RESUMEN
OBJECTIVE: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.
Asunto(s)
Aneurisma/cirugía , Isquemia/cirugía , Recuperación del Miembro/estadística & datos numéricos , Arteria Poplítea/patología , Trombosis/cirugía , Enfermedad Aguda/epidemiología , Enfermedad Aguda/terapia , Anciano , Amputación Quirúrgica/estadística & datos numéricos , Aneurisma/complicaciones , Aneurisma/epidemiología , Aneurisma/patología , Australia/epidemiología , Brasil/epidemiología , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Europa (Continente)/epidemiología , Femenino , Carga Global de Enfermedades , Humanos , Incidencia , Isquemia/epidemiología , Isquemia/etiología , Recuperación del Miembro/efectos adversos , Recuperación del Miembro/métodos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Arteria Poplítea/cirugía , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Trombosis/epidemiología , Trombosis/etiología , Resultado del Tratamiento , Injerto Vascular/efectos adversos , Injerto Vascular/métodos , Injerto Vascular/estadística & datos numéricos , Grado de Desobstrucción VascularRESUMEN
INTRODUCCIÓN: El trauma vascular es un evento de baja frecuencia, con alta morbimortalidad que afecta la población joven; requiere en general un manejo quirúrgico. Se asocia a complicaciones desde la reintervención quirúrgica hasta la amputación de la extremidad, influenciado por variables tanto asociadas al trauma como a la atención hospitalaria. OBJETIVO: Determinar los factores de riesgo relacionados con amputación, en pacientes con trauma arterial periférico (TAP), atendidos en un Hospital de III nivel Huila- Colombia entre 2014-2017. MATERIALES Y MÉTODOS: Estudio observacional, analítico de corte retrospectiva con pacientes mayores de 13 años con TAP. RESULTADOS: Se incluyeron 79 pacientes, con un 1,56% de las consultas en nuestro Servicio de Urgencia. 89% hombres, promedio de edad 28,5 años. La principal comorbilidad fue la farmacodependencia 8,8%. El MESS (mangled extremity severity) promedio fue de 5,27 puntos y un tiempo critico de isquemia de extremidad > a 6 horas en el 38%. El mayor compromiso fue de miembros superiores, secundario a heridas por arma cortopunzante. La lesión predominante fue la transección arterial. Las principales complicaciones posquirúrgicas fueron la trombosis del vaso (21,5%) y la amputación (13,9%). Factores de riesgo asociados a amputación fueron la edad > 20 años, estancia hospitalaria > 7 días, MESS > 7 puntos, que presentaran como complicación quirúrgica la trombosis arterial y que requirieran reintervención quirúrgica. CONCLUSIONES: El trauma arterial periférico es una patología con gran repercusión socioeconómica y secuelas funcionales. Es necesaria la atención oportuna con tratamiento de las variables relacionadas con mal pronóstico, con el fin de disminuir las tasas de morbimortalidad.
INTRODUCTION: Vascular trauma is a low frequency event, with high morbidity and mortality that affects the young population; In general, it requires surgical management. It is associated with complications from surgical reintervention to amputation of the limb, influenced by trauma associated variables such as hospital care. AIM: Determine risk factors related to amputation, in patients with peripheral arterial trauma (TAP), treated at a Hospital of III level Huila-Colombia between 2014-2017. MATERIALS AND METHOD: Observational, retrospective analytical study with patients older than 13 years with TAP. RESULTS: We included 79 patients with an incidence of 1.56%. 89% men, average age 28.5 years. The main comorbidity was 8.8% drug dependence. The MESS (Mangled extremity severity) average was of 5.27 points and a critical time of limb ischemia > to 6 hours in 38%. The greater commitment was of superior members, secondary to injuries by sharp weapon. The predominant lesion was arterial transection. The main postoperative complications were vessel thrombosis (21.5%) and amputation in 13.9%. Risk factors associated with amputation were determined by age > 20 years, hospital stay > 7 days, MESS > 7 points, and that they presented arterial thrombosis as a surgical complication and finally required surgical reoperation. CONCLUSIONS: Peripheral arterial trauma is a pathology with great socioeconomic impact and functional sequelae. It is necessary the timely attention with treatment of the variables related to poor prognosis, in order to decrease the morbidity and mortality rates.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Heridas no Penetrantes/cirugía , Extremidades/cirugía , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/complicaciones , Procedimientos Endovasculares/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Pronóstico , Reoperación/estadística & datos numéricos , Estudios Transversales , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Estudios de Seguimiento , Colombia , Recuperación del Miembro/estadística & datos numéricos , Extremidades/lesiones , Procedimientos Endovasculares/métodos , Amputación Quirúrgica/estadística & datos numéricosRESUMEN
BACKGROUND: After the devastating earthquake in Haiti on January 12, 2010, a British orthoplastic limb salvage team was mobilized. The team operated in a suburb of Port-au-Prince from January 20, 2010. This analysis gives an overview of the caseload and early outcomes. METHODS: A retrospective analysis of operative data from the log book was performed from the opening of the facility on January 20, 2010, until March 12, 2010. RESULTS: In total, 348 operations were carried out on 158 patients, at an average of 47 cases per week. Seventy-three percent of the cases were soft-tissue cases and 25 percent were bony or combined soft-tissue and bony cases. The majority of bony procedures (n = 26; 16 percent) and flap procedures (n = 16; 10 percent) took place in the early weeks (weeks 1 through 4). Combined orthoplastic cases accounted for 37 percent of cases (16 of 44) in week 2 but only 7 percent (three of 43) in week 7. General anesthetic cases accounted for 89 percent of cases (39 of 44) in week 2 but only 40 percent (17 of 43) in week 7. Only six patients (4 percent) underwent amputation, but 36 operations (10 percent) dealt with the sequelae of amputation. Sixteen patients (10 percent) suffered complications, including two amputations for failed limb salvage. CONCLUSIONS: This article reports the outcomes of a limb salvage team in the acute response after an earthquake disaster with a favorable amputation rate and highlights the potential benefit of mobilizing this type of team. Detailing the changing caseload over time will allow for more efficient planning in case of a similar future disaster.
Asunto(s)
Traumatismos del Brazo/cirugía , Terremotos , Pierna/cirugía , Recuperación del Miembro , Grupo de Atención al Paciente , Adulto , Amputación Quirúrgica/estadística & datos numéricos , Anestesiología , Niño , Haití , Humanos , Recuperación del Miembro/estadística & datos numéricos , Ortopedia , Enfermería Perioperatoria , Complicaciones Posoperatorias , Cirugía Plástica , Resultado del TratamientoRESUMEN
BACKGROUND: The emergence of limb salvage surgery as an option for patients with osteosarcoma is attributable to preoperative chemotherapy and advancements in musculoskeletal imaging and surgical technique. While the indications for limb salvage have greatly expanded it is unclear whether limb salvage affects overall survival. QUESTIONS/PURPOSES: We asked whether over the past three decades limb-sparing procedures in high-grade osteosarcoma had increased, and whether this affected survival and ultimate amputation. METHODS: We retrospectively reviewed 251 patients with high-grade osteosarcoma treated from 1980 to 2004 with a multidisciplinary approach, including neoadjuvant chemotherapy. We compared survival rates, limb-salvage treatment, and amputation after limb-sparing procedure during three different periods of time. Fifty-three patients were treated from 1980 to 1989, 97 from 1990 to 1999, and 101 from 2000 to 2004. Thirty-seven patients were treated with primary amputations and 214 with primary limb salvage. RESULTS: The 5-year survival rate in the first period was 36%, whereas in the 1990 s, it was 60% and 67% from 2000-2004. Limb salvage surgery rate in the 1980s was 53% (28 of 53), whereas in the 1990 s, it was 91% (88 of 97) and 97% from 2000-2004 (98 of 101). In the limb salvage group, 22 of the 214 patients (10%) required secondary amputation; the final limb salvage rate in the first period was 36% (19 of 53), whereas in the 1990 s, it was 81% (79 of 97) and 93% from 2000-2004 (94 of 101). CONCLUSIONS: Patients with osteosarcoma treated in the last two periods had higher rates of limb salvage treatment and survival, with lower secondary amputation.
Asunto(s)
Neoplasias Óseas/mortalidad , Neoplasias Óseas/cirugía , Recuperación del Miembro/estadística & datos numéricos , Procedimientos Ortopédicos/estadística & datos numéricos , Osteosarcoma/mortalidad , Osteosarcoma/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/estadística & datos numéricos , Argentina/epidemiología , Neoplasias Óseas/patología , Quimioterapia Adyuvante , Niño , Preescolar , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Osteosarcoma/patología , Reoperación , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: A previous meta-analysis reported on the mid-term outcomes of infrainguinal bypass grafts in patients with critical limb ischemia and end-stage renal disease. Given the competing interest in endovascular procedures, the results of bypass surgery must be assessed as precisely as possible for future comparison. In this study, the original meta-analysis was refined and updated by increasing the number of studies reviewed, estimating primary graft patency, extending follow-up time, and investigating the problem of early amputation despite a patent graft. METHODS: Studies published from 1987 through 2005 were identified from two electronic databases. Two investigators independently extracted the survival data from life tables, survival curves, and texts. Pooled survival curves were then constructed for graft patency, limb salvage, and patient survival according to a random-effects protocol for meta-analysis. RESULTS: Of 28 articles included, 18 reported amputation despite a patent graft in 84 (10%) out of 844 limbs, and 25 described a perioperative mortality of 88 (8.8%) out of 996 patients. The 5-year pooled estimate (SE) was 50.4% (15.4%) for primary patency, 50.8% (19.0%) for secondary patency, 66.6% (11.2%) for limb salvage, and 23.0% (11.7%) for patient survival. No publication bias was detected. CONCLUSIONS: Limb salvage can be achieved in most end-stage renal disease patients who undergo bypass surgery for critical ischemia, but survival is poor. To avoid early amputation despite a patent graft, bypass grafting should not be offered to patients with a great amount of tissue loss or extensive infection.
Asunto(s)
Isquemia/cirugía , Fallo Renal Crónico/complicaciones , Pierna/irrigación sanguínea , Recuperación del Miembro/estadística & datos numéricos , Amputación Quirúrgica/estadística & datos numéricos , Arterias/cirugía , Humanos , Isquemia/complicaciones , Isquemia/mortalidad , Isquemia/fisiopatología , Selección de Paciente , Modelos de Riesgos Proporcionales , Sensibilidad y Especificidad , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricosRESUMEN
Functional outcome and survival in 253 patients treated for critical leg ischemia (CLI) in Guadeloupe (French West Indies) were analyzed. Analysis included calculation of quality-of-life score (QLS) from telephone survey data, with a median follow-up time of 42 months (range 12-109). A slight but significant benefit was observed in the 140 patients who underwent arterial reconstruction, with 76% autonomous ambulatory function, 51% independent residential status, and a QLS of 6.9 +/- 1.5 in comparison with the 113 patients who underwent amputation: 34%, 17%, and 5.1 +/- 2, respectively (p < 0.0001). Survival was comparable in the two groups. Inadequate medical follow-up that was either totally lacking or performed only in case of recurrent CLI as well as low rates of rehabilitation (50%) and prosthetic fitting (32%) in the amputation group highlight the existence of a double problem involving therapeutic compliance and vascular follow-up care/rehabilitation in Guadeloupe.
Asunto(s)
Amputación Quirúrgica/mortalidad , Isquemia/mortalidad , Isquemia/cirugía , Pierna/irrigación sanguínea , Recuperación del Miembro/mortalidad , Calidad de Vida , Procedimientos Quirúrgicos Vasculares/mortalidad , Actividades Cotidianas , Anciano , Amputación Quirúrgica/estadística & datos numéricos , Estudios de Cohortes , Enfermedad Crítica , Femenino , Estudios de Seguimiento , Guadalupe/epidemiología , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Isquemia/fisiopatología , Isquemia/rehabilitación , Estimación de Kaplan-Meier , Recuperación del Miembro/estadística & datos numéricos , Masculino , Recuperación de la Función , Reoperación , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricosRESUMEN
PURPOSE: A variety of predictive factors for the evolution of arterial grafts in patients with critical ischemia have been well defined in clinical studies, including diabetes mellitus, dialytic renal insufficiency, smoking, and distal arterial runoff. The goal of this study was to determine whether patients with critical ischemia undergoing arterial reconstruction in which ischemic lesions appeared spontaneously, compared to those in which the ischemic lesion appeared following an external aggression to the limb present different patterns of evolution. METHODS: From February 2002 to January 2004, 100 patients undergoing infra-inguinal arterial reconstruction were followed. They were divided into 2 groups: 1) the spontaneous group (n = 52), comprising individuals presenting with ischemic lesions of spontaneous origin and 2) the external aggression to the limb group (n = 48), comprising individuals for which an external causal mechanism for the appearance of the ischemic lesion was identified. The variables analyzed were limb salvage and graft functioning rates. RESULTS: Patients with spontaneous lesions had rates of limb salvage and graft functioning significantly lower than those for patients with lesions that were secondary to external aggression (42.3% versus 87.5%, respectively for both outcomes; P <.001). CONCLUSIONS: The absence of an external aggression as a contributing factor to a critical ischemic lesion in the lower limb may result in a poorer evolution of both graft function and limb salvage following arterial revascularization. However, this factor is not expected to directly influence the case conduct, since almost half of the patients without evident external aggression had good graft functioning and limb salvage. This prognostic factor should be used just as all others are, i.e., to give patients and doctors a better idea of the possible evolution in such cases.
Asunto(s)
Implantación de Prótesis Vascular , Isquemia/cirugía , Recuperación del Miembro , Extremidad Inferior/irrigación sanguínea , Amputación Quirúrgica/estadística & datos numéricos , Distribución de Chi-Cuadrado , Enfermedad Crítica , Femenino , Supervivencia de Injerto , Humanos , Recuperación del Miembro/estadística & datos numéricos , Extremidad Inferior/lesiones , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJETIVO: Diversos fatores preditivos de evolução de enxertos arteriais em pacientes com isquemia grave foram definidos em estudos clínicos como diabetes mellitus, insuficiência renal, fumo e vasão distal. O objetivo deste estudo foi verificar se pacientes com isquemia grave submetidos a revascularização nos quais as lesões apareceram espontaneamente apresentam evolução diferente daquela em que as lesões apareceram após uma agressão externa ao membro.MÉTODOS: De fevereiro de 2002 a janeiro de 2004, 100 pacientes submetidos a revascularizações infra-inguinais foram seguidos. Eles foram divididos em 2 grupos: 1) Grupo com lesão espontânea (52 pacientes), que compreendia pacientes apresentando lesões isquêmicas de origem espontânea e 2) Grupo de lesão por agressão externa (48 pacientes) que compreendia pacientes em que um mecanismo externo era identificado como causa do aparecimento da lesão isquêmica. As variáveis analisadas foram salvamento de membro e índices de perviedade dos enxertos. RESULTADOS: Pacientes com lesão espontânea apresentam índices de salvamento de membro e perviedade do enxerto significativamente menores que pacientes com lesões secundárias a agressão externa (42,3% x 87,5%, respectivamente para ambos itens de estudo;p<0,01). CONCLUSÕES: A ausência de agressão externa para o aparecimento de lesões tróficas em membros inferiores isquêmicos é fator prognóstico de pior evolução tanto para o funcionamento dos enxertos como para o salvamento do membro nos pacientes submetidos a revascularizações infra-inguinais. No entanto esse fator não é suficiente para definir uma conduta médica, visto que metade dos pacientes que apresentaram lesão espontânea também tiveram boa evolução. O fator prognóstico deve ser usado como todos os outros - para oferecer aos pacientes e aos médicos uma idéia melhor sobre a possível evolução do caso.