46 research outputs found

    Prospective Randomized Controlled Trial to Analyze the Effects of Intermittent Pneumatic Compression on Edema Following Autologous Femoropopliteal Bypass Surgery

    Get PDF
    Background: Patients who undergo autologous femoropopliteal bypass surgery develop postoperative edema in the revascularized leg. The effects of intermittent pneumatic compression (IPC) to treat and to prevent postreconstructive edema were examined in this study. Methods: In a prospective randomized trial, patients were assigned to one of two groups. All patients suffered from peripheral arterial disease, and all were subjected to autologous femoropopliteal bypass reconstruction. Patients in group 1 used a compression stocking (CS) above the knee exerting 18 mmHg (class I) on the leg postoperatively for 1 week (day and night). Patients in group 2 used IPC on the foot postoperatively at night for 1 week. The lower leg circumference was measured preoperatively and at five postoperative time points. A multivariate analysis was done using a mixed model analysis of variance. Results: A total of 57 patients were analyzed (CS 28; IPC 29). Indications for operation were severe claudication (CS 13; IPC 13), rest pain (10/5), or tissue loss (7/11). Revascularization was performed with either a supragenicular (CS 13; IPC10) or an infragenicular (CS 15; IPC 19) autologous bypass. Leg circumference increased on day 1 (CS/IPC): 0.4%/2.7%, day 4 (2.1%/6.1%), day 7 (2.5%/7.9%), day 14 (4.7%/7.3%), and day 90 (1.0%/3.3%) from baseline (preoperative situation). On days 1, 4, and 7 there was a significant difference in leg circumference between the two treatment groups. Conclusions: Edema following femoropopliteal bypass surgery occurs in all patients. For the prevention and treatment of that edema the use of a class I CS proved superior to treatment with IPC. The use of CS remains the recommended practice following femoropopliteal bypass surgery

    Increased external tibial torsion and osteochondritis dissecans of the knee

    No full text
    In the past, osteochondritis dissecans of the knee was associated with increased tibial exotorsion, established with a clinical measuring method. Now the gold standard for determining tibial torsion is computed tomography. The aim of the current study was to establish whether the abovementioned association could be confirmed in the current patients, measured with computed tomography. Confounding aberrations of femoral torsion were ruled out. Twenty-three patients with osteochondritis dissecans in 27 knees were treated between 1991 and 1999. Symptoms and treatment results were comparable with those reported in the literature. Femoral and tibial torsion were measured with a computed tomography scan. The average femoral antetorsion was comparable with that in the literature. The average tibial exotorsion was significantly higher than the control value. Exotorsion was increased more in patients with bilateral osteochondritis, and extremely high in patients with persisting complaints. Increased tibial exotorsion could play a role in development of osteochondritis dissecans of the knee. Extreme exotorsion might be prognostic for persistent complaint

    The impact of a restrictive transfusion trigger on post-operative complication rate and well-being following elective orthopaedic surgery: a post-hoc analysis of a randomised study

    No full text
    BACKGROUND: Peri-operative red blood cell transfusions have been associated with post-operative complications in patients undergoing elective orthopaedic hip or knee replacement surgery. MATERIALS AND METHODS: We performed a post-hoc analysis of data extracted from a randomised study on transfusion triggers using pre-storage leucocyte-depleted red blood cells. Patients who were assigned to the most restrictive transfusion policy ("restrictive group") were compared with patients who were assigned to the most liberal policy ("liberal group"). End-points were red blood cell use, hospital stay, haemoglobin levels, post-operative complications and quality of life scores. RESULTS: Of 603 patients, 26.4% patients in the restrictive group and 39.1% in the liberal group were transfused (P =0.001). The rate of post-operative infections was lower, although not statistically significantly so, in the restrictive group than in the liberal group (5.4% vs 10.2%, respectively) as was the rate of respiratory complications (1.7% vs 4.9%, respectively), whereas hospital stay, cardiovascular complications and mortality rate were not different in the two groups. Quality of life scores were not associated with type of transfusion policy, the number of red blood cell transfusions or the transfusion status. DISCUSSION: A restrictive transfusion protocol was not associated with worse outcome and resulted in a lower transfusion rate compared to the liberal policy. Well-being (quality of life) was not associated with transfusion policy or with red blood cell transfusions.Analysis and support of clinical decision makin

    Quality of life in patients suffering from critical limb ischemia

    No full text
    Objective:  Various treatment options exist for patients suffering from critical limb ischemia (CLI). These options consist of endovascular procedures, surgical revascularization, primary amputation or conservative therapy. The effect of the treatment is traditionally focused on outcomes such as primary patency and limb salvage, though quality of life (QoL) is considered an important additional primary endpoint in a more patient-oriented healthcare system. The aim of this systematic review is to explore the best clinical decision making possible, to increase QoL in CLI patients. Methods:  This review is based on a systematic electronic literature search using the PubMed and EMBASE databases. Articles evaluating QoL in patients with CLI were selected for further analysis. Only prospective studies, written in English, describing QoL and health status (HS) after endovascular or surgical revascularization, amputation or conservative therapy were considered for inclusion. Treatment results were divided into short-term (≤3 months follow-up) and long-term results (≥1 year follow-up) to achieve a clear view of the QoL in patients suffering for CLI patients. Results:  Twenty-five articles describing health status (HS) in patients suffering from CLI were included. It was found that while most of these articles reported HS of patients, rarely did they report on QoL. As result it is difficult to determine the best treatment to increase HS as studies that focus on the comparison of treatment modalities are lacking. All four treatment modalities can raise HS in the short and the long-term, however endovascular and surgical revascularization seem to positively effect HS the most. QoL results are lacking in both the short- and long-term. Conclusion:  All treatment methods included in the study resulted in an increase in patients' HS in both short- and long-term. More comparative studies with inclusion of all different treatments of CLI are needed to assist in clinical decision-making and perform tailored interventions for the individual patient. QoL and HS are confusingly used in current international literature with abundant HS research. To take patients individual opinions more into account, focus on QoL research is needed to designate the superior treatment in patients suffering from CLI

    Midterm follow-up of quality of life following peripheral bypass surgery

    No full text
    Background Peripheral bypass surgery is an important treatment option for patients with peripheral arterial disease. Short-term results of quality of life (QoL) after peripheral bypass surgery showed an increase in QoL at 3 months. Little is known about QoL at more than 2 years of follow-up. This study was performed to analyze QoL at midterm follow-up, and overall survival after peripheral bypass surgery. Methods This study was part of a randomized control trial in which intermittent pneumatic compression was compared with compression stockings in the treatment of edema after bypass surgery. Patients completed a QoL questionnaire before surgery, 14 days and 3 months postoperatively, and at least 2 years after the original operation. A survival analysis was performed to calculate survival for patients who received both autologous and polytetrafluoroethylene (PTFE) bypass grafts. Results The original study consisted of 93 patients, and QoL midterm follow-up was achieved for 42. QoL scores at midterm follow-up were comparable to the preoperative baseline scores for both the autologous and the PTFE groups. Three-year survival rates were 75% and 54%, respectively. Conclusion Although peripheral bypass surgery significantly increased QoL 3 months after surgery, midterm follow-up showed a return to baseline scores. No significant difference was found in survival between patients in the autologous and PTFE groups
    corecore