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Clinical Outcomes Following Lower Extremity Vein Bypass for Chronic Limb Threatening Ischaemia (CLTI) at the University of Colombo, Sri Lanka
- Source :
- European Journal of Vascular and Endovascular Surgery. 60:560-566
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Although high quality epidemiological data are lacking, the global increase in chronic limb threatening ischaemia may be disproportionately affecting low and LMICs. All available data for outcomes from bypass for limb salvage are from high income countries, with none from LMIC settings where the challenge is greatest. This study aimed to assess the clinical outcomes following vein lower extremity bypass for chronic limb threatening ischaemia at the University of Colombo, Sri Lanka, and to compare patients and outcomes with those described in the Society for Vascular Surgery (SVS) Objective Performance Goals (OPG) and United States National Surgical Quality Improvement Program (NSQIP).Consecutive patients (n = 367) undergoing SVS-OPG eligible lower extremity bypass between 2015 and 2017 were studied. Thirty day major adverse cardiovascular events (MACE), major adverse limb events (MALE), deaths, and amputations are reported, along with one year overall survival, limb salvage, and amputation free survival.Patients at University of Colombo had more diabetes mellitus (80% vs. SVS 57% vs. NSQIP 50%, p .001) and tissue loss (100% vs. SVS 74% vs. NSQIP 59%, p .001). The 30 day MALE was 7.6%, which is not a statistically significant difference from the SVS (6.1%) or NSQIP (9%). The 30 day MACE was 8.2%, statistically significantly higher than NSQIP (4.2%, p .001) but not SVS (6.2%, p = .20). At 12 months, the overall survival (82%) was within the OPG threshold, but limb salvage (81.8%) and amputation free survival (64.5%) were just outside.Outcomes following vein bypass for ischaemic necrosis at the University of Colombo, Sri Lanka, are acceptable and similar to those reported from high income countries despite greater limb threat severity and resource limitations. Further real world data from similar settings on outcomes following revascularisation are required. These data suggest that a vein bypass first strategy for advanced ischaemic necrosis is feasible and effective even in resource limited settings.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Databases, Factual
Ischemia
030204 cardiovascular system & hematology
030230 surgery
Amputation, Surgical
Veins
Peripheral Arterial Disease
03 medical and health sciences
0302 clinical medicine
Risk Factors
Diabetes mellitus
Epidemiology
medicine
Humans
Registries
Vein
Aged
Retrospective Studies
Sri Lanka
Aged, 80 and over
business.industry
Middle Aged
Vascular surgery
Limb Salvage
medicine.disease
Progression-Free Survival
medicine.anatomical_structure
Lower Extremity
Chronic Disease
Emergency medicine
Feasibility Studies
Female
Vascular Grafting
Surgery
Sri lanka
Cardiology and Cardiovascular Medicine
business
Vein bypass
Mace
Subjects
Details
- ISSN :
- 10785884
- Volume :
- 60
- Database :
- OpenAIRE
- Journal :
- European Journal of Vascular and Endovascular Surgery
- Accession number :
- edsair.doi.dedup.....072acb98104a179391e5845d4ed6692a