registry of long term follow up of pad
DESCRIPTION
registry of PAD by Dr.Ahmed Abdallah Emam under the supervision of prof.Dr.Ayman SalehTRANSCRIPT
PAD:-Major healthcare issue worldwide.
-Patients with PAD = risk ofmortality, MI and CVS.
-Pressing need to commence aneffective therapeutic strategy fortreating patients with PAD.
PAD•Common.•Under-diagnosed•Under-treated .•Diagnosed accurately withsimple, noninvasive, office-based tests .
REVASCULARIZATION
• prospective registry.• ASU and NHI.• Symptomatic PAD pts. who
underwent PTA.
•The study assessed the influence of varying factors (baseline clinical, demographic, and imaging) on the success rate IMMEDIATELY and 12 ms. after PTA for symptomatic PAD pts.
It also suggested a standardized REPORTING TEMPLATE that can be used for reporting results of studies relating to peripheral vascular interventions.
Immediate outcome:
Clinical Success : Improvement by at least on clinical category, & well felt distal pulsation.
Technical Success : Success to enter the vessel, cross the lesion, or improve blood flow.
Clinical and technical success had to be fulfilled to consider the intervention successful.
66.5%
33.5%
57%
43%
73%
27%
70%
30%
9.6%
90.4%
0
20
40
60
80
100
DM HTN DYSLIP. Smoking S.Cr. level >1.5 mg/dl.
Y
N
56.8%
43.2%
0
10
20
30
40
50
60
CLI Claud.
40 %
30 %
18 %12 %
0
5
10
15
20
25
30
35
40
A B C D
Type of ischemia TASC
32%6.7%
13.3%
48%
Above inguinal ligament
Below inguinal ligament; above knee
Below knee
Combined
SDMeanMaxMinNo.1.9194.80102Diameter
mm.
138Pre stentBalloons
12.5004731.25480.0010.00Lengthmm.
2.6568.00151Pressureatm.
2.9383.4719*1No. of inflations
1.1717.22105Diametermm.185
Stents 27.73469.1915015Lengthmm.
3.19412.20178Pressureatm.
1.5866.47102Diameter
121Post stent deployment
balloons
17.69337.578019Length
2.98110.10184Pressureatm.
1.6643.058*1No. of inflations
This patient was originally advised to undergo an above knee amputation of his right foot , which prompted a second opinion and the resulting endovascular procedure. Ulcerative cellulitis and critical limb ischemia (gangrene) of the fourth toe were evident.
Seven weeks , the patient reported significant improvement in the symptoms of claudication . Other than the loss of the gangrenous toe, the patient was walking without difficulty and extremely pleased to have been able to avoid the above knee amputation.Limb salvage was accomplished.
Healing ulcer of the RT foot 4 weeks after restored blood flow to the plantar surface of the foot
Wound-healing progress was also made on the LT foot.
Non-healing ulcers of the LT & RT foot that prompted endovascular therapy .
FactorIn Hosp. Mortality
M. S.D P S
AgeNo 57.8
89.56
9.042 SYes 68.4
015.093
No of stents
No 1.61 .693.650 NS
Yes 1.80 .837Number of lesions
No 1.33 .688
.037 SYes 2.00 1.000
Cr.>1.5 mg/dl
No 1.18 .353.001 HSYes 1.72 .421
TASC DNo 1.01 1.01
7.496 NS
Yes 1.40 1.32
FactorIn hosp.
morbidityM. S.D P S
AgeNo 58.19 9.437
.441 NSYes 56.00 12.87
1
Number of stents
No 1.59 .701
.074NS
Yes 2.00 .535
Number of
lesions
No 1.36 .715
.808NS
Yes 1.31 .630
Cr.>1.5 mg/dl
No 1.18 .305
.034SYes 1.43 .801
TASC D
No 1.09 1.037.013 SYes .38 .650
In hospital mortalityP. Sig.
No Yes
DM No% within In
hospital mortality
34.7% .0%.046 S
Yes% within In
hospital mortality
65.3% 100.0%
In hospital morbidity
No Yes
DM No% within In
hospital morbidity
35.3% 15.4%.146 NS
Yes% within In
hospital morbidity
64.7% 84.6%
Alive 84% Dead 16%
SCD
Leg gangrene
Others
Alive
0 20 40 60 80 100
Symptomsrecurrence
No symptomsrecurrence
Claudication CLI Acute limb ischemia
85 %
10 %4 %
1 %
One year follow up criteria Value %
Patient state:AliveDead
cause of death:Leg gangrene Sudden cardiac deathOthers
Recurrence of LL symptomsSite of recurrence responsible for symptoms:
Target lesionOther lesion
Type of ischemia:ClaudicationCLIAcute
Management of patients with recurrence of LL symptoms:
EndovascularSurgicalMedical ttt
84.016.0
3.012.01.015
78
1041
10.35.1
84.6
Factor Patient state
Mean Std. Deviation P Sig.
AgeAlive 57.12 9.862
.021 SDead 63.50 10.752
No of stentsAlive 1.60 .746
.929 NSDead 1.63 .744
Number of lesions
Alive 1.30 .576.628 NSDead 1.38 .619
Creatinine >1.5 mg/dl
Alive 1.24 .422.555 NSDead 1.18 .274
TASC DAlive 1.06 1.068
.469 NSDead 1.21 1.122
Variant Factor P value Sig.
Affected LL(single,
bilateral)
Smoking 0.02 SHypertension 0.05 S
+ve Family history 0.028 S
Number of lesions .0001 HS
DM
Age .0001 HS
Creatinine >1.5 mg/dl .039 S
Hypertension 0.001 HSDyslipidemia
0.043 SLesion
Calcification 0.005 HS
Long lesion 0.024 S
In hospital mortality 0.046S
-Dramatic shifts in the management of PVD have occurred toward endovascular intervention.
-There seems to be a significant M&M advantages for endovascular as compared to surgery.
-The increasing safety of vascular interventions should be considered with the caveat that INDEPENDENT FACTORS OF OUTCOMES SHOULD BE RESPECTED.
•Endovascular ttt is not withoutpossible in-hospital mortality.•Endovascular revascularizationis a good palliative ttt for CCLIwith a recurrence rate of 15 %(only 4 % recurrence of CCLI).
•Interestingly limb salvagewas 100% in this series .•The need for urgentsurgical revascularizationwas 1.3 %.
Case reporting byinterventionistsneeds to beimproved andunified.
•Improving the identification ofpts with symp. PAD. By ensuringthat physicians are well informedabout PAD prevention, detection,and management.•An endovascular approach shouldbe tailored based on a patient’scomorbidities and anatomicalfactors.
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| F | 31 | 38.6 |
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| East | 7 | 6 | 87 |