Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes
Purpose To investigate the impact of angiosome-oriented revascularization on clinical outcomes in critical limb ischemia (CLI) patients excluding those with both diabetes and wound infection. Methods Using a retrospective multicenter database, a propensity score matching analysis was performed of 53...
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| Veröffentlicht in: | Journal of endovascular therapy 2014-10, Vol.21 (5), p.607-615 |
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| creator | Iida, Osamu Takahara, Mitsuyoshi Soga, Yoshimitsu Yamauchi, Yasutaka Hirano, Keisuke Tazaki, Junichi Yamaoka, Terutoshi Suematsu, Nobuhiro Suzuki, Kenji Shintani, Yoshiaki Miyashita, Yusuke Uematsu, Masaaki |
| description | Purpose
To investigate the impact of angiosome-oriented revascularization on clinical
outcomes in critical limb ischemia (CLI) patients excluding those with both
diabetes and wound infection.
Methods
Using a retrospective multicenter database, a propensity score matching
analysis was performed of 539 consecutive CLI patients (375 men; mean age
71±11 years) without concurrent wound infection and diabetes who
underwent balloon angioplasty of isolated infrapopliteal lesions. Propensity
score matching produced 2 groups of 182 patients each who underwent
angiosome-oriented direct revascularization (123 men; mean age 72±11
years) or indirect revascularization (125 men; mean age 72±11 years).
The groups were compared for wound healing rate, freedom from major adverse
limb events (MALE), and amputation-free survival (AFS).
Results
In the overall population, indirect revascularization was performed in
36.6% (n=197). In the propensity matching analysis, the
complete wound healing rate at 12 months was higher in the direct group than
the indirect revascularization patients (75% vs. 64%,
p=0.01), while freedom from MALE (p=0.99) and AFS
(p=0.17) were not significantly different at up to 24 months. In
multivariate analysis, indirect revascularization had an independent
negative impact on wound healing (adjusted hazard ratio 0.7,
p=0.008).
Conclusion
After propensity matching analysis for CLI patients other than those with
both diabetes and wound infection, the wound healing rate was higher after
direct revascularization than after indirect revascularization, whereas MALE
and AFS were not significantly different. |
| doi_str_mv | 10.1583/14-4692R.1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1609507684</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1583_14-4692R.1</sage_id><sourcerecordid>3538835851</sourcerecordid><originalsourceid>FETCH-LOGICAL-c413t-c7b1d6f83e21b33062fdceb9b4f82f4d70cae990be18449425919020e030f8303</originalsourceid><addsrcrecordid>eNplkdtqFTEUhgdR7EFvfAAJeNEiTF0rkznksmxPGzZsKUovh0xmTZsyk2xzEPRBfF7TvauIQiDJz7e-BP6ieIFwgXVXvUFRikbyqwt8VBxjLeoS6xoe3595UzbAu6PiJIQ7AI4c8WlxxGsuoe2a4-LnetkpHZmb2KW9MS64hcqtN2QjjeyKvqmg06y8-aGicZbltZqNNVrNbJuiznhgJofexH24McvA1kHf0mIU-5SnsiqwaxNvXYps5axO3ueMXbtkR7a2E-m9WuXbW6MGihSeFU8mNQd6_rCfFl_ev_u8-lhuth_Wq8tNqQVWsdTtgGMzdRVxHKoKGj6NmgY5iKnjkxhb0IqkhIGwE0IKXkuUwIGggjwF1WlxfvDuvPuaKMR-MUHTPCtLLoUeG5A1tE0nMvrqH_TOJW_z7zIloK0yKDP1-kBp70LwNPU7bxblv_cI_X1bPYp-31aPGX75oEzDQuMf9Hc9GTg7AEHd0F_v_a_6BV9RnI0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1640739509</pqid></control><display><type>article</type><title>Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes</title><source>MEDLINE</source><source>SAGE Complete</source><creator>Iida, Osamu ; Takahara, Mitsuyoshi ; Soga, Yoshimitsu ; Yamauchi, Yasutaka ; Hirano, Keisuke ; Tazaki, Junichi ; Yamaoka, Terutoshi ; Suematsu, Nobuhiro ; Suzuki, Kenji ; Shintani, Yoshiaki ; Miyashita, Yusuke ; Uematsu, Masaaki</creator><creatorcontrib>Iida, Osamu ; Takahara, Mitsuyoshi ; Soga, Yoshimitsu ; Yamauchi, Yasutaka ; Hirano, Keisuke ; Tazaki, Junichi ; Yamaoka, Terutoshi ; Suematsu, Nobuhiro ; Suzuki, Kenji ; Shintani, Yoshiaki ; Miyashita, Yusuke ; Uematsu, Masaaki</creatorcontrib><description>Purpose
To investigate the impact of angiosome-oriented revascularization on clinical
outcomes in critical limb ischemia (CLI) patients excluding those with both
diabetes and wound infection.
Methods
Using a retrospective multicenter database, a propensity score matching
analysis was performed of 539 consecutive CLI patients (375 men; mean age
71±11 years) without concurrent wound infection and diabetes who
underwent balloon angioplasty of isolated infrapopliteal lesions. Propensity
score matching produced 2 groups of 182 patients each who underwent
angiosome-oriented direct revascularization (123 men; mean age 72±11
years) or indirect revascularization (125 men; mean age 72±11 years).
The groups were compared for wound healing rate, freedom from major adverse
limb events (MALE), and amputation-free survival (AFS).
Results
In the overall population, indirect revascularization was performed in
36.6% (n=197). In the propensity matching analysis, the
complete wound healing rate at 12 months was higher in the direct group than
the indirect revascularization patients (75% vs. 64%,
p=0.01), while freedom from MALE (p=0.99) and AFS
(p=0.17) were not significantly different at up to 24 months. In
multivariate analysis, indirect revascularization had an independent
negative impact on wound healing (adjusted hazard ratio 0.7,
p=0.008).
Conclusion
After propensity matching analysis for CLI patients other than those with
both diabetes and wound infection, the wound healing rate was higher after
direct revascularization than after indirect revascularization, whereas MALE
and AFS were not significantly different.</description><identifier>ISSN: 1526-6028</identifier><identifier>EISSN: 1545-1550</identifier><identifier>DOI: 10.1583/14-4692R.1</identifier><identifier>PMID: 25290786</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Aged, 80 and over ; Amputation ; Angioplasty, Balloon - adverse effects ; Angioplasty, Balloon - methods ; Chi-Square Distribution ; Clinical outcomes ; Critical Illness ; Disease-Free Survival ; Female ; Hospitals ; Humans ; Ischemia - diagnosis ; Ischemia - physiopathology ; Ischemia - therapy ; Japan ; Kaplan-Meier Estimate ; Limb Salvage ; Logistic Models ; Lower Extremity - blood supply ; Male ; Middle Aged ; Multivariate Analysis ; Popliteal Artery - physiopathology ; Propensity Score ; Proportional Hazards Models ; Registries ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Veins & arteries ; Wound Healing</subject><ispartof>Journal of endovascular therapy, 2014-10, Vol.21 (5), p.607-615</ispartof><rights>2014 International Society of Endovascular Specialists</rights><rights>Copyright Allen Press Publishing Services Oct 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-c7b1d6f83e21b33062fdceb9b4f82f4d70cae990be18449425919020e030f8303</citedby><cites>FETCH-LOGICAL-c413t-c7b1d6f83e21b33062fdceb9b4f82f4d70cae990be18449425919020e030f8303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1583/14-4692R.1$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1583/14-4692R.1$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21799,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25290786$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iida, Osamu</creatorcontrib><creatorcontrib>Takahara, Mitsuyoshi</creatorcontrib><creatorcontrib>Soga, Yoshimitsu</creatorcontrib><creatorcontrib>Yamauchi, Yasutaka</creatorcontrib><creatorcontrib>Hirano, Keisuke</creatorcontrib><creatorcontrib>Tazaki, Junichi</creatorcontrib><creatorcontrib>Yamaoka, Terutoshi</creatorcontrib><creatorcontrib>Suematsu, Nobuhiro</creatorcontrib><creatorcontrib>Suzuki, Kenji</creatorcontrib><creatorcontrib>Shintani, Yoshiaki</creatorcontrib><creatorcontrib>Miyashita, Yusuke</creatorcontrib><creatorcontrib>Uematsu, Masaaki</creatorcontrib><title>Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes</title><title>Journal of endovascular therapy</title><addtitle>J Endovasc Ther</addtitle><description>Purpose
To investigate the impact of angiosome-oriented revascularization on clinical
outcomes in critical limb ischemia (CLI) patients excluding those with both
diabetes and wound infection.
Methods
Using a retrospective multicenter database, a propensity score matching
analysis was performed of 539 consecutive CLI patients (375 men; mean age
71±11 years) without concurrent wound infection and diabetes who
underwent balloon angioplasty of isolated infrapopliteal lesions. Propensity
score matching produced 2 groups of 182 patients each who underwent
angiosome-oriented direct revascularization (123 men; mean age 72±11
years) or indirect revascularization (125 men; mean age 72±11 years).
The groups were compared for wound healing rate, freedom from major adverse
limb events (MALE), and amputation-free survival (AFS).
Results
In the overall population, indirect revascularization was performed in
36.6% (n=197). In the propensity matching analysis, the
complete wound healing rate at 12 months was higher in the direct group than
the indirect revascularization patients (75% vs. 64%,
p=0.01), while freedom from MALE (p=0.99) and AFS
(p=0.17) were not significantly different at up to 24 months. In
multivariate analysis, indirect revascularization had an independent
negative impact on wound healing (adjusted hazard ratio 0.7,
p=0.008).
Conclusion
After propensity matching analysis for CLI patients other than those with
both diabetes and wound infection, the wound healing rate was higher after
direct revascularization than after indirect revascularization, whereas MALE
and AFS were not significantly different.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amputation</subject><subject>Angioplasty, Balloon - adverse effects</subject><subject>Angioplasty, Balloon - methods</subject><subject>Chi-Square Distribution</subject><subject>Clinical outcomes</subject><subject>Critical Illness</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ischemia - diagnosis</subject><subject>Ischemia - physiopathology</subject><subject>Ischemia - therapy</subject><subject>Japan</subject><subject>Kaplan-Meier Estimate</subject><subject>Limb Salvage</subject><subject>Logistic Models</subject><subject>Lower Extremity - blood supply</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Popliteal Artery - physiopathology</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><subject>Wound Healing</subject><issn>1526-6028</issn><issn>1545-1550</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNplkdtqFTEUhgdR7EFvfAAJeNEiTF0rkznksmxPGzZsKUovh0xmTZsyk2xzEPRBfF7TvauIQiDJz7e-BP6ieIFwgXVXvUFRikbyqwt8VBxjLeoS6xoe3595UzbAu6PiJIQ7AI4c8WlxxGsuoe2a4-LnetkpHZmb2KW9MS64hcqtN2QjjeyKvqmg06y8-aGicZbltZqNNVrNbJuiznhgJofexH24McvA1kHf0mIU-5SnsiqwaxNvXYps5axO3ueMXbtkR7a2E-m9WuXbW6MGihSeFU8mNQd6_rCfFl_ev_u8-lhuth_Wq8tNqQVWsdTtgGMzdRVxHKoKGj6NmgY5iKnjkxhb0IqkhIGwE0IKXkuUwIGggjwF1WlxfvDuvPuaKMR-MUHTPCtLLoUeG5A1tE0nMvrqH_TOJW_z7zIloK0yKDP1-kBp70LwNPU7bxblv_cI_X1bPYp-31aPGX75oEzDQuMf9Hc9GTg7AEHd0F_v_a_6BV9RnI0</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Iida, Osamu</creator><creator>Takahara, Mitsuyoshi</creator><creator>Soga, Yoshimitsu</creator><creator>Yamauchi, Yasutaka</creator><creator>Hirano, Keisuke</creator><creator>Tazaki, Junichi</creator><creator>Yamaoka, Terutoshi</creator><creator>Suematsu, Nobuhiro</creator><creator>Suzuki, Kenji</creator><creator>Shintani, Yoshiaki</creator><creator>Miyashita, Yusuke</creator><creator>Uematsu, Masaaki</creator><general>SAGE Publications</general><general>Allen Press Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201410</creationdate><title>Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes</title><author>Iida, Osamu ; Takahara, Mitsuyoshi ; Soga, Yoshimitsu ; Yamauchi, Yasutaka ; Hirano, Keisuke ; Tazaki, Junichi ; Yamaoka, Terutoshi ; Suematsu, Nobuhiro ; Suzuki, Kenji ; Shintani, Yoshiaki ; Miyashita, Yusuke ; Uematsu, Masaaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c413t-c7b1d6f83e21b33062fdceb9b4f82f4d70cae990be18449425919020e030f8303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amputation</topic><topic>Angioplasty, Balloon - adverse effects</topic><topic>Angioplasty, Balloon - methods</topic><topic>Chi-Square Distribution</topic><topic>Clinical outcomes</topic><topic>Critical Illness</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Ischemia - diagnosis</topic><topic>Ischemia - physiopathology</topic><topic>Ischemia - therapy</topic><topic>Japan</topic><topic>Kaplan-Meier Estimate</topic><topic>Limb Salvage</topic><topic>Logistic Models</topic><topic>Lower Extremity - blood supply</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Popliteal Artery - physiopathology</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><topic>Wound Healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iida, Osamu</creatorcontrib><creatorcontrib>Takahara, Mitsuyoshi</creatorcontrib><creatorcontrib>Soga, Yoshimitsu</creatorcontrib><creatorcontrib>Yamauchi, Yasutaka</creatorcontrib><creatorcontrib>Hirano, Keisuke</creatorcontrib><creatorcontrib>Tazaki, Junichi</creatorcontrib><creatorcontrib>Yamaoka, Terutoshi</creatorcontrib><creatorcontrib>Suematsu, Nobuhiro</creatorcontrib><creatorcontrib>Suzuki, Kenji</creatorcontrib><creatorcontrib>Shintani, Yoshiaki</creatorcontrib><creatorcontrib>Miyashita, Yusuke</creatorcontrib><creatorcontrib>Uematsu, Masaaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of endovascular therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iida, Osamu</au><au>Takahara, Mitsuyoshi</au><au>Soga, Yoshimitsu</au><au>Yamauchi, Yasutaka</au><au>Hirano, Keisuke</au><au>Tazaki, Junichi</au><au>Yamaoka, Terutoshi</au><au>Suematsu, Nobuhiro</au><au>Suzuki, Kenji</au><au>Shintani, Yoshiaki</au><au>Miyashita, Yusuke</au><au>Uematsu, Masaaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes</atitle><jtitle>Journal of endovascular therapy</jtitle><addtitle>J Endovasc Ther</addtitle><date>2014-10</date><risdate>2014</risdate><volume>21</volume><issue>5</issue><spage>607</spage><epage>615</epage><pages>607-615</pages><issn>1526-6028</issn><eissn>1545-1550</eissn><abstract>Purpose
To investigate the impact of angiosome-oriented revascularization on clinical
outcomes in critical limb ischemia (CLI) patients excluding those with both
diabetes and wound infection.
Methods
Using a retrospective multicenter database, a propensity score matching
analysis was performed of 539 consecutive CLI patients (375 men; mean age
71±11 years) without concurrent wound infection and diabetes who
underwent balloon angioplasty of isolated infrapopliteal lesions. Propensity
score matching produced 2 groups of 182 patients each who underwent
angiosome-oriented direct revascularization (123 men; mean age 72±11
years) or indirect revascularization (125 men; mean age 72±11 years).
The groups were compared for wound healing rate, freedom from major adverse
limb events (MALE), and amputation-free survival (AFS).
Results
In the overall population, indirect revascularization was performed in
36.6% (n=197). In the propensity matching analysis, the
complete wound healing rate at 12 months was higher in the direct group than
the indirect revascularization patients (75% vs. 64%,
p=0.01), while freedom from MALE (p=0.99) and AFS
(p=0.17) were not significantly different at up to 24 months. In
multivariate analysis, indirect revascularization had an independent
negative impact on wound healing (adjusted hazard ratio 0.7,
p=0.008).
Conclusion
After propensity matching analysis for CLI patients other than those with
both diabetes and wound infection, the wound healing rate was higher after
direct revascularization than after indirect revascularization, whereas MALE
and AFS were not significantly different.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>25290786</pmid><doi>10.1583/14-4692R.1</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1526-6028 |
| ispartof | Journal of endovascular therapy, 2014-10, Vol.21 (5), p.607-615 |
| issn | 1526-6028 1545-1550 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1609507684 |
| source | MEDLINE; SAGE Complete |
| subjects | Aged Aged, 80 and over Amputation Angioplasty, Balloon - adverse effects Angioplasty, Balloon - methods Chi-Square Distribution Clinical outcomes Critical Illness Disease-Free Survival Female Hospitals Humans Ischemia - diagnosis Ischemia - physiopathology Ischemia - therapy Japan Kaplan-Meier Estimate Limb Salvage Logistic Models Lower Extremity - blood supply Male Middle Aged Multivariate Analysis Popliteal Artery - physiopathology Propensity Score Proportional Hazards Models Registries Retrospective Studies Risk Factors Time Factors Treatment Outcome Veins & arteries Wound Healing |
| title | Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes |
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