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    Impact of comorbidities on decision-making in chronic critical limb ischemia

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    Authors
    Schanzer, Andres
    UMass Chan Affiliations
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2009-12-17
    Keywords
    Age Factors
    Amputation
    Chronic Disease
    Comorbidity
    Coronary Artery Disease
    *Decision Support Techniques
    Dialysis
    Hematocrit
    Humans
    Ischemia
    Lower Extremity
    Predictive Value of Tests
    Risk Assessment
    Risk Factors
    Vascular Surgical Procedures
    Surgery
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    Link to Full Text
    http://dx.doi.org/10.1053/j.semvascsurg.2009.10.002
    Abstract
    Given both the high-risk nature of the critical limb ischemia (CLI) patient population, as well as the variety of available treatment options, the ability to use preprocedure variables to predict a given outcome has become increasingly important. The three main advantages associated with accurate risk stratification include: (1) improved clinical decision-making based on realistic patient and physician expectations, (2) ability to benchmark individual practitioners and institutions by comparing their outcomes with expected outcomes specific to the actual patients being treated, and (3) creation of objective performance goals for the evaluation of new treatment modalities in specific patient populations. Patients with CLI have multiple comorbidities that can impact greatly on the outcomes of attempted revascularization. The PREVENT III CLI Risk Score was developed as a tool to estimate amputation-free survival at 1 year in patients undergoing vein bypass surgery for limb salvage, and has now been validated using data from >3,000 cases. The score incorporates five baseline clinical variables-dialysis, tissue loss, age, hematocrit, and coronary artery disease-and assigns patients into three distinct risk groups. Patients in the high-risk subgroup (8.2% of total number of patients evaluated) experienced <50% amputation-free survival at 1 year. This tool may be valuable in assisting both the surgeon and patient faced with treatment decisions in CLI.
    Source
    Semin Vasc Surg. 2009 Dec;22(4):209-15. Link to article on publisher's site
    DOI
    10.1053/j.semvascsurg.2009.10.002
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49812
    PubMed ID
    20006800
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1053/j.semvascsurg.2009.10.002
    Scopus Count
    Collections
    UMass Chan Faculty and Researcher Publications

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