ปัจจัยพยากรณ์การตัดขาในผู้ป่วยโรคหลอดเลือดขาขาดเลือดเฉียบพลัน

Sirintha Rungkhachonsak; Tittayaporn Sumnuan; Sirawit Vutisirinukool; Sireerak Dechpong

doi:10.1016/hscr.v37i1.256103

Authors

Sirintha Rungkhachonsak Medical Education Center Uttaradit Hospital
Tittayaporn Sumnuan
Sirawit Vutisirinukool
Sireerak Dechpong

DOI:

https://doi.org/10.1016/hscr.v37i1.256103

Keywords:

Acute limb ischemia, Prognostic factors, Major amputation

Abstract

Abstract

Introduction: Amputation treatment can cause disability in patients with acute limb ischemia. A total of 6 prognostic factors associated with amputation were found in the literature review, including the time from onset to treatment more than 24 hours, diabetes, stroke, chronic kidney disease, history of amputation for other causes and history of vascular surgery. Therefore, researchers are interested in studying the prognostic factors associated with amputation, in order to monitor the operation of the
disease and lead to appropriate treatment.
Objective: Study the prognostic factors for amputation in patients with acute limb ischemia.
Methods: Studying 76 acute limb ischemia patients in Uttaradit Hospital from January 1st, 2015 – July 11th, 2021. There were 24 patients who underwent amputation and 52 patients who were without amputation. Collecting data from ICD-10 medical records divided into 2 groups. All data were analyzed by descriptive and analytic statistics.
Results: The results of study revealed that patients who had a Diabetes Mellitus history had increased the risk of amputation (odds ratio [OR] 4.5, 95% confidence [CI] 1.27-15.91, p=0.020) Old cerebrovascular accident (OR 4.5, 95% CI 1.06-19.27, p=0.042) and occlusion at superficial femoral artery (OR 5.8,
95% CI 1.47-22.75, p=0.012).
Conclusion: The study confirmed history of diabetes mellitus, old cerebrovascular accidents and occlusion of the superficial femoral artery are the prognostic factors for amputation in patients with acute limb ischemia.

Keywords: Acute limb ischemia, Prognostic factors, Major amputation

References

Hess CN, Huang Z, Patel MR, Baumgartner I, Berger JS, Blomster JI, et al. Acute Limb Ischemia in Peripheral Artery Disease: Insights From EUCLID. Circulation. 2019 Aug 13; 140(7):556–65.

Olinic D-M, Stanek A, Tataru D-A, Homorodean C, Olinic M. Acute Limb Ischemia: An Update on Diagnosis and Management. J Clin Med. 2019 Aug 14;8(8):1215.

Creager MA, Kaufman JA, Conte MS. Acute Limb Ischemia. N Engl J Med. 2012 Jun 7;366(23):2198-206.

Fluck F, Augustin AM, Bley T, Kickuth R. Current Treatment Options in Acute Limb Ischemia. Fortschritte Auf Dem Geb Röntgenstrahlen Bildgeb Verfahr. 2020 Apr;192(4):319–26.

Krisada Luengrungruang. Acute limb ischemia. In: Textbook of surgery that you should know. First printing, 800/35-37, Soi Trakulsuk, Asoke Din Daeng Road, Bangkok 10400: Nam Aksorn Printing house;2020;50–9.

Smith DA, Lilie CJ. Editor’s Choice e 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). In: Acute Arterial Occlusion [Internet]. StatPearls Publishing; 2020 [cited 2021 Jul 10];305–68. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441851/

Braun R, Lin M. Acute Limb Ischemia: A Case Report and Literature Review. J Emerg Med. 2015 Dec1;49(6):1011–7.

Duval S, Keo HH, Oldenburg NC, Baumgartner I, Jaff MR, Peacock JM, et al. The impact of prolonged lower limb ischemia on amputation, mortality, and functional status: the FRIENDS registry. Am Heart J. 2014 Oct;168(4):577–87.

Phrueksawatnon K, Kaweewan R. Surgical outcome and prognostic factors of amputation in patients with below-the-knee (BTK) and Below-the-ankle (BTA) arteries bypass surgery in Nakornping Hospital, Thailand. J Assoc Gen Surg Thail R Patronage HM King. 2563;5(2):18–25.

Fagundes C, Fuchs FD, Fagundes A, Poerschke RA, Vacaro MZ. Prognostic Factors for Amputation or Death in Patients Submitted to Vascular Surgery for Acute Limb Ischemia. Vasc Health Risk Manag. 2005 Dec; 1(4): 345–9.

Long CA, Mulder H, Fowkes FGR, Baumgartner I, Berger JS, Katona BG, et al. Incidence and Factors Associated With Major Amputation in Patients With Peripheral Artery Disease: Insights From the EUCLID Trial. Circ Cardiovasc Qual Outcomes. 2020 Jul;13(7):395–403.

Techniques for lower extremity amputation UpToDate [Internet]. [cited 2021 Jul 15]. Available from:https://www.uptodate.com/contents/techniques-for-lower-extremityamputation search=techniques%20for%20lower%20ex%20amputation&source=search_result & selectedTitle=2~150&usage_type=default&display_rank=2#H603464736

Nazri MY, Aminudin CA, Ahmad FS, Mohd JMA, Jamalludin AR, Ramli M. Quality of life of diabetesamputees following major and minor lower limb amputations. Med J Malaysia. 2019 Feb; 74(1): 25-29.

Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997 Sep; 26(3): 517–38

Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic). Circulation. 2006 Mar 21; 113(11):

–654.

Katzen BT. Clinical diagnosis and prognosis of acute limb ischemia. Rev Cardiovasc Med. 2002;3 Suppl2:S2-6.

Joh JH. Risk Factor of Lower Limb Amputation in Peripheral Arterial Disease. J Vasc Surg. 2016 Jun 1;63(6):114S.

Genovese EA, Chaer RA, Taha AG, Marone LK, Avgerinos E, Makaroun MS, et al. Risk Factors for Long Term Mortality and Amputation after Open and Endovascular Treatment of Acute Limb Ischemia. Ann Vasc Surg. 2016 Jan;30:82–92.

Aboyans V, Ricco J-B, Bartelink M-LEL, Björck M, Brodmann M, Cohnert T, et al. ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular

Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018 Mar;55(3):305–68.

Kuoppala M, Franzén S, Lindblad B, Acosta S. Long-term prognostic factors after thrombolysis for lower limb ischemia. J Vasc Surg. 2008 Jun; 47(6):1243–50.

Aarabi S, Emanuels D, Quiroga E, Tran N, Starnes BW, Singh N. Factors Predicting Limb Salvage in Acute Limb Ischemia Treated at a Tertiary Referral Center. J Vasc Surg. 2017 Jun 1; 65(6):22S-3S.