30 research outputs found
Mortality after major amputation in elderly patients with critical limb ischemia
Background: Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown. For this reason, this study evaluated mortality rates and patient-related factors associated with mortality after a major amputation in elderly patients with CLI.
Methods: From 2006 to 2013, we included patients aged >70 years who were treated for chronic CLI by primary or secondary major amputation within or after 3 months of initial therapy (revascularization or conservative management). Outcome measurements were mortality after major amputation and factors associated with mortality (age, comorbidity and timing of amputation).
Results: In total, 168/651 patients (178 legs; 26%) underwent a major amputation. Patients were stratified by age: 70–80 years (n=86) and > 80 years (n=82). Overall mortality after major amputation was 44%, 66% and 85% after 1, 3 and 5 years, respectively. The 6-month and 1-year mortality in patients aged 80 years or older was, respectively, 59% or 63% after a secondary amputation 3 months. Per year of age, the mortality rate increased by 4% (P=0.005). No significant difference in mortality after major amputation was found in the presence of comorbidity or according to Rutherford classification.
Conclusion: Despite developments in the treatment of CLI by revascularization, amputation rates remain high and are associated with tremendous mortality rates. Secondary amputation after a failed attempt of revascularization causes a higher mortality. Further research concerning timing of amputation and patient-related outcome is needed to evaluate if selected patients might benefit from primary amputation
Supervised exercise therapy and revascularization: Single-center experience of intermittent claudication management
Guidelines recommend supervised exercise therapy (SET) as first-line treatment for intermittent claudication.
However, the use of revascularization is widespread. We addressed the effectiveness of preventing (additional) invasive
revascularization after primary SET or revascularization based on lesion and patient characteristics. In this single-center,
retrospective, cohort study, 474 patients with intermittent claudication were included. Patients with occlusive disease
of the aortoiliac tract and/or common femoral artery (inflow) were primarily considered for revascularization, while
patients with more distal disease (outflow) were primarily considered for SET. In total, 232 patients were referred for
SET and 242 patients received revascularization. The primary outcome was freedom from (additional) intervention,
analyzed by Kaplan–Meier estimates. Secondary outcomes were survival, critical ischemia, freedom from target lesion
revascularization (TLR), and an increase in maximum walking distance. In the SET-first strategy, 71% of patients had
significant outflow lesions. Freedom from intervention was 0.90 ± 0.02 at 1-year and 0.82 ± 0.03 at 2-year follow-up. In
the primary revascularization group, 90% of patients had inflow lesions. Freedom from additional intervention was 0.78
± 0.03 at 1-year and only 0.65 ± 0.04 at 2-year follow-up, despite freedom from TLR of 0.91 ± 0.02 and 0.85 ± 0.03 at
1- and 2-year follow-up, respectively. In conclusion, SET was effective in preventing invasive treatment for patients with
mainly outflow lesions. In contrast, secondary intervention rates following our strategy of primary revascularization for
inflow lesions were unexpectedly high. These findings further support the guideline recommendations of SET as first-line
treatment for all patients with intermittent claudication irrespective of level of disease
Contacten buiten de kantooruren: klachten gepresenteerd aan de huisarts en aan
Doel: Vaststellen in hoeverre klachten die buiten de kantooruren worden gepresenteerd aan de afdeling Spoedeisende Hulp (SEH) van een ziekenhuis en aan huisartsen verschillend zijn en of het volgens de artsen terecht is dat een patiënt contact opneemt
Oekologische Schaeden und ihre Bewertung in internationalen, europaeischen und nationalen Haftungssystemen - eine juristische und oekonomische Analyse Gutachten
SIGLEAvailable from TIB Hannover: RN 8908(2000,496) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Umwelt, Naturschutz und Reaktorsicherheit, Bonn (Germany)DEGerman
Mortality after major amputation in elderly patients with critical limb ischemia
Sanne Klaphake,1,2 Kevin de Leur,1 Paul GH Mulder,1,3 Gwan H Ho,1 Hans G de Groot,1 Eelco J Veen,1 Hence JM Verhagen,2 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, 3Amphia Academy, Amphia Hospital, Breda, the Netherlands Background: Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown. For this reason, this study evaluated mortality rates and patient-related factors associated with mortality after a major amputation in elderly patients with CLI.Methods: From 2006 to 2013, we included patients aged >70 years who were treated for chronic CLI by primary or secondary major amputation within or after 3 months of initial therapy (revascularization or conservative management). Outcome measurements were mortality after major amputation and factors associated with mortality (age, comorbidity and timing of amputation).Results: In total, 168/651 patients (178 legs; 26%) underwent a major amputation. Patients were stratified by age: 70–80 years (n=86) and >80 years (n=82). Overall mortality after major amputation was 44%, 66% and 85% after 1, 3 and 5 years, respectively. The 6-month and 1-year mortality in patients aged 80 years or older was, respectively, 59% or 63% after a secondary amputation <3 months versus 34% and 44% after a secondary amputation >3 months. Per year of age, the mortality rate increased by 4% (P=0.005). No significant difference in mortality after major amputation was found in the presence of comorbidity or according to Rutherford classification.Conclusion: Despite developments in the treatment of CLI by revascularization, amputation rates remain high and are associated with tremendous mortality rates. Secondary amputation after a failed attempt of revascularization causes a higher mortality. Further research concerning timing of amputation and patient-related outcome is needed to evaluate if selected patients might benefit from primary amputation. Keywords: peripheral arterial disease, aged, limb ischemia, primary amputation, octogenarians, patient selectio