Lower Extremity Revascularization Surgery Research Articles

Is the use of direct anticoagulants justified after lower extremity revascularization surgery?

Is the use of direct anticoagulants justified after lower extremity revascularization surgery?

Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study.

Rates of hospital readmission following surgery can serve as a marker for quality of care. The aim of this study was to establish the rates and causes of readmission and emergency department visits after vascular surgery and to understand how these patients are managed. We conducted a prospective observational cohort study including all inpatients who underwent major vascular surgery between September 2015 and June 2016 at a tertiary vascular care centre in Toronto. Patients were followed at 30 days after discharge via telephone interview. We enrolled 133 patients (94 men [70.7%] and 39 women [29.3%] with a mean age of 65.3 years). The most common index admission diagnosis was peripheral artery disease (67 patients [50.4%]). At 30 days, 19 patients (14.8%) had been readmitted or had visited the emergency department, most commonly after lower extremity revascularization (19.4%). Ten patients were readmitted a mean of 16.8 days following discharge; surgical site infection was the most common cause for readmission (3 patients). The most common treatment was antimicrobial therapy (4 patients). The mean hospital length of stay was 14.4 days. Nine patients presented to the emergency department a mean of 10.6 days after discharge; 6 reported a wound issue, and most (6 of 9) were managed with oral antibiotic treatment. Early readmission/emergency department visits after lower extremity revascularization surgery in patients with peripheral artery disease are common and are often due to surgical site infection or wound-related issues. Follow-up within 7-10 days and a specialized wound care team may help reduce the occurrence of these events.

Vascular Graft Infection: Incidence and Potential Risk Factors.

The purpose of this study was to identify factors that increase the risk of vascular graft infections (VGI) in patients following abdominal or lower extremity revascularization surgery. Retrospective, descriptive study. We reviewed the electronic health records of 223 patients who had undergone abdominal or lower extremity revascularization procedures from July 2012 to November 2014, looking for factors associated with VGI. We reviewed 28 preoperative, intraoperative, and post-operative factors. Descriptive statistics (mean, range, and standard deviation) were used to describe the sample; χ was used to determine correlations between the risk factors and subsequent VGIs. The level of significance was determined at P = .05, with a confidence level of 95%. We identified 33 cases of VGIs for the 223 charts reviewed, yielding an incidence rate of 15%. Seventeen of the 33 patients with VGI (51.5%) were male. The average age of patients who experienced VGI was 60.9 years (standard deviation, 12.2 years, range, 29-81 years). Preoperative factors that were shown to show statistical significance for the development of VGI were sequential procedures (P = .003), diabetes mellitus (P = .002), hemoglobin A1c more than 7.0 (P = .0002), blood glucose more than 180 mg/dL (P = .0006), and lack of mobility (0.0097). Intraoperative factors associated with VGI were hemostatic agents applied to the surgical field intraoperatively (P = .003) and perioperative hypoxemia (P = .027). Postoperative factors associated with VGI were discharge from the hospital to skilled nursing facility or acute rehabilitation facility (P = .005) and unscheduled clinic visits (P = .008). We measured a 15% incidence of VGI and identified multiple pre-, intra-, and postoperative associated factors. Vigilance is required to prevent VGI and knowledge of specific risk factors is important.

Preoperative Pulse Pressure and Major Perioperative Adverse Cardiovascular Outcomes After Lower Extremity Vascular Bypass Surgery

Preoperative increased pulse pressure (PP) has been found to be a predictor of major adverse cardiovascular events (MACEs) after coronary artery bypass graft surgery. In this study, we evaluated the predictive ability of increased preoperative PP to identify MACEs in patients with peripheral vascular disease undergoing lower extremity vascular bypass surgery. We used the prospectively collected vascular surgery database at our institution to identify 412 consecutive patients who had lower extremity bypass surgery between January 2003 and December 2004. Preoperative demographics including comorbidities, medications, intraoperative characteristics, and postoperative MACE outcomes (myocardial infarction, congestive heart failure, stroke, and in-hospital mortality) were recorded. PP data as a continuous and categorical variable (PP <80 or ≥80 mm Hg) were tested for the ability to predict postoperative MACEs. A final parsimonious logistic regression was built to evaluate the predictive ability of PP. MACEs occurred in 5.7% of patients in the PP <80 mm Hg group compared with 8.8% in the PP ≥80 mm Hg group (P = 0.229). Patients with MACEs were older (76 ± 10 years vs 68 ± 12 years; P = 0.001), had a history of myocardial infarction (9% vs 4%; P = 0.049), and had a preoperative PP of 75 ± 19 mm Hg vs 71 ± 21 mm Hg (P = 0.306). In the final logistic regression model, only age in years was a predictor of MACEs (odds ratio, 1.062; 95% confidence interval, 1.02-1.10; P = 0.02). There was no relationship between PP ≥80 mm Hg and risk for MACEs (odds ratio, 1.36; 95% confidence interval, 0.62-2.90; P = 0.44). Preoperative increase in PP is not a predictor of adverse cardiovascular outcomes in patients having lower extremity revascularization surgery.

Vascular Smooth Muscle Cells Derived from Atherosclerotic Human Arteries Exhibit Greater Adhesion, Migration, and Proliferation Than Venous Cells

Background. Phenotypic variation of vascular smooth muscle cells (VSMC) may result in altered biological behavior and responses. Within the vessel wall, arterial VSMC have a greater propensity to form atherosclerotic lesions as compared to venous VSMC. In this study the rates of proliferation, adhesion, and migration were compared between VSMC of atherosclerotic arterial and venous origin.Materials and methods. Human VSMC cultures were isolated from 18 infragenicular arteries at the time of below knee amputation and from 20 saphenous veins during lower extremity revascularization surgery. Cell cultures were isolated from the media of each specimen and maintained in distinct cell lines for all assays. Cells from passages 2 and 3 were assayed for their proliferative capacity using total DNA fluorescence photometry and for adhesion and migration using a modified Boyden chamber.Results. Patient age and the incidence of atherosclerotic risk factors did not vary significantly between the arterial and the venous patient groups. VSMC of atherosclerotic arterial origin demonstrated greater proliferation (arterial, 162 ± 59 absorption units, vs venous, 106 ± 56 aborption units, P < 0.001), adhesion (arterial, 74.1 ± 22.6 cells/microscopic field, vs venous, 41.3 ± 12.8 cells/microscopic field, P < 0.001) and migration (arterial, 427 ± 185 cells/microscopic field, vs venous, 119 ± 101 cells/microscopic field, P < 0.001) than VSMC of venous origin.Conclusion. Human atherosclerotic arterial VSMC exhibit significantly increased rates of proliferation, adhesion, and migration as compared to human venous VSMC. These observations of VSMC in culture are consistent with the clinical predilection for the hyperplasic responses that result in the development of atherosclerosis in the arterial wall. Possible intrinsic differences in VSMC phenotype should be considered in designing methods to limit atherosclerosis.

The quality of life of the limb-threatened patient after lower-extremity revascularization

There is limited research evaluating the quality of life after lower-extremity revascularization surgery. Nursing is concerned not only with survival and decreased morbidity, but also with the whole patient. An impact analysis survey was used to investigate whether patients perceived their quality of life to be improved after they underwent lower-extremity revascularization surgery. The Medical Outcomes Study-36 (MOS-36, 1990) survey was used to help us assess the patients' overall perceptions after lower-extremity revascularization surgery. The MOS-36 has a scale that measures life health concepts and a health-transition item. The purpose of this study was to determine the effect of lower-extremity revascularization on the quality of life in limb-threatened patients. The study examined quality of life as an outcome after revascularization.