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Anand Dayama Nikolaos Tsilimparis Stephen Kolakowski Nathaniel M. Matolo Misty D. Humphries 《Journal of vascular surgery》2019,69(1):156-163.e1
Background
Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease.Methods
We reviewed the American College of Surgeons National Surgical Quality Improvement Program targeted lower extremity revascularization database from 2012 to 2015 to identify patients with CLTI and isolated infrageniculate arterial disease who underwent primary infrageniculate bypass or endovascular intervention. We excluded patients with a history of ipsilateral revascularization and proximal interventions. The end points were major adverse limb event (MALE), major adverse cardiovascular event (MACE), amputation at 30 days, reintervention, patency, and mortality. Multivariable logistic regression was used to determine the association of a bypass-first or an endovascular-first intervention with outcomes.Results
There were 1355 CLTI patients undergoing first-time revascularization to the infrageniculate arteries (821 endovascular-first revascularizations and 534 bypass-first revascularizations) identified. There was no significant difference in adjusted rate of 30-day MALE in the bypass-first vs endovascular-first revascularization cohort (9% vs 11.2%; odds ratio [OR], 0.73; 95% confidence interval [CI], 0.50-1.08). However, the incidence of transtibial or proximal amputation was lower in the bypass-first cohort (4.3% vs 7.4%; OR, 0.60; CI, 0.36-0.98). Patients with bypass-first revascularization had higher wound complication rates (9.7% vs 3.7%; OR, 2.75; CI, 1.71-4.42) compared with patients in the endovascular-first cohort. Compared with the endovascular-first cohort, the incidence of 30-day MACE was significantly higher in bypass-first patients (6.9% vs 2.6%; adjusted OR, 3.88; CI, 2.18-6.88), and 30-day mortality rates were 3.23% vs 1.8% (adjusted OR, 2.77; CI, 1.26-6.11). There was no difference in 30-day untreated loss of patency, reintervention of treated arterial segment, readmissions, and reoperations between the two cohorts. In subgroup analysis after exclusion of dialysis patients, there was also no significant difference in MALE or amputation between the bypass-first and endovascular-first cohorts.Conclusions
CLTI patients with isolated infrageniculate arterial disease treated by a bypass-first approach have a significantly lower 30-day amputation. However, this benefit was not observed when dialysis patients were excluded. The bypass-first cohort had a higher incidence of MACE compared with an endovascular-first strategy. These results reaffirm the need for randomized controlled trials, such as the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL-2) trial and Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI), to provide level 1 evidence for the role of endovascular-first vs bypass-first revascularization strategies in the treatment of this population of challenging patients. 相似文献3.
Background: Previous studies into leisure have employed methodologies that may understate the significance of experiential components. This exploratory study investigated the leisure experiences of retired Australians over 65 years of age.
Methods: Five semistructured interviews were used to explore the leisure experience of older people from metropolitan Adelaide. Data were coded and analysed thematically.
Results: Relaxation and engrossment emerged as commonly expressed experiences, yet were found to emerge as a result of engagement in occupations predefined as leisure. Experiences of freedom from both necessary duties and a sense of obligation were discussed as potential determinants of leisure consciousness.
Practice implications: This study highlights a need for therapists to actively access clients' subjective leisure experiences to enable engagement in personally meaningful leisure occupations. 相似文献
Methods: Five semistructured interviews were used to explore the leisure experience of older people from metropolitan Adelaide. Data were coded and analysed thematically.
Results: Relaxation and engrossment emerged as commonly expressed experiences, yet were found to emerge as a result of engagement in occupations predefined as leisure. Experiences of freedom from both necessary duties and a sense of obligation were discussed as potential determinants of leisure consciousness.
Practice implications: This study highlights a need for therapists to actively access clients' subjective leisure experiences to enable engagement in personally meaningful leisure occupations. 相似文献
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Tarek A. Amer Tarek F. Elwakil Mahmoud S. Elbasiouny 《European journal of plastic surgery》2007,30(2):67-73
Haemangiomas are the most common tumours of infancy. They typically proliferate then involute with considerable variation
as regards to their rates of proliferation and involution. Haemangioma of the nasal tip is a lesion of special characteristics.
During proliferation, it expands, contracts and deviates the nasal cartilages. Particularly, it regresses slowly and frequently
involutes incompletely. That is why excision of the lesion is frequently suggested. The present study was conducted to evaluate
open rhinoplasty after initial non-excision treatment modalities namely, intra-lesional corticosteroid injections and laser
treatment, as a protocol of treatment for nasal tip haemangiomas. Twelve patients with nasal tip haemangiomas were included
in the present study. Patients of both sexes, of different ages, with deep and mixed haemangiomas were studied. Disfigurement
was the constant presenting symptom. Initial non-excision treatment reported different responses as denoted by the regression
of the lesions’ size. Haemangiomas constantly extended between the medial crura of the alar cartilages as noted by the constant
widening of the columella pre-operatively and the obvious separation of the nasal cartilages intra-operatively. This separation
was constantly found to require approximation by sutures. The results of the present study concluded that whenever an early
presentation with nasal tip haemangioma could be established, initial non-excision treatment followed by open rhinoplasty
could be a useful protocol of treatment. Within the limitations of the present study, this protocol could achieve an early,
safe and effective treatment for nasal tip haemangiomas with provisionally acceptable cosmetic outcomes so far. 相似文献
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腹腔镜手术与开放手术治疗精索静脉曲张的对比性研究(附273例分析) 总被引:5,自引:0,他引:5
目的:对比研究腹腔镜和开放手术精索静脉高位结扎术治疗精索静脉曲张的疗效。方法:回顾分析121例腹腔镜和152例开放手术精索静脉高位结扎术的临床资料,比较两种方法在手术时间、术后住院天数及综合治疗费用及术后止痛药应用等的差异。结果:两组在手术时间、术后住院天数及止痛药应用等方面差异均有高度显著性(P<0.01),腹腔镜组均优于开放手术组;综合治疗费用两组差异无显著性(P>0.05)。结论:腹腔镜治疗精索静脉曲张较开放手术具有创伤小、康复快,术后住院时间短及美容效果好等优点。 相似文献
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Reviews major activities of the Editor and changes in the Journalof Pediatric Psychology (JPP) for issues published in 1993 through1997. Significant trends and accomplishments are reviewed, includingthe increased use of Special Issues and Special Sections tohighlight current pediatric psychological research. Articlespublished during the term are analyzed interms of article typeand population type Comarisons are made to earlier trends inJPP publication as reported by Roberts (1 992). 相似文献
10.
化学品环境管理与水生实验动物 总被引:3,自引:1,他引:2
从分析化学品的特性入手,在概述化学品的环境管理对水生实验生物需求和国内外水生实验生物发展现状的基础上,从加强化学品环境管理的科学基础建设出发,对我国水生实验生物的研究与发展的标准化、产业化、必要的资质认可及信息交流提出建议。 相似文献