Abstract
The present study aimed to clarify the current status, therapeutic strategy, and 1-year outcome in acute limb ischemia (ALI) patients in Japan. The EnDOvascular treatment (Edo) registry database includes 324 patients from 10 institutes who were registered between November 2011 and October 2013. A total of 70 ALI patients (mean age 74.0 years) from the Edo registry database were enrolled in this study. Of the 70 included patients, 72.9% were male and 35.7% had embolism. Of patients, 38.6%, 42.9%, and 18.6% underwent EVT, surgery, and hybrid thrombectomy, respectively, in primary revascularization strategy. Limb ischemia was categorized into four classes at initial evaluation: SVS/ISCVS class I (n = 13, 18.6%), SVS/ISCVS class IIa (n = 36, 51.4%), SVS/ISCVS class IIb (n = 21, 30%), and SVS/ISCVS class III (n = 0, 0%). Three patients with SVS/ISCVS class IIb limb ischemia developed myonephropathic metabolic syndrome. No catheter-directed thrombolysis was employed as a primary revascularization strategy. The 1-year rates of all-cause death, major amputation, and a composite of perioperative death or major adverse limb event were 28.6%, 5.7%, and 40.0%, respectively. Lower age, male sex, dyslipidemia, high estimated glomerular filtration rate, high albumin level, and low C-reactive protein level were independent positive predictors of all-cause death. In this registry, SVS/ISCVS class IIa ALI was predominant. Approximately 40% of primary revascularization strategy was surgery and EVT, followed by hybrid therapy. All-cause death and major amputation rates at 1 year were less than 30% and 6%, respectively.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fowkes FG, Rudan D, Rudan I, 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;382:1329–40.
Diehm C, Allenberg JR, Pittrow D, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120:2053–61.
Kullo IJ, Rooke TW. Clinical practice. Peripheral artery disease. N Engl J Med. 2016;374:861–71.
Utsunomiya M, Takahara M, Iida O, et al. Wound blush obtainment is the most important angiographic endpoint for wound healing. JACC Cardiovasc Interv. 2017;10:188–94.
Yamauchi Y, Takahara M, Shintani Y, et al. One-year outcomes of endovascular therapy for aortoiliac lesions. Circ Cardiovasc Interv. 2019;12:e007441.
Kawarada O, Yasuda S, Huang J, et al. Contemporary infrapopliteal intervention for limb salvage and wound healing: harmonization of revascularization and wound management. Circ J. 2014;78:1540–9.
Cambou JP, Aboyans V, Constans J, Lacroix P, Dentans C, Bura A. Characteristics and outcome of patients hospitalised for lower extremity peripheral artery disease in France: the COPART Registry. Eur J Vasc Endovasc Surg. 2010;39:577–85.
Higashitani M, Uemura Y, Mizuno A, et al. Cardiovascular outcome and mortality in patients undergoing endovascular treatment for symptomatic peripheral artery disease—short-term results of the Toma-Code Registry. Circ J. 2018;82:1917–25.
Eliason JL, Wainess RM, Proctor MC, et al. A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia. Ann Surg. 2003;238:382–9.
de Donato G, Setacci F, Sirignano P, Galzerano G, Massaroni R, Setacci C. The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia. J Vasc Surg. 2014;59:729–36.
Darwood R, Berridge DC, Kessel DO, Robertson I, Forster R. Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev. 2018;8:CD002784.
Inagaki E, Farber A, Kalish JA, et al. Outcomes of peripheral vascular interventions in select patients with lower extremity acute limb ischemia. J Am Heart Assoc. 2018;7:e004782.
Mizuno A, Anzai H, Utsunomiya M, et al. Real clinical practice of catheter therapy for deep venous thrombosis: periprocedural and 6-month outcomes from the EDO registry. Cardiovasc Interv Ther. 2015;30:251–9.
Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med. 2012;366:2198–206.
Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001;38:2101–13.
The International Expert Committee. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–34.
Japanese Society of Hypertension Guidelines Subcommittee for the Management of Hypertension. Guidelines for the management of hypertension for general practitioners. Hypertens Res. 2001;24:613–34.
Teramoto T, Sasaki J, Ueshima H, et al. Diagnostic criteria for dyslipidemia. Executive summary of Japan Atherosclerosis Society (JAS) guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases for Japanese. J Atheroscler Thromb. 2007;14:155–8.
Dormandy J, Heeck L, Vig S. Acute limb ischemia. Semin Vasc Surg. 1999;12:148–53.
Byrne RM, Taha AG, Avgerinos E, Marone LK, Makaroun MS, Chaer RA. Contemporary outcomes of endovascular interventions for acute limb ischemia. J Vasc Surg. 2014;59:988–95.
Ravn H, Björck M. Popliteal artery aneurysm with acute ischemia in 229 patients. Outcome after thrombolytic and surgical therapy. Eur J Vasc Endovasc Surg. 2007;33:690–5.
Cervin A, Tjärnström J, Ravn H, et al. Treatment of popliteal aneurysm by open and endovascular surgery: a contemporary study of 592 procedures in Sweden. Eur J Vasc Endovasc Surg. 2015;50:342–50.
Obara H, Matsubara K, Kitagawa Y. Acute limb ischemia. Ann Vasc Dis. 2018;11:443–8.
Trousseau A. Phlegmasia alba dolens. In: Cormack JR, editor. Clinique médicale de l’Hôtel-Dieu de Paris [Lectures on clinical medicine at Hôtel-Dieu de Paris]. London: New Sydenham Society; 1872. p. 281–332.
Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26:517–38.
Honma Y, Urasawa K, Sato K, Koshida R. A new device for percutaneous mechanical thrombectomy in acute limb ischemia. Cardiovasc Interv Ther. 2011;26:166–71.
Leung DA, Blitz LR, Nelson T, et al. Rheolytic pharmacomechanical thrombectomy for the management of acute limb ischemia: results from the PEARL Registry. J Endovasc Ther. 2015;22:546–57.
Zaraca F, Stringari C, Ebner JA, Ebner H. Routine versus selective use of intraoperative angiography during thromboembolectomy for acute lower limb ischemia: analysis of outcomes. Ann Vasc Surg. 2010;24:621–7.
Bhatt DL, Eagle KA, Ohman EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010;304:1350–7.
Acknowledgements
The authors thank Yuichi Suzuki, Yoshinori Nagashima, and Junji Yajima for collecting data and improving our discussion. The authors also express great gratitude for the cooperation of the hospitals involved in the Edo registry.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflicts of interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Higashitani, M., Anzai, H., Mizuno, A. et al. One-year limb outcome and mortality in patients undergoing revascularization therapy for acute limb ischemia: short-term results of the Edo registry. Cardiovasc Interv and Ther 36, 226–236 (2021). https://doi.org/10.1007/s12928-020-00662-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12928-020-00662-6