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
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PAD:-Major healthcare issue worldwide.
-Patients with PAD = risk ofmortality, MI and CVS.
-Pressing need to commence aneffective therapeutic strategy fortreating patients with PAD.
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PAD•Common.•Under-diagnosed•Under-treated .•Diagnosed accurately withsimple, noninvasive, office-based tests .
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REVASCULARIZATION
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• prospective registry.• ASU and NHI.• Symptomatic PAD pts. who
underwent PTA.
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•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.
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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.
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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
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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
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32%6.7%
13.3%
48%
Above inguinal ligament
Below inguinal ligament; above knee
Below knee
Combined
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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
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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.
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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 .
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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
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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%
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Alive 84% Dead 16%
SCD
Leg gangrene
Others
Alive
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0 20 40 60 80 100
Symptomsrecurrence
No symptomsrecurrence
Claudication CLI Acute limb ischemia
85 %
10 %4 %
1 %
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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
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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
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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
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-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.
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•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).
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•Interestingly limb salvagewas 100% in this series .•The need for urgentsurgical revascularizationwas 1.3 %.
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Case reporting byinterventionistsneeds to beimproved andunified.
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•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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Chart1
M | M |
F | F |
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Sheet1
M | F | |
M | 119 | 25.6 |
F | 31 | 38.6 |
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Chart1
<50 |
50-60 |
> 60 |
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Sheet1
<50 | 50-60 | > 60 | |
East | 7 | 6 | 87 |