Outcome Of Arterial Reconstruction Research Articles

The influence of socioeconomic status on outcomes of lower extremity arterial reconstruction

Although it has been shown that patient socioeconomic status (SES) is associated with the surgical treatments chosen for severe peripheral arterial disease (PAD), the association between SES and outcomes of arterial reconstruction have not been well-studied. The objective of this study was to determine if SES is associated with outcomes following lower extremity arterial reconstruction. Patients 40years and older who had surgical revascularization for severe lower extremity PAD were identified in the Nationwide Readmissions Database, 2010 to 2014. Measures of SES including median household income (MHI) quartiles of patients' residential ZIP codes were extracted. Factors associated with repeat revascularization, subsequent major amputations, hospital mortality, and 30-day all-cause readmission were evaluated using multivariable regression analyses. Of the 131,529 patients identified, the majority (61%) were male, and the average age was 69years. On unadjusted analyses, subsequent amputations were higher among patients in the lowest MHI quartile compared with patients in the highest MHI quartile (13% vs 10%; overall P< .001). On multivariable analyses, compared with patients in the lowest quartile, those in the highest quartile had lower amputation (adjusted odds ratio [aOR], 0.70; 95% confidence interval (CI), 0.63-0.77; overall P< .001) and readmission (aOR, 0.91; 95% CI, 0.84-0.99; overall P= .028) rates. However, subsequent revascularization (aOR, 1.04; 95% CI, 0.94-1.15) and mortality (aOR, 1.01; 95% CI, 0.79-1.28) rates were not different across the groups. Lower SES is associated with disproportionally worse outcomes following lower extremity arterial reconstruction for severe PAD. These data suggest that improving outcomes of lower extremity arterial reconstruction may involve addressing socioeconomic disparities.

Outcomes of Arterial Reconstruction with Autologous Femoral Vein Grafts

Outcomes of Arterial Reconstruction with Autologous Femoral Vein Grafts

Outcome of Arterial Reconstruction and Free-Flap Coverage in Diabetic Foot Ulcers: Long-Term Results

Outcome of Arterial Reconstruction and Free-Flap Coverage in Diabetic Foot Ulcers: Long-Term Results

Outcome of Arterial Reconstruction and Free‐Flap Coverage in Diabetic Foot Ulcers: Long‐Term Results

Major amputation for advanced soft tissue loss with bone and tendon exposure, can be prevented in diabetes patients with a combined arterial reconstruction and free-flap transfer. We reviewed our 15-year outcome and evaluated the feasibility to save diabetic feet by means of this aggressive strategy. A total of 55 type II diabetes patients (42-80 years of age), hospitalized between January 1992 and December 2006 for a combined arterial reconstruction and free-flap transfer, were followed until December 2007. All would have otherwise required at least a below-knee amputation. Arterial reconstructions, preferentially with autologous vein, were performed in combination with free tissue transfer, simultaneously or staged. The rectus abdominis muscle was the most frequently used muscle graft, although in recent years a growing number of alternative muscle and perforator flaps were used. The mean follow-up was 22 months (range: 1-180 months). Major complications occurred in 37% with only one in-hospital death. Major amputations were performed in 15 patients, 5 in the early postoperative period. The 1-year and 3-year limb salvage rates were 75.8 and 64.3%, with a 1-year and 3-year amputation-free survival of 69.5% and 55.8%. The 1-year and 3-year secondary patency for graft and free flap was 78.7% and 60.2%, respectively. Renal insufficiency was a major risk factor for limb loss (Hazard Ratio [HR] 5.581 (95% Confidence Interval [CI] 1.384-22.5)). Independent ambulation was regained in 38 patients. Combined arterial reconstruction and free tissue transfer provides an excellent long-term result with regard to amputation-free survival and limb salvage. It should be considered in every diabetes patient with extensive soft tissue deficits before amputation is performed.

Post-Traumatic Ulnar Artery Thrombosis: Outcome of Arterial Reconstruction Using Reverse Interpositional Vein Grafting at 2 Years Minimum Follow-Up

Post-Traumatic Ulnar Artery Thrombosis: Outcome of Arterial Reconstruction Using Reverse Interpositional Vein Grafting at 2 Years Minimum Follow-Up

Local Delivery of Gene Vectors From Bare-Metal Stents by Use of a Biodegradable Synthetic Complex Inhibits In-Stent Restenosis in Rat Carotid Arteries

Local Delivery of Gene Vectors From Bare-Metal Stents by Use of a Biodegradable Synthetic Complex Inhibits In-Stent Restenosis in Rat Carotid Arteries

Post-Traumatic Ulnar Artery Thrombosis: Outcome of Arterial Reconstruction Using Reverse Interpositional Vein Grafting at 2 Years Minimum Follow-Up

Conclusion: Successful arterial reconstruction of patients with symptomatic post-traumatic ulnar artery thrombosis (UAT) improves function in microvascular physiology, decreases symptoms, and positively affects quality of life. Summary: The authors report follow-up of use of interposition vein grafts to treat symptomatic patients with UAT. Patients included in this retrospective study had to have arteriographically proven UAT treated with excision and reversed interposition veins grafts, no known collagen vascular disease, coagulopathy, or peripheral vascular disease, and a minimum follow-up of 24 months. There were 13 patients (13 hands) identified and evaluated before surgery and at final follow-up using health-related quality of life outcome instruments. These included the McCabe cold sensitivity scale, the McGill visual analog pain scale, the Levine symptom and function scale, and the Wake Forest University symptoms scale incorporating pain, numbness, and cold intolerance. Microvascular perfusion testing was done using laser Doppler perfusion imaging. Cold stress tests were also performed. Results of cold testing were compared with 28 healthy controls. Graft patency was assessed by Allen testing or Doppler ultrasound imaging, or both. At the final follow-up, 10 of 13 grafts (77%) were patent. In patients with patent grafts, the Levine symptom scale, the McGill visual analog pain scale, and the McCabe cold sensitivity severity score all uniformly improved postoperatively. Cold testing responses also improved at final follow-up and were not different from those of normal controls. Changes in Levine function scale, Wake Forest University scale, and laser Doppler perfusion were not significant. In the three patients with nonpatent grafts, two complained of pain, numbness, and cold sensitivity, whereas the other had minimal symptoms. Comments: Although the number of patients is small, this is actually a relatively large series with prolonged follow-up of an unusual condition infrequently treated by operation. Of particular interest is improvement in quality of life noted in these patients and the normalization of their physiologic response to cold testing. Interposition vein grafting of the distal ulnar artery is relatively straightforward if the thrombosed segment does not involve the digital vessels. In such cases the saphenous vein at the ankle is an appropriate conduit. The operation, of course, is considerably more technically demanding when digital arteries must be reimplanted into the saphenous vein graft. This may be done through individual anastomoses of the digital arteries to the saphenous vein graft, or more commonly in our experience, incorporation as a patch graft of the portion of the thrombosed ulnar artery from which the digital arteries originate onto a longitudinally oriented venotomy in the saphenous vein graft.

Post-Traumatic Ulnar Artery Thrombosis: Outcome of Arterial Reconstruction Using Reverse Interpositional Vein Grafting at 2 Years Minimum Follow-Up

Treatment of posttraumatic symptomatic ulnar artery thrombosis (UAT) is controversial. This study reports the outcome at 2 years minimum follow-up of a uniform approach using reversed interpositional vein grafting to treat symptomatic patients with UAT. The records of all patients with vascular disease of the upper extremity who were revascularized at the authors' institution were retrospectively reviewed, and the following inclusion criteria were applied: (1) arteriographically proven UAT treated with excision of the involved segment and reversed interpositional vein grafting; (2) absence of collagen vascular disease, coagulopathy, or peripheral vascular disease, (3) minimum follow-up of 24 months. Twelve patients (13 hands) were identified and evaluated before surgery and at final follow-up using the following health-related quality of life outcome instruments: (1) McCabe cold sensitivity severity scale, (2) McGill visual analog pain scale, (3) Levine symptom and function scale, and (4) Wake Forest University symptom scale (pain, numbness, and cold intolerance). Digital microvascular perfusion testing (laser Doppler perfusion imaging and isolated cold stress testing) was also performed, and the final test was compared with 28 normal controls. All patients were evaluated for graft patency as determined by Allen's testing and/or Doppler ultrasound. Ten of the 13 grafts were patent at final follow-up (77% patency rate). In all the patients with patent grafts, the Levine symptom scale, the McGill visual analog pain scale, the McCabe cold sensitivity severity scale, and the isolated cold stress testing responses of the patients were significantly improved at final follow-up. Isolated cold stress testing responses were not different from those of normal controls. The changes in the Levine function scale, Wake Forest University scale, and laser Doppler perfusion imaging were not significant. In the nonpatent grafts (3 of 13), 2 patients still complained of pain, numbness, and cold sensitivity, whereas 1 patient has minimal symptoms and continues to improve. Successful arterial reconstruction in symptomatic posttraumatic UAT decreases symptoms, improves function and microvascular physiology, and has a positive effect on the health-related quality of life. Therapeutic IV.

Smoking and arterial reconstruction.

Fasting levels of serum triglyceride, serum cholesterol, lipoprotein, uric acid, fibrinogen and carboxyhaemoglobin (COHb) were measured in 64 patients with stenosing arterial disease before reconstructive surgery, and were compared with those for normal, age- and sex-matched controls. All except fibrinogen were significantly higher in the patients with arterial disease than in the controls. The outcome of arterial reconstruction, assessed both clinically and by Doppler pressure measurement, was compared in terms of these risk factors. The reconstruction of 12 patients failed between 3 months and 5 years, leaving 52 patients with patent reconstructions at the end of the follow-up period. There was no difference between the two groups in terms of any of the risk factors, except for COHb. The COHb level (associated with inhalation of cigarette smoke) was significantly higher in the reconstruction failure group than in the reconstruction success group. We believe that patients should stop smoking cigarettes before reconstructive arterial surgery is undertaken.

The role of heparin-associated antiplatelet antibodies in the outcome of arterial reconstruction

Purpose: This study was designed to determine the incidence rate of heparin-associated antiplatelet antibodies (HAAb) in patients who require major vascular reconstruction and to determine whether the HAAb were associated with perioperative thrombotic events. Methods: One hundred six patients who underwent elective arterial reconstruction for cerebrovascular occlusive disease (n = 48), aortoiliac occlusive disease (n = 13), aortoiliac aneurysm (n = 17), mesenteric arterial occlusive disease (n = 1), or infrainguinal arterial occlusive disease (n = 28) prospectively underwent evaluation from July 1, 1996, to June 30, 1997. Heparin-associated antibody tests (with a two-point platelet aggregation assay) and platelet counts (via Coulter counter) were performed before surgery and on or after the 4th day after vascular reconstruction. Arterial reconstruction thromboses were established by means of duplex ultrasound scanning or angiography. Acute myocardial infarction (AMI) and venous thromboses were diagnosed with clinical criteria and duplex ultrasound scanning, respectively. A significant decrease in platelet count was defined as a platelet count of less than 100,000/mm 3 or as a more than 30% drop in the platelet count. Results: Twenty-two patients (21%) had at least one positive HAAb assay: one assay was positive before surgery only (after angiography), six were positive both before and after surgery, and 15 were positive after surgery only. There were three perioperative deaths—one in the HAAb-positive group and two in the HAAb-negative group. Ten thrombotic events occurred in the perioperative period. Four thrombotic events (three operative site thromboses and one AMI) occurred in the HAAb-positive group (18.2%). All of these patients were undergoing heparin therapy. Of the six patients (with three operative site thromboses, two deep venous thromboses, and one AMI) in the HAAb-negative group (7%; P = .21), three were undergoing heparin therapy. No patient who was HAAb positive with a thrombotic event had thrombocytopenia or a significant decrease in platelet count. Conclusion: The frequent exposure to heparin by patients with peripheral vascular disease is associated with a high incidence rate (21%) of HAAb formation, which makes it one of the more common hypercoagulable conditions in these patients. The patients who were HAAb positive had a 2.6-fold increase in perioperative thrombotic events. Thrombocytopenia or decreasing platelet counts were not reliable clinical markers for identifying patients who were HAAb positive. It is suggested that all patients who have undergone heparin therapy and who have an unexplained perioperative thrombotic event develop should undergo testing for HAAb. (J Vasc Surg 1999;29:779-86.)

間けつ性は行肢例および重症虚血肢例に対する治療方針 手術成績からの検討

間けつ性は行肢例および重症虚血肢例に対する治療方針 手術成績からの検討