Document Detail


Peroneal artery-only runoff following endovascular revascularizations is effective for limb salvage in patients with tissue loss.
MedLine Citation:
PMID:  18502081     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Peroneal artery bypass is effective for limb salvage (LS), however, the efficacy of peroneal artery-only runoff (PAOR) following endovascular (EV) interventions is unknown. The goal of our article was to compare the efficacy of EV interventions with PAOR to those with other runoff vessels for LS in patients presenting with tissue loss.
METHODS: A retrospective review of 111 consecutive patients who underwent infrainguinal EV revascularizations for nonhealing ulcers/gangrene between June 2001 and December 2006 was performed. Patients with PAOR (n = 33) were compared with those with other vessel runoff (OTHER, n = 78). Fisher exact test and chi2 test were used for comparing variables, Kaplan-Meier analyses for patency, LS, and Cox regression multivariate analysis was used for identifying factors associated with limb loss.
RESULTS: The patients in PAOR were older, but other morbidities were similar between groups. The most distal level of intervention was infrapopliteal (tibioperoneal or peroneal artery) in 42% in PAOR group whereas this was 24% in OTHER group (P = .071). Preoperative ankle-brachial index (ABI) was similar (0.49 +/- 0.23 vs 0.50 +/- 0.23), however, postprocedure ABI was significantly less for patients with PAOR (0.76 +/- 0.21 vs 0.92 +/- 0.13, P = .001). The primary patency, assisted primary patency, secondary patency and LS were not significantly different between groups. There was also no difference in time-to healing between groups (PAOR vs OTHER, 2.9 +/- 2.1 mo vs 3.7 +/- 3.6 mo, P = .319). We found the presence of gangrene (odds ratio [OR]: 3.5, 95% confidence interval [CI], 1.1-10.8, P = .028) and dialysis-dependence (OR: 2.9, 95% CI, 1.0-8.2, P = .046) to be associated with limb loss, when adjusted for diabetes, hypertension, hyperlipidemia, smoking, location of wound, and PAOR.
CONCLUSION: Endovascular revascularization with PAOR results in acceptable patency and limb salvage rates in patients presenting with tissue loss, and is equivalent to other vessel runoff for patency, limb salvage and wound healing rates.
Authors:
Hasan H Dosluoglu; Gregory S Cherr; Purandath Lall; Linda M Harris; Maciej L Dryjski
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-05-23
Journal Detail:
Title:  Journal of vascular surgery     Volume:  48     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-30     Completed Date:  2008-08-29     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  137-43     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, VA Western NY Healthcare System, Buffalo, NY 14215, USA. dosluoglu@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Balloon*
Comorbidity
Female
Gangrene
Groin / blood supply
Humans
Ischemia / physiopathology*,  therapy*
Leg / blood supply*
Limb Salvage / methods*
Male
Middle Aged
Multivariate Analysis
Regional Blood Flow
Retrospective Studies
Ulcer / complications,  physiopathology
Vascular Patency
Comments/Corrections
Comment In:
J Vasc Surg. 2008 Dec;48(6):1642-3; author reply 1643   [PMID:  19118756 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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