Araştırma Makalesi
BibTex RIS Kaynak Göster

Patency and Survival in Patients Undergoing Revascularization for Peripheral Arterial Disease

Yıl 2024, Cilt: 14 Sayı: 2, 215 - 223, 22.05.2024
https://doi.org/10.33631/sabd.1401456

Öz

Aim: Peripheral arterial disease is a progressive, and chronic disease caused by atherosclerosis, and characterized by narrowing, or occlusion of the arterial structures of the lower extremities, which can lead to high morbidity and mortality. The aim of this study is to investigate the short and medium-term patency, and survival outcomes of different peripheral arterial revascularization techniques.
Material and Methods: Patients undergoing revascularization for lower extremity arterial disease between January 2015 and August 2019 were retrospectively analyzed. Patients were divided into three groups according to the type of revascularization: endovascular, surgical, or hybrid. Major amputation, occlusion, and death were the primary endpoints. Expected primary patency and overall survival rates were estimated using Kaplan-Meier analyses.
Results: The study included 285 patients and 338 revascularization procedures. There was no difference in primary outcome between treatment groups (p=0.080). Improvement in Rutherford category was observed in 57.1% of patients after revascularization. There was no difference between the groups in terms of change in Rutherford category (p=0.230). Expected primary patency rates were significantly lower in patients with chronic limb-threatening ischemia, and in patients with chronic renal failure (respectively; p<0.001, p=0.02). There was no difference in expected primary patency between the groups (p=0.069). Overall survival rates were lower in the presence of chronic limb-threatening ischemia, chronic renal failure and atrial fibrillation (respectively; p=0.013, p=0.010, p<0.001).
Conclusion: In our study, chronic limb-threatening ischemia and renal failure were associated with worse survival and lower primary patency rates. There was no difference in survival between revascularization groups. Atrial fibrillation was associated with worse survival.

Kaynakça

  • Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382(9901): 1329-40.
  • Bozkurt KA. Kardiyovasküler risk faktörlerinin tedavisi. Bozkurt KA (editör). Periferik arter ve ven hastalıkları Ulusal Tedavi Kılavuzu. İstanbul: Ege Reklam Basım Sanatları San.Tic. Ltd. Şti; 2016. S. 3-9.
  • Shu J, Santulli G. Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis. 2018; 275(8): 379‐81.
  • ESC Guidelines on the diagnosis and treatment of peripheral artery diseases (Editorial). Turk Kardiyol Dern Ars. 2012; 40(1): 5-60.
  • Zdanowski Z, Troeng T, Norgren L. Outcome and influence of age after infrainguinal revascularisation in critical limb ischaemia. The Swedish Vascular Registry. Eur J Vasc Endovasc Surg. 1998; 16(2): 137-41.
  • Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366(9501): 1925-34.
  • Shammas NW. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease. Vasc Health Risk Manag. 2007; 3(2): 229-34.
  • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007; 45(1): 5-67.
  • Nathaniel R. Smilowitz, Nipun Bhandari, Jeffrey S. Berger. Chronic kidney disease and outcomes of lower extremity revascularization for peripheral artery disease. Atherosclerosis. 2020; 297(6): 149-56.
  • Ambur V, Park P, Gaughan JP, Golarz S, Schmieder F, Van Bemmelen P et al. The impact of chronic kidney disease on lower extremity bypass outcomes in patients with critical limb ischemia. J Vasc Surg. 2019; 69(2): 491-6.
  • Vierthaler L, Callas PW, Goodney PP, Schanzer A, Patel VI, Cronenwett J et al. Determinants of survival and major amputation after peripheral endovascular intervention for critical limb ischemia. J Vasc Surg. 2015; 62(3): 655-64.
  • Kobayashi N, Hirano K, Nakano M, Ito Y, Ishimori H, Yamawaki M, et al. Prognosis of critical limb ischemia patients with tissue loss after achievement of complete wound healing by endovascular therapy. J Vasc Surg. 2015; 61(4): 951-59.
  • Liew YP, Bartholomew JR, Demirjian S, Michaels J, Schreiber MJ Jr. Combined effect of chronic kidney disease and peripheral arterial disease on all-cause mortality in a high-risk population. Clin J Am Soc Nephrol. 2008; 3(4): 1084-90
  • Rodriguez-Padilla J, Varela C, Carrascosa T, March JR. Infrainguinal revascularization in patients with critical limb ıschemia on end-stage renal disease patients (ESRD) and comparison results with non-ESRD population. J Angiol Vasc Surg. 2020; 5(1): 1-7.
  • Li CY, Lin CP, Lin YS, Wu LS, Chang CJ, Chu PH. Newly diagnosed atrial fibrillation is an independent factor for future major adverse cardiovascular events. PLoS One. 2015; 10(4); 1-12.
  • Goto S, Bhatt DL, Röther J, Alberts M, Hill MD, Ikeda Y et. al. REACH Registry Investigators. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Am Heart J. 2008; 156(5): 855-63.

Periferik Arter Hastalığı Nedeniyle Revaskülarizasyon İşlemi Yapılan Hastalarda Açıklık ve Sağkalım

Yıl 2024, Cilt: 14 Sayı: 2, 215 - 223, 22.05.2024
https://doi.org/10.33631/sabd.1401456

Öz

Amaç: Periferik arter hastalığı, aterosklerozun neden olduğu, yüksek morbidite ve mortalite ile sonuçlanabilen alt ekstremite arteriyel yapılarının daralması veya tıkanması ile karakterize, ilerleyici ve kronik bir hastalıktır. Bu çalışma, farklı periferik arteriyel revaskülarizasyon tekniklerinin, kısa ve orta dönem açıklık ve sağkalım sonuçlarının araştırılmasını amaçlamaktadır.
Gereç ve Yöntemler: Çalışmada Ocak 2015 - Ağustos 2019 tarihleri arasında alt ekstremite arter hastalığı nedeniyle revaskülarizasyon işlemi gerçekleştirilen hastalar retrospektif olarak incelendi. Revaskülarizasyon tipine göre hastalar, endovasküler, cerrahi veya hibrid tedavi olmak üzere üç gruba ayrıldı. Majör amputasyon, oklüzyon ve ölüm primer sonlanım noktaları olarak belirlendi. Beklenen primer açıklık ve genel sağkalım oranları Kaplan-Meier analizleri kullanılarak tahmin edildi.
Bulgular: Çalışmaya 285 hastaya uygulanan 338 revaskülarizasyon işlemi dahil edilmiştir. Tedavi grupları arasında primer sonlanım gerçekleşmesi açısından fark saptanmamıştır (p=0,080). Olguların %57,1’inde revaskülarizasyon sonrası Rutherford kategorisinde iyileşme gözlenmiştir. Rutherford kategorisindeki değişim açısından gruplar arasında fark bulunmamıştır (p=0,230). Kronik ekstremite tehdit edici iskemi ile başvuran hastalarda ve kronik böbrek yetmezliği olan hastalarda beklenen primer açıklık oranları anlamlı olarak düşük bulunmuştur (sırasıyla; p<0,001, p=0,020). Gruplar arasında beklenen primer açıklık açısından fark saptanmamıştır. (p=0,069). Kronik ekstremite tehdit edici iskemi, kronik böbrek yetmezliği ve atriyal fibrilasyon varlığında genel sağkalım oranları daha düşük bulunmuştur. (sırasıyla; p=0,013, p=0,010 ve p<0,001).
Sonuç: Çalışmamızda, kronik ekstremite tehdit edici iskemi ve böbrek yetmezliği daha kötü sağkalım ve düşük primer açık kalma oranları ile ilişkili bulundu. Revaskülarizasyon grupları arasında sağkalım açısından farklılık saptanmadı Atriyal fibrilasyon ise daha kötü sağkalım beklentisi ile ilişkiliydi.

Destekleyen Kurum

Destekleyen bir kurum veya kuruluş bulunmamaktadır.

Kaynakça

  • Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382(9901): 1329-40.
  • Bozkurt KA. Kardiyovasküler risk faktörlerinin tedavisi. Bozkurt KA (editör). Periferik arter ve ven hastalıkları Ulusal Tedavi Kılavuzu. İstanbul: Ege Reklam Basım Sanatları San.Tic. Ltd. Şti; 2016. S. 3-9.
  • Shu J, Santulli G. Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis. 2018; 275(8): 379‐81.
  • ESC Guidelines on the diagnosis and treatment of peripheral artery diseases (Editorial). Turk Kardiyol Dern Ars. 2012; 40(1): 5-60.
  • Zdanowski Z, Troeng T, Norgren L. Outcome and influence of age after infrainguinal revascularisation in critical limb ischaemia. The Swedish Vascular Registry. Eur J Vasc Endovasc Surg. 1998; 16(2): 137-41.
  • Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366(9501): 1925-34.
  • Shammas NW. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease. Vasc Health Risk Manag. 2007; 3(2): 229-34.
  • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007; 45(1): 5-67.
  • Nathaniel R. Smilowitz, Nipun Bhandari, Jeffrey S. Berger. Chronic kidney disease and outcomes of lower extremity revascularization for peripheral artery disease. Atherosclerosis. 2020; 297(6): 149-56.
  • Ambur V, Park P, Gaughan JP, Golarz S, Schmieder F, Van Bemmelen P et al. The impact of chronic kidney disease on lower extremity bypass outcomes in patients with critical limb ischemia. J Vasc Surg. 2019; 69(2): 491-6.
  • Vierthaler L, Callas PW, Goodney PP, Schanzer A, Patel VI, Cronenwett J et al. Determinants of survival and major amputation after peripheral endovascular intervention for critical limb ischemia. J Vasc Surg. 2015; 62(3): 655-64.
  • Kobayashi N, Hirano K, Nakano M, Ito Y, Ishimori H, Yamawaki M, et al. Prognosis of critical limb ischemia patients with tissue loss after achievement of complete wound healing by endovascular therapy. J Vasc Surg. 2015; 61(4): 951-59.
  • Liew YP, Bartholomew JR, Demirjian S, Michaels J, Schreiber MJ Jr. Combined effect of chronic kidney disease and peripheral arterial disease on all-cause mortality in a high-risk population. Clin J Am Soc Nephrol. 2008; 3(4): 1084-90
  • Rodriguez-Padilla J, Varela C, Carrascosa T, March JR. Infrainguinal revascularization in patients with critical limb ıschemia on end-stage renal disease patients (ESRD) and comparison results with non-ESRD population. J Angiol Vasc Surg. 2020; 5(1): 1-7.
  • Li CY, Lin CP, Lin YS, Wu LS, Chang CJ, Chu PH. Newly diagnosed atrial fibrillation is an independent factor for future major adverse cardiovascular events. PLoS One. 2015; 10(4); 1-12.
  • Goto S, Bhatt DL, Röther J, Alberts M, Hill MD, Ikeda Y et. al. REACH Registry Investigators. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Am Heart J. 2008; 156(5): 855-63.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri (Diğer)
Bölüm Araştırma Makaleleri
Yazarlar

Ömer Faruk Rahman 0000-0002-4248-2867

Erdem Ali Özkısacık 0000-0002-8842-1103

Yayımlanma Tarihi 22 Mayıs 2024
Gönderilme Tarihi 7 Aralık 2023
Kabul Tarihi 3 Nisan 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 14 Sayı: 2

Kaynak Göster

Vancouver Rahman ÖF, Özkısacık EA. Patency and Survival in Patients Undergoing Revascularization for Peripheral Arterial Disease. SABD. 2024;14(2):215-23.