Acute ischemia and bypass occlusion: current options
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Acute ischemia and bypass occlusion: current options. / Larena-Avellaneda, A; Debus, E S; Kölbel, T; Wipper, S; Diener, H.
in: J CARDIOVASC SURG, Jahrgang 55, Nr. 2 Suppl 1, 04.2014, S. 187-194.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Acute ischemia and bypass occlusion: current options
AU - Larena-Avellaneda, A
AU - Debus, E S
AU - Kölbel, T
AU - Wipper, S
AU - Diener, H
PY - 2014/4
Y1 - 2014/4
N2 - AIM: Acute limb ischemia (ALI) and bypass occlusion are vascular emergencies and require immediate decisions and therapy. There are a lot of options, and the vascular therapist should be able to provide multiple alternatives. In this article we give on overview over the actual therapeutic options and present the data of a retrospective analysis of bypass occlusions.METHODS: Therapeutic options of ALI are discussed according to the current literature. For the retrospective study, patients with acute or subacute occlusion of below knee alloplastic bypass were included. Endpoints of the study were secondary patency and limb salvage rate. A prognostic index was calculated to estimate the specific risk.RESULTS: We analyzed 262 bypass occlusions; 161 patients were male. The majority of patients (N.=249) presented with threatened limb at readmission. After one year, 2/3 of the bypasses showed a reocclusion. Introducing the therapy with bypass thrombolysis enhanced the prognosis significantly. Of the factors examined, cardiac and renal insufficiency had a significant poor influence, whereas therapy with Coumadin enhanced the prognosis in terms of patency. The prognostic index was calculated using the factors identified as relevant in the multivariate analysis.DISCUSSION: Despite all new technical tools, ALI and bypass occlusion is still associated with a significant risk for limb loss and mortality. Endovascular procedures are excellent options. The prognostic index may be a helpful tool in estimating the patency or risk of limb loss.
AB - AIM: Acute limb ischemia (ALI) and bypass occlusion are vascular emergencies and require immediate decisions and therapy. There are a lot of options, and the vascular therapist should be able to provide multiple alternatives. In this article we give on overview over the actual therapeutic options and present the data of a retrospective analysis of bypass occlusions.METHODS: Therapeutic options of ALI are discussed according to the current literature. For the retrospective study, patients with acute or subacute occlusion of below knee alloplastic bypass were included. Endpoints of the study were secondary patency and limb salvage rate. A prognostic index was calculated to estimate the specific risk.RESULTS: We analyzed 262 bypass occlusions; 161 patients were male. The majority of patients (N.=249) presented with threatened limb at readmission. After one year, 2/3 of the bypasses showed a reocclusion. Introducing the therapy with bypass thrombolysis enhanced the prognosis significantly. Of the factors examined, cardiac and renal insufficiency had a significant poor influence, whereas therapy with Coumadin enhanced the prognosis in terms of patency. The prognostic index was calculated using the factors identified as relevant in the multivariate analysis.DISCUSSION: Despite all new technical tools, ALI and bypass occlusion is still associated with a significant risk for limb loss and mortality. Endovascular procedures are excellent options. The prognostic index may be a helpful tool in estimating the patency or risk of limb loss.
KW - Acute Disease
KW - Aged
KW - Aged, 80 and over
KW - Amputation
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Chi-Square Distribution
KW - Female
KW - Graft Occlusion, Vascular/diagnosis
KW - Humans
KW - Ischemia/diagnosis
KW - Kaplan-Meier Estimate
KW - Limb Salvage
KW - Lower Extremity/blood supply
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Patient Readmission
KW - Proportional Hazards Models
KW - Regional Blood Flow
KW - Reoperation
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Vascular Patency
M3 - SCORING: Review article
C2 - 24796913
VL - 55
SP - 187
EP - 194
JO - J CARDIOVASC SURG
JF - J CARDIOVASC SURG
SN - 0021-9509
IS - 2 Suppl 1
ER -