio G, Donas KP, Ferretto L. Endovascular treatment as first line approach for infrarenal aortic occlusive disease. J Vasc Surg. 2011;53:1550-6.

  25. Probst H, Saucy F, Dusmet M, Ris HB, Ducrey N, Haller C, et al. Clinical results of autologous infrainguinal revascularization using grafts originating distal to the femoral bifurcation in patients with mild inflow disease. J Cardiovasc Surg (Torino). 2006;47(4):437-43.

  26. O'Brien MS, Dosluoglu HH, Harris LM, Dryjski ML. Outcomes after endovascular intervention for chronic critical limb ischemia. J Vasc Surg. 2011;53:1575-81.

  27. Van Hattum ES, Tangelder MJ, Huis IT, Veld MA, Lawson JA. Medical treatment after peripheral bypass surgery over the past decade. Eur J Vasc Endovasc Surg. 2011;41:805-13.

  28. Arvela E, Venermo M, Soderstrom M, Korhonen K, Halmesmaki A, Alback E, et al. Infrainguinal angioplasty or bypass surgery in patients aged 80 years and older with critical leg ischaemia. Br J Surg. 2011;98(4):518-26.




2020     |     www.medigraphic.com