Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle

Tadashi Furuyama, Toshihiro Onohara, Ryosuke Yoshiga, Keiji Yoshiya, Yutaka Matsubara, Kentaro Inoue, Daisuke Matsuda, Koichi Morisaki, Takuya Matsumoto, Yoshihiko Maehara

Research output: Contribution to journalArticle

Abstract

Objective: Patients with critical limb ischemia have serious systemic comorbidities and are at high risk of impairment of limb function. In this study, we assessed the prognostic factors of limbs after revascularization. Methods: In this retrospective single-center cohort study, from April 2008 to December 2012, we treated 154 limbs of 121 patients with critical limb ischemia by the endovascular therapy-first approach based on the patients’ characteristics. The primary end point was amputation-free survival. Secondary end points were patency of a revascularized artery, major adverse limb events, or death. Furthermore, we investigated the ambulatory status one year after revascularization as prognosis of limb function. Results: Endovascular therapy was performed in 85 limbs in 65 patients as the initial therapy (endovascular therapy group) and surgical reconstructive procedures (bypass group) were performed in 69 limbs in 56 patients. Early mortality within 30 days was not observed in either group. The primary patency rate was significantly better in the bypass group than in the endovascular therapy group (p < 0.0001). Furthermore, the secondary patency rate was similar between the two groups (p = 0.0096). There were no significant differences in amputation-free survival and major adverse limb event between the two groups. Univariate analysis showed that ulcer healing (p < 0.0001), no hypoalbuminemia (p = 0.0019), restoration of direct flow below the ankle (p = 0.0219), no previous cerebrovascular disease (p = 0.0389), and Rutherford 4 (p = 0.0469) were predictive factors for preservation of ambulatory status one year after revascularization. In multivariate analysis, ulcer healing (p < 0.0001) and restoration of direct flow below the ankle (p = 0.0060) were significant predictors. Conclusions: Ulcer healing and restoration of direct flow below the ankle are independently associated with prognosis of limb functions in patients who undergo infrainguinal arterial reconstruction.

Original languageEnglish
Pages (from-to)38-45
Number of pages8
JournalVascular
Volume27
Issue number1
DOIs
Publication statusPublished - Feb 1 2019

Fingerprint

Ankle
Ischemia
Extremities
Ulcer
Group Psychotherapy
Amputation
Reconstructive Surgical Procedures
Cerebrovascular Disorders
Hypoalbuminemia
Survival
Comorbidity
Cohort Studies
Therapeutics
Multivariate Analysis
Arteries
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle. / Furuyama, Tadashi; Onohara, Toshihiro; Yoshiga, Ryosuke; Yoshiya, Keiji; Matsubara, Yutaka; Inoue, Kentaro; Matsuda, Daisuke; Morisaki, Koichi; Matsumoto, Takuya; Maehara, Yoshihiko.

In: Vascular, Vol. 27, No. 1, 01.02.2019, p. 38-45.

Research output: Contribution to journalArticle

Furuyama, T, Onohara, T, Yoshiga, R, Yoshiya, K, Matsubara, Y, Inoue, K, Matsuda, D, Morisaki, K, Matsumoto, T & Maehara, Y 2019, 'Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle', Vascular, vol. 27, no. 1, pp. 38-45. https://doi.org/10.1177/1708538118798886
Furuyama, Tadashi ; Onohara, Toshihiro ; Yoshiga, Ryosuke ; Yoshiya, Keiji ; Matsubara, Yutaka ; Inoue, Kentaro ; Matsuda, Daisuke ; Morisaki, Koichi ; Matsumoto, Takuya ; Maehara, Yoshihiko. / Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle. In: Vascular. 2019 ; Vol. 27, No. 1. pp. 38-45.
@article{d524118e5afb4f31b57bd85f0c31ac62,
title = "Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle",
abstract = "Objective: Patients with critical limb ischemia have serious systemic comorbidities and are at high risk of impairment of limb function. In this study, we assessed the prognostic factors of limbs after revascularization. Methods: In this retrospective single-center cohort study, from April 2008 to December 2012, we treated 154 limbs of 121 patients with critical limb ischemia by the endovascular therapy-first approach based on the patients’ characteristics. The primary end point was amputation-free survival. Secondary end points were patency of a revascularized artery, major adverse limb events, or death. Furthermore, we investigated the ambulatory status one year after revascularization as prognosis of limb function. Results: Endovascular therapy was performed in 85 limbs in 65 patients as the initial therapy (endovascular therapy group) and surgical reconstructive procedures (bypass group) were performed in 69 limbs in 56 patients. Early mortality within 30 days was not observed in either group. The primary patency rate was significantly better in the bypass group than in the endovascular therapy group (p < 0.0001). Furthermore, the secondary patency rate was similar between the two groups (p = 0.0096). There were no significant differences in amputation-free survival and major adverse limb event between the two groups. Univariate analysis showed that ulcer healing (p < 0.0001), no hypoalbuminemia (p = 0.0019), restoration of direct flow below the ankle (p = 0.0219), no previous cerebrovascular disease (p = 0.0389), and Rutherford 4 (p = 0.0469) were predictive factors for preservation of ambulatory status one year after revascularization. In multivariate analysis, ulcer healing (p < 0.0001) and restoration of direct flow below the ankle (p = 0.0060) were significant predictors. Conclusions: Ulcer healing and restoration of direct flow below the ankle are independently associated with prognosis of limb functions in patients who undergo infrainguinal arterial reconstruction.",
author = "Tadashi Furuyama and Toshihiro Onohara and Ryosuke Yoshiga and Keiji Yoshiya and Yutaka Matsubara and Kentaro Inoue and Daisuke Matsuda and Koichi Morisaki and Takuya Matsumoto and Yoshihiko Maehara",
year = "2019",
month = "2",
day = "1",
doi = "10.1177/1708538118798886",
language = "English",
volume = "27",
pages = "38--45",
journal = "Vascular",
issn = "1708-5381",
publisher = "SAGE Publications Ltd",
number = "1",

}

TY - JOUR

T1 - Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle

AU - Furuyama, Tadashi

AU - Onohara, Toshihiro

AU - Yoshiga, Ryosuke

AU - Yoshiya, Keiji

AU - Matsubara, Yutaka

AU - Inoue, Kentaro

AU - Matsuda, Daisuke

AU - Morisaki, Koichi

AU - Matsumoto, Takuya

AU - Maehara, Yoshihiko

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objective: Patients with critical limb ischemia have serious systemic comorbidities and are at high risk of impairment of limb function. In this study, we assessed the prognostic factors of limbs after revascularization. Methods: In this retrospective single-center cohort study, from April 2008 to December 2012, we treated 154 limbs of 121 patients with critical limb ischemia by the endovascular therapy-first approach based on the patients’ characteristics. The primary end point was amputation-free survival. Secondary end points were patency of a revascularized artery, major adverse limb events, or death. Furthermore, we investigated the ambulatory status one year after revascularization as prognosis of limb function. Results: Endovascular therapy was performed in 85 limbs in 65 patients as the initial therapy (endovascular therapy group) and surgical reconstructive procedures (bypass group) were performed in 69 limbs in 56 patients. Early mortality within 30 days was not observed in either group. The primary patency rate was significantly better in the bypass group than in the endovascular therapy group (p < 0.0001). Furthermore, the secondary patency rate was similar between the two groups (p = 0.0096). There were no significant differences in amputation-free survival and major adverse limb event between the two groups. Univariate analysis showed that ulcer healing (p < 0.0001), no hypoalbuminemia (p = 0.0019), restoration of direct flow below the ankle (p = 0.0219), no previous cerebrovascular disease (p = 0.0389), and Rutherford 4 (p = 0.0469) were predictive factors for preservation of ambulatory status one year after revascularization. In multivariate analysis, ulcer healing (p < 0.0001) and restoration of direct flow below the ankle (p = 0.0060) were significant predictors. Conclusions: Ulcer healing and restoration of direct flow below the ankle are independently associated with prognosis of limb functions in patients who undergo infrainguinal arterial reconstruction.

AB - Objective: Patients with critical limb ischemia have serious systemic comorbidities and are at high risk of impairment of limb function. In this study, we assessed the prognostic factors of limbs after revascularization. Methods: In this retrospective single-center cohort study, from April 2008 to December 2012, we treated 154 limbs of 121 patients with critical limb ischemia by the endovascular therapy-first approach based on the patients’ characteristics. The primary end point was amputation-free survival. Secondary end points were patency of a revascularized artery, major adverse limb events, or death. Furthermore, we investigated the ambulatory status one year after revascularization as prognosis of limb function. Results: Endovascular therapy was performed in 85 limbs in 65 patients as the initial therapy (endovascular therapy group) and surgical reconstructive procedures (bypass group) were performed in 69 limbs in 56 patients. Early mortality within 30 days was not observed in either group. The primary patency rate was significantly better in the bypass group than in the endovascular therapy group (p < 0.0001). Furthermore, the secondary patency rate was similar between the two groups (p = 0.0096). There were no significant differences in amputation-free survival and major adverse limb event between the two groups. Univariate analysis showed that ulcer healing (p < 0.0001), no hypoalbuminemia (p = 0.0019), restoration of direct flow below the ankle (p = 0.0219), no previous cerebrovascular disease (p = 0.0389), and Rutherford 4 (p = 0.0469) were predictive factors for preservation of ambulatory status one year after revascularization. In multivariate analysis, ulcer healing (p < 0.0001) and restoration of direct flow below the ankle (p = 0.0060) were significant predictors. Conclusions: Ulcer healing and restoration of direct flow below the ankle are independently associated with prognosis of limb functions in patients who undergo infrainguinal arterial reconstruction.

UR - http://www.scopus.com/inward/record.url?scp=85059681370&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059681370&partnerID=8YFLogxK

U2 - 10.1177/1708538118798886

DO - 10.1177/1708538118798886

M3 - Article

C2 - 30193553

AN - SCOPUS:85059681370

VL - 27

SP - 38

EP - 45

JO - Vascular

JF - Vascular

SN - 1708-5381

IS - 1

ER -