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Impact of Preoperative Symptoms and Revascularized Arterial Segment in Patients With Chronic Limb-Threatening Ischemia

Artikel i vetenskaplig tidskrift
Författare Erik Baubeta Fridh
M. Andersson
M. Thuresson
Joakim Nordanstig
Mårten Falkenberg
Publicerad i Vascular and Endovascular Surgery
Volym 53
Nummer/häfte 5
Sidor 365-372
ISSN 1538-5744
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för radiologi
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 365-372
Språk en
Länkar dx.doi.org/10.1177/1538574419834765
Ämnesord arterial occlusive diseases, peripheral arterial disease, atherosclerosis, mortality, amputations, validation, amputation, Surgery, Cardiovascular System & Cardiology
Ämneskategorier Klinisk medicin

Sammanfattning

Background: Little is known about the relative impact of the preoperative symptoms rest pain and tissue loss, and of the arterial segment revascularized, on amputation rate and mortality in patients with chronic limb-threatening ischemia (CLTI). We wanted to investigate this topic further. Method: This population-based observational cohort study involved 10 419 patients revascularized for CLTI in Sweden, 2008 to 2013. Data were collected from health-care registries and medical records. The effect of preoperative symptoms and revascularized arteries was determined using Cox regression models. A competing risk analysis was used to determine the effect of symptoms on the combined endpoint "amputation or death". Results: The amputation rate during a mean follow-up of 2 years was 7.5% in patients with rest pain, 15.6% in patients with tissue loss only, and 20.1% when both symptoms were present. Mortality was 39% lower in patients with rest pain only than in those with both symptoms. Revascularizations targeted the aortoiliac, femoropopliteal, and infrapopliteal segments in 19.4%, 76.8%, and 30.6%, respectively. Distal revascularizations were associated with a higher amputation rate, but this difference disappeared after adjustment for comorbidities. Aortoiliac revascularizations were associated with high mortality. Competing risk analysis showed that mortality became the major determinant of amputation-free survival outcomes from 1 year after revascularization. Conclusions: Tissue loss implies a clearly worse prognosis compared to rest pain for patients with CLTI. Most revascularizations for CLTI are done in the femoropopliteal segment. Infrapopliteal procedures are associated with a higher amputation rate, whereas aortoiliac revascularizations are associated with higher mortality.

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