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Outcomes following Lower Extremity Revascularization (LER) for Treatment of Critical Limb Ischemia (CLI) with Tissue Loss (TL) in Patients with Systemic Auto- Inflammatory Disease (SAID)
Sherif Shaliby, MD, Monica S. O'Brien-Irr, MS, RN, Maciej L. Dryjski, MD, PhD, Hasan H. Dosluoglu, Gregory S. Cherr, Mariel Rivero, MD, Linda M. Harris.
SUNY @ Buffalo, Buffalo, NY, USA.

Objective(s): To evaluate outcomes following LER for CLI with TL in patients with SAID.
Methods: A retrospective medical record review of all LER for CLI with TL at a University affiliated hospital over a 3 year period was completed for demographics, co-morbidities, LER indication, angiogram results, complications, mortality, limb salvage (LS) and re-intervention. [SAID vs. Non-SAID (NSAID) were compared by Chi Sq, Student T test, Kaplan Meier and Cox Regression.
Results: There were 340 procedures (295 patients): 43(13%) primary amputation (PA), 297(87%)LER: 83% endovascular interventions (EVI), 12% bypass, 5% hybrid; 41% infra-inguinal, 59% infra-geniculate, 72% WIFI-TL Class 2-3, 33% SAID. No differences were noted between SAID and N-SAID for PA (P= 0.35), LER type (P= 0.15) or LER anatomic level (P= 0.99). Mean age was 71+13 years, male gender 56%. Although runoff < 1 vessel (53% vs. 47%; P= 0.84) was comparable, SAID presented with lower WIFi TL classification: Class 1 (39% vs. 23%; P=0.007). Increased age(79 + 10 vs. 70 + 17; P= 0.005)and renal disease (44% vs. 18%; P= 0.05) were more prevalent among Class 1 with SAID, yet 24 month LS ( 93% + 5% vs. 64% + 10%; P= 0.05) and re-intervention (33% vs. 61%; P= 0.03) were better; intra/post-operative complications and 24 month survival (77 + 9% vs. 88% + 6%; P= 0.34) comparable. Among LER for WIFI TL Class 2-3, runoff < 1 vessel was similar for SAID vs. Non-SAID: (57% vs. 41%; P= 0.12); HTN (98% vs. 85%; P=0.008), CVA (9% vs. 2%; P= 0.02), CHF (56% vs. 32%; P= 0.003) occurred more often; minority status(17% vs. 39%; P=0.004) and Medicaid (23% vs. 38%; P= 0.05) less frequently. Intra/post-operative complications, 24 month survival (84% + 6% vs. 87% + 3%; P= 0.56), LS (59% + 8% vs. 61% + 5%; P= 0.76) and re-intervention (37% vs. 52%; P= 0.08) were similar. Renal disease (LR 1.6: 1.3 -2.1; P< 0.001) and Medicaid (LR 1.6: 1.1 - 2.5; P= 0.03) were independent predictors for major amputation. SAID treated with steroid/anti-inflammatory (29%) had improved LS (80% + 9% vs. 68% + 6%; P= 0.05).
Conclusions: Patients with CLI, TL and concomitant SAID can be successfully treated with LER; LS is comparable/better and need for re-intervention is lower. Steroid/anti-inflammatory use appears beneficial.


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