Abstract:
BACKGROUND:Strategies available to facilitate decision making for patients with peripheral arterial disease (PAD) include a Markov-based decision analysis (DA) model and the Lower Extremity Grading System (LEGS) score. Both have suggested inferior outcomes when the actual treatment received (ATX) differs from that predicted. This study focuses on patient outcomes when such discordance exists. METHODS:All patients referred for symptomatic lower extremity PAD over a 3-year period were evaluated using the DA model and the LEGS score. Calculated quality of life (cQOL) values were assigned before treatment based on patient symptom, perfusion, and amputation status and at follow-up (range 1.000 [perfect health] to .000 [death]). The primary outcome of cQOL was compared according to whether the ATX matched that proposed by the surgeon or predicted by the DA model or LEGS score. Secondary outcomes for revascularized patients included major adverse limb event with perioperative death (MALE + POD) and amputation-free survival (AFS). RESULTS:Among 375 procedures in 345 consecutive patients, the greatest improvement in cQOL at last follow-up (median 16 months) was observed with endovascular (0.23 ± 0.16, n = 93) or open (0.21 ± 0.17, n = 137) revascularization compared with primary amputation (0.10 ± 0.07, n = 23) or medical therapy (0.04 ± 0.09, n = 122). Multivariate regression showed discordance with the surgeon's recommendation (P < 0.05) and/or the DA model (P < 0.05) to be independent predictors of improvement failure. ATX did not always agree with that proposed by the surgeon (89% agree, κ = 0.84), the DA model (68% agree, κ = 0.53), or the LEGS score (53% agree, κ = 0.32). Improvement in cQOL was greatest when ATX was concordant with treatment proposed by the surgeon (0.18 vs. 0.08, P < 0.01), the DA model (0.19 vs. 0.13, P < 0.01), or the LEGS score (0.23 vs. 0.10, P < 0.01). Patient refusal to follow the surgeon's recommendations and continued smoking were associated with minimal improvement (cQOL ranges 0.05-0.07 and 0.00-0.02, respectively), while pursuing a less morbid procedure was associated with greater improvement (cQOL range 0.28-0.38). Among revascularized patients, MALE + POD was lower at 36 months after endovascular than open surgery (21% ± 5% vs. 36% ± 4%, P < 0.05), while AFS was not significantly different. Only discordance with the surgeon's recommendation was an independent predictor of MALE + POD, possibly because of limitations in sample subset size. CONCLUSIONS:Mean cQOL improved most with direct revascularization, especially when the treatment received matched that predicted by the models or proposed by the surgeon. Type of treatment received was an independent predictor of agreement of treatment with recommendations. Patient refusal to follow the recommended treatment as well as the strategy not to revascularize claudicants who persist in smoking were associated with much less patient benefit from treatment.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Brothers TEdoi
10.1016/j.avsg.2014.08.006subject
Has Abstractpub_date
2015-02-01 00:00:00pages
244-59issue
2eissn
0890-5096issn
1615-5947pii
S0890-5096(14)00569-Xjournal_volume
29pub_type
杂志文章abstract::This case report describes concurrent splenic peliosis and vascular Ehlers-Danlos syndrome (EDS) in a 59-year-old male patient. After splenic rupture due to peliosis, the complicated postoperative period hinted at the possibility of vascular EDS. This diagnosis was confirmed by genetic testing, which revealed a novel ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.02.004
更新日期:2009-03-01 00:00:00
abstract::Use of the Neodymium: yttrium -aluminum -garnet (Nd:YAG) laser to recanalize stenosed arteries may require delivery of the beam through blood. To assess the degree of hemolysis and debris formation, 54 samples of citrated whole blood were exposed to Nd:YAG laser radiation of varying powers (10, 20 and 30 watts) and du...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60780-2
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:Endovenous ablation of great (GSV) and short saphenous vein (SSV) reflux has become the initial procedure for most patients with symptomatic venous insufficiency, and perforator ablation is increasingly used to assist in healing venous ulceration. Many patients have comorbid conditions, which require long-te...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.10.019
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:In abdominal aortic aneurysm (AAA), pathophysiology deterioration of the medial aortic layer plays a critical role. Key players in vessel wall degeneration are reactive oxygen species (ROS), smooth muscle cell apoptosis, and extracellular matrix degeneration by matrix metalloproteinase-9 (MMP-9). Lipocalin-2...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.11.006
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Noninvasive diagnostic testing may be beneficial to identify stenotic (failing) stents placed for occlusive lower extremity peripheral arterial disease (LEPAD), especially if subsequent intervention proves useful in maintaining prolonged stent patency. We previously documented the benefit of surveillance dup...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.08.086
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:The aim of this study was to review the efficacy of the Flixene™ (Atrium™, Hudson, NH, USA) hemodialysis arterio-venous graft (AVG) in a multiethnic Asian cohort of patients with end-stage renal failure (ESRF). Primary outcome was graft primary patency rate and secondary end points included graft usability, ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.11.029
更新日期:2020-12-26 00:00:00
abstract:BACKGROUND:Renal vein aneurysms (RVAs) are uncommon entities, which are usually incidental findings or may cause mild nonspecific symptoms. Modern radiological imaging, mainly multislice computed tomography (CT), has substantially contributed to a prompt and accurate diagnosis. Treatment may range from watchful waiting...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.08.075
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Open repair of juxta-renal abdominal aortic aneurysms (AAA) sometimes involves the ligation and division of the left renal vein (LRV). Some surgeons advocate repair, but this is not common practice. The aim was to study the effect of LRV ligation on renal function. METHODS:A retrospective audit of all open ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.02.008
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:There are two principally different methods for measuring toe pressures (TP)-photoplethysmography (PPG) and laser Doppler (LD). PPG is based on detecting changes in the blood filling of the digital arteries and arterioles, and the LD perfusion signal is derived from the Doppler shift undergone by the emitted...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.10.011
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:To propose a protocol for the routine clinical use of duplex ultrasound (DUS) assessment after transcarotid artery revascularization (TCAR) procedures, with its specific point of vascular access, based on DUS data from routine clinical practice. METHODS:DUS data were retrospectively collected at 2 centers f...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.09.065
更新日期:2020-11-24 00:00:00
abstract:BACKGROUND:Delirium in patients with critical limb ischemia (CLI) is associated with increased mortality. The main goal of this study was to investigate the association between delirium and mortality in patients undergoing major lower limb amputation for CLI. In addition, other risk factors associated with mortality we...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.02.014
更新日期:2019-10-01 00:00:00
abstract::In this report we describe catheter-based bailout techniques for when the distal end of the ipsilateral leg of an Excluder endograft has remained undeployed due to a broken deployment string. We attempted to advance a percutaneous transluminal angioplasty (PTA) balloon into an undeployed leg via the brachial artery, b...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.06.024
更新日期:2013-08-01 00:00:00
abstract::The aim of this study was to determine the status and the role of oxidative stress and antioxidant defenses in patients with Buerger disease and atherosclerotic peripheral arterial occlusive disease (PAOD). Seventy-three subjects resembling each other in general characteristics were involved in the study: 21 with lowe...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.11.006
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Carotid endarterectomy (CEA) prevents the occurrence of stroke in the future, although its efficacy depends on the detection and control of high perioperative risk factors. We aimed to analyze the association between preoperative neurological deficit and the 30-day risk of major adverse cardiovascular events...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.11.045
更新日期:2021-01-04 00:00:00
abstract:BACKGROUND:As high healthcare costs are increasing scrutinized, a movement toward reducing patient hospital admissions and lengths of stay has emerged, particularly for operations that may be performed safely in the outpatient setting. Our aim is to describe recent temporal trends in the proportion of dialysis access p...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.07.032
更新日期:2018-01-01 00:00:00
abstract::Advanced complicated atherosclerotic lesions have been related to many factors, including inflammation, infectious agents, and growth factors. Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP), inflammation, and growth factors have been associated with severe atherosclerotic lesions in necropsy material in rece...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9076-1
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Early identification of carotid and vertebral artery dissections has been advocated to reduce stroke among trauma patients. We sought to characterize trends in the diagnosis of traumatic carotid and vertebral artery dissections and association changes in stroke rate among Medicare beneficiaries. METHODS:Usi...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.06.001
更新日期:2016-10-01 00:00:00
abstract::Compression of adjacent anatomic structures by an abdominal aortic aneurysm (AAA) can result in a variety of symptoms. We describe the case of an 88-year-old Caucasian woman with jaundice, elevated laboratory parameters for extrahepatic and intrahepatic cholestasis, and concomitant juxtarenal AAA compressing the liver...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.04.080
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Isolated bilateral profunda femoris artery aneurysm (PFAA) is a very rare entity. Most of the cases are unilateral and occur with synchronous aneurysms elsewhere. Symptoms range from none to limb ischemia or hemorrhage because of rupture. METHODS:We present a rare case of PFAA. In contrast to the general ru...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.02.025
更新日期:2010-08-01 00:00:00
abstract::Current methods of ligating venous branches during in situ vein tibial bypass are associated with significant wound complications, especially in diabetics. Making only proximal and distal wound incisions could avoid these wound problems. We report the use of endovascular techniques with coils and balloons guided by in...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02002882
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:Endovascular treatment of aortoiliac occlusive disease (AIOD) involving the aortic bifurcation is challenging. The gold standard is open surgery with patency rates up to 90% at 5 years, but has considerable morbidity and mortality. The kissing stent (KS) technique was introduced as an alternative. The goal o...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2017.01.009
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Leiomyosarcoma of the inferior vena cava (IVC) is a rare mesenchymal tumor with poor prognosis. Surgical resection is currently the only potential curative treatment. This study analyzed long-term outcomes of patients who underwent surgical resection of leiomyosarcoma of the IVC. METHODS:The charts of 12 pa...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.05.053
更新日期:2019-11-01 00:00:00
abstract::Endoleaks remain a significant challenge after endovascular abdominal aortic aneurysm repair (EVAR). Translumbar thrombin injection of the aneurysm sac has been used to treat endoleaks, with low reported morbidity. We present an unusual case of ischemic colitis following translumbar thrombin injection of an endoleak. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-003-0102-2
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Type II endoleaks are the most common complications after endovascular repair of abdominal aortic aneurysms (EVARs). Some studies have shown the benefit of preventive inferior mesenteric artery (IMA) embolization, but its efficacy and cost-effectiveness continue to be controversial. The aim of this study was...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.03.012
更新日期:2019-10-01 00:00:00
abstract::Primary popliteal venous aneurysm is a rare condition. To date, approximately 150 cases have been reported. In the present article, we report a 59-year-old man who presented with a swelling of the left popliteal fossa. Duplex ultrasound scan revealed a saccular aneurysm of the popliteal vein, with a diameter of 2.5 × ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2011.11.027
更新日期:2012-07-01 00:00:00
abstract::Stable coil placement is an imperative when treating arterial pathology at branch points. Coil kick and escape threaten distal organs, particularly as the pack tightens. Before the development of the VBX balloon-expandable stent graft (W.L. Gore, Flagstaff, AZ), vessel caliber change often precluded straightforward st...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.05.026
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). METHODS:The clinical data of five patients with acute SMAE treated by PMT in our center from October 2015 to May 2018 were retrospectively analyzed...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.08.096
更新日期:2020-02-01 00:00:00
abstract::True and false aneurysms of veins are very rare conditions and only few cases have been described in the literature. We present a case of a 56-year-old female with personal history of primary arterial hypertension and connective tissue disease. Ultrasound of the neck showed a saccular, compressible, hypoechoic structu...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.09.017
更新日期:2017-05-01 00:00:00
abstract::Inflammatory aneurysms represent only 3-10% of all aortoiliac aneurysms and tend to be more common in men. We report a case of a solitary inflammatory aneurysm of the right common iliac artery in a healthy young woman. The patient presented with persistent abdominal and right flank pain. She had no risk factors for va...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-7713-8
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:An aggressive surgical approach to locally advanced malignancy is being increasingly used in the absence of distant metastatic disease. This includes resection and reconstruction of major venous structures. We investigated the results of using a multidisciplinary surgical approach in these instances. METHOD...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.01.012
更新日期:2015-07-01 00:00:00