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Background: The aim of the present study was to compare the early- and midterm outcomes after infrainguinal bypass surgery in the treatment of low- and high-risk patients with critical limb ischemia (CLI) (Finnvasc score 0-2 and 3-4, respectively), and to evaluate limits of infrainguinal bypass surgery in treatment of the latter group., Methods: Two hundred seventy-four infrainguinal bypass procedures performed in 218 patients were retrospectively reviewed. The Finnvasc score (range: 0-4) was calculated by assigning one point to each of four preoperative risk factors, that is, coronary artery disease, diabetes, urgency of the procedure, and gangrene. Major outcome end points were survival, limb salvage, and amputation-free survival., Results: Among 274 infrainguinal bypass procedures performed for CLI, 92 procedures (33.6%) were performed in patients with Finnvasc score 3-4. They had significantly lower leg salvage (at 3-year follow-up, 53.7 vs. 70.6%; log-rank: p = 0.004), survival (at 3-year follow-up, 49.7 vs. 69.7%; log-rank: p < 0.0001), and amputation-free survival (at 3-year follow-up, 27.7 vs. 53.1%; log-rank: p < 0.0001) compared with patients with Finnvasc score 0-2. Patients with Finnvasc score 3-4 and a preoperative serum creatinine level of >150 μmol/L had 1-year amputation-free survival of 12.5%, whereas patients with lower level of creatinine had 1-year amputation-free survival of 53.1% (p = 0.028)., Conclusions: Infrainguinal bypass revascularization in CLI patients who present with Finnvasc score 3-4 can be considered at higher risk of poor intermediate outcome in terms of survival, leg salvage, and amputation-free survival. Poor outcome is particularly expected in patients with Finnvasc score 3-4 and renal failure. In this subgroup of patients, primary amputation should be considered., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

The aim of the present study was to validate the Finnvasc score for prediction of immediate outcome after infrainguinal percutaneous transluminal angioplasty (PTA) for critical lower limb ischemia (CLI). Our registry included prospective data on 512 patients who underwent isolated infrainguinal PTA revascularization procedures for CLI. The Finnvasc score herein evaluated was calculated by assigning one point each to diabetes, coronary artery disease, foot gangrene, and urgent operation. Early mortality and major limb amputation rates after PTA revascularization were 2.5% and 12.3%, respectively. Seventy-two patients (14.1%) died and/or had lower limb amputation. Diabetes (p = 0.001), foot gangrene (p = 0.047), urgent operation (p < 0.0001), and preoperative renal failure (p = 0.001) were independent predictors of postoperative mortality and/or major limb amputation. Finnvasc score was predictive of major lower limb amputation (p = 0.003), mortality (p < 0.0001), and mortality and/or major amputation (p < 0.0001) after PTA. Mortality, major lower limb amputation, and combined end point rates in patients with a Finnvasc score of 3-4 were 12.8%, 25.6%, and 35.9%, respectively. The Finnvasc score is a simple risk scoring method which can be useful to estimate the risk of immediate postprocedural mortality and/or major lower limb amputation also in patients undergoing infrainguinal PTA for CLI.

Objectives: The aim of the present study was to estimate the need for late lower limb revascularization and/or major amputation after coronary artery bypass grafting (CABG)., Design: Retrospective study., Patients and Methods: 1307 residents of Oulu who underwent CABG from 1990 to 2006 formed the basis of this community-wide study., Results: During a mean follow-up of 7.1+/-4.5 years, 111 patients (8.5%) underwent 251 vascular procedures for lower limb ischemia and 25 major amputations. In four patients, revascularization was done for complicated wound after vein graft harvesting. Freedom rates from lower limb revascularization and/or major amputation at 5-, 10- and 15-year were 92.9%, 88.4% and 85.1%, whereas freedom rates from lower limb revascularization for critical ischemia and/or major amputation were 98.1%, 95.2% and 94.7%. Age (p=0.013, HR 1.05), extracardiac arteriopathy (p<0.0001, HR 5.39), left ventricular ejection fraction classes (p=0.03), diabetes (p<0.0001, HR 5.78), and estimated glomerular filtration rate<60mg/min/m(2) (p=0.02, HR 2.22) were independent predictors of lower limb revascularization for critical leg ischemia and/or major amputation., Conclusions: Patients with extracardiac arteriopathy, diabetes and decreased glomerular filtration rate at the time of CABG are at risk for late lower limb ischemia. These patients would most benefit of a closer follow-up for prevention of peripheral vascular disease and its related complications.

We report three cases of lower limb ischemia occurring after the use of arterial puncture closure devices (APCDs). In two patients, who have undergone percutaneous angioplasty of lower limb arteries, the Angio-Seal APCD led to thrombosis of the common femoral artery. In another patient who has undergone coronary angiography, this device has led to dissection of the common femoral artery. Since these observations seem to not be merely sporadic, radiologists and cardiologists as well as vascular surgeons should be aware of their possible occurrence in order to avoid these complications and to provide promptly an adequate treatment.

Background: The role of antioxidants in the pathogenesis of type 2 diabetes is uncertain., Objective: We evaluated cross-sectional relations of dietary intakes and plasma concentrations of antioxidants with glucose metabolism in a high-risk population., Design: The subjects were 81 male and 101 female first- and second-degree, nondiabetic relatives of patients with type 2 diabetes. Antioxidant intake data were based on 3-d food records. Subjects taking supplements containing beta-carotene or alpha-tocopherol were excluded. Plasma antioxidant concentrations were measured by HPLC. By using multiple linear regression analysis and adjusting for demographic, anthropometric, and lifestyle covariates, we studied whether dietary and plasma alpha- and beta-carotene, lycopene, and alpha- and gamma-tocopherol were related to fasting and 2-h concentrations of glucose and nonesterified fatty acids during an oral-glucose-tolerance test, to the homeostasis model assessment index of insulin resistance, and to measures of beta cell function (incremental 30-min serum insulin concentration during an oral-glucose-tolerance test and first-phase insulin secretion during an intravenous-glucose-tolerance test)., Results: In men, dietary carotenoids were inversely associated with fasting plasma glucose concentrations (P < 0.05), plasma beta-carotene concentrations were inversely associated with insulin resistance (P = 0.003), and dietary lycopene was directly related to baseline serum concentrations of nonesterified fatty acids (P = 0.034). In women, dietary alpha-tocopherol and plasma beta-carotene concentrations were inversely and directly associated, respectively, with fasting plasma glucose concentrations (P < 0.05). In both sexes, cholesterol-adjusted alpha-tocopherol concentrations were directly associated with 2-h plasma glucose concentrations (P < 0.05)., Conclusion: The data suggest an advantageous association of carotenoids, which are markers of fruit and vegetable intake, with glucose metabolism in men at high risk of type 2 diabetes.

Purpose: This study reviewed the long-term outcome of patients who underwent open repair of infrarenal abdominal aortic aneurysms (AAAs)., Methods: A retrospective study of 208 patients (188 men and 20 women) with a mean age of 65.6 years who survived elective or emergency open repair of an infrarenal AAA was conducted at a university referral hospital. Main outcome measures included late graft-related complications, survival free from any reintervention, survival free from any vascular reintervention, and overall survival rates., Results: Late graft-related complications occurred in 32 patients (15.4%). A proximal para-anastomotic pseudoaneurysm developed in six patients (2.9%), and a distal pseudoaneurysm developed in 18 patients (8.7%); in seven of these cases (3.4%), it was bilateral or recurrent. A graft limb occlusion occurred in 11 patients (5.3%). These complications required 37 surgical or other invasive procedures in 27 patients (13.0%). Thirty-one vascular and/or endovascular reoperations were performed. The 5-year, 10-year, and 15-year survival free from any reintervention rates were 91.5%, 86.2%, and 72.0%, respectively. At the same intervals, the survival free from any vascular reintervention rates were 93.8%, 88.5%, and 73.9%, respectively, and the overall survival rates were 66.8%, 39.4%, and 18.0%, respectively. Complications associated with a ruptured femoral artery pseudoaneurysm, a ruptured aortic pseudoaneurysm, an aortoduodenal fistula, and the elective repair of a femoral pseudoaneurysm were the graft-related causes of death, which occurred in four patients (1.9%). Age (P <.0001) and chronic obstructive pulmonary disease (P =.002) were shown by means of multivariate analysis to be predictive of poor survival outcome, and chronic obstructive pulmonary disease (P =.02) and lower limb ischemia (P =.04) were shown to be associated with an increased need for vascular reinterventions to treat graft-related complications., Conclusion: Open repair of infrarenal AAAs can achieve satisfactory 15-year follow-up rates of survival free from reintervention for any graft-related complications, suggesting that surgery should still be considered the procedure of choice for infrarenal AAAs, at least in patients who are fit for surgery.

Objective: To assess mortality related to rupture of abdominal aortic aneurysm (RAAA)., Design: A 4-year cross-sectional study based on a nationwide vascular registry Finnvasc and national cause-of-death registry (Statistics Finland)., Materials and Methods: A total of 454 operations for RAAA among 11,747 surgical vascular reconstructions recorded in the Finnvasc registry and 1004 deaths due to RAAA during the same period based on Statistics Finland., Results: The operative mortality rate was 49% based on the Finnvasc registry and 54% based on Statistics Finland. With all RAAA deaths at hospitals included, total hospital mortality was 68%. No association existed between hospital volume of RAAA operations and surgical mortality, although an inverse association did exist between hospital volume of RAAA operations and all RAAA deaths in the hospital (p = 0.01). The case fatality for RAAA in Finland was 80%., Conclusions: RAAA surgical mortality calculations for RAAA, based on a vascular registry, underestimate the true rate because some cases with fatal outcome tend to escape registration. Because surgical mortality rates may also be skewed by patient selection, total hospital RAAA mortality thus represents the results of RAAA treatment more accurately.

Purpose: To assess the factors affecting immediate outcome of surgery for chronic critical leg ischemia, especially the influence of surgeon's caseload and hospital volume., Methods: The data of Finnvasc registry were retrospectively analyzed. A total of 11,747 surgical vascular reconstructions included 1,761 operations for chronic critical leg ischemia during 1991 to 1994., Results: The 30-day postoperative leg amputation rate was 7.5% and the mortality rate 4.7%. Diabetes, previous vascular surgery or amputation, preoperative ulcer or gangrene, a surgeon's annual caseload fewer than 10 operations, and hospital volume fewer than 20 operations for chronic critical leg ischemia adversely affected amputation rates. The presence of coronary artery disease and renal dysfunction increased postoperative mortality rates. Both amputation rates and postoperative mortality rates were affected by the type of procedure., Conclusions: A surgeon's caseload and hospital volume affect amputation rate, but not mortality rate, in patients operated for chronic critical leg ischemia.

Objective: To assess the 30-day mortality and morbidity rates related to carotid endarterectomy on a nation-wide basis., Design: Retrospective cross-sectional study based on vascular registry Finnvasc., Materials and Methods: A total of 17,465 recorded vascular and endovascular procedures included exactly 1600 carotid endarterectomies performed by 104 surgeons in 23 hospitals. Fourteen per cent of the patients were operated on for asymptomatic carotid stenosis., Results: The combined mortality and permanent stroke rate was 3.3%, without any difference between operations done on symptomatic or asymptomatic patients. There was a clear inverse association between surgeon's carotid case load and poor outcomes in carotid surgery (p < 0.005), the critical patient mass per surgeon and year being 10 operations. There was no association between outcome after carotid surgery and hospital volume of carotid operations., Conclusions: Surgeon's experience in carotid surgery clearly improves the results of carotid surgery.

Objective: To assess the validity of a national vascular registry., Materials and Methods: 17,465 vascular and endovascular procedures, immediate reoperations excluded, registered in the Finnvasc registry from 26 centres during the years 1991-1994., Chief Outcome Measures: Comparison of the number of registered procedures with hospital records, comparison of initial registrations with a random sample of re-registration and comparison of the 1-year local data input of one major centre to the same data input of the central unit., Results: The rate of missing registrations was 19% ranging from 0-47%. The data of the re-registered forms were in agreement with the original data in 93% of all data points, the range being from 81-100%. There was a difference of 1.5% in the data between the major centre and the central unit., Conclusions: The Finnvasc registry makes it possible to audit vascular surgery nationally, although a potential limitation is centres with low registration rates.

Objective: Assessment of mortality in abdominal aortic aneurysm surgery., Design: A 4-year cross sectional study based on a nationwide vascular registry: Finnvasc., Material and Methods: A total of 17,465 vascular interventions included 929 elective repairs for abdominal aortic aneurysms (AAA), and 610 emergency cases with 454 ruptures. Fifty-three percent of the operations were done in university hospitals, 44% in central hospitals and 3% in district hospitals., Results: The 30-day mortality rate for AAA repair was 5.1% in elective and 46% in ruptured cases. A clear dependence of operative mortality on surgeon's experience in AAA surgery was observed, both regarding the surgeon's total vascular case load (p < 0.01) and the number of operated elective aneurysms (p < 0.01), but not the number of operated ruptured aneurysms. However, no association was found between hospital volume and mortality in AAA surgery., Conclusions: Vascular surgical experience clearly improves the results of elective aneurysm surgery.