MARCADORES ANALÍTICOS QUE CONDICIONAM OS RESULTADOS DE CIRURGIA DE REVASCULARIZAÇÃO EM DOENTES COM DOENÇA ARTERIAL PERIFÉRICA
DOI:
https://doi.org/10.48750/acv.288Palavras-chave:
Doença arterial periférica, Marcadores analíticos, Cirurgia vascular, RevascularizaçãoResumo
Introdução: Os doentes com doença arterial periférica e isquemia crítica de membro requerem um procedimento de revascularização no sentido de evitar a perda de membro. Contudo, com alguma frequência, estes doentes apresentam alterações analíticas que condicionam os seus outcomes.
Métodos: Foi realizado um estudo retrospetivo com análise de todos os doentes, consecutivamente admitidos e eletivamente submetidos a revascularização de membro inferior numa única instituição entre 2012 e 2014. Procedeu-se à recolha de determinados marcadores analíticos realizados pré operatoriamente e efetuada análise estatística para inferir sobre a sua correlação com os resultados obtidos. Os outcomes primários foram permeabilidade de Bypass, perda de membro e mortalidade.
Resultados: Foram analisados 174 doentes, 158 (91%) do sexo masculino, com idade média de 67 ± 9 anos. Em termos de permeabilidade, os doentes submetidos a Bypass supra-genicular tiveram melhores taxas de permeabilidade aos 6 e 12 meses relativamente aqueles com anastomose distal infra-genicular (86% vs 75% e 82% vs 60%). Também os doentes do sexo masculino tiveram melhores resultados comparativamente com os doentes do sexo feminino (90% vs 74% e 88% vs 62%). Em termos de taxa de mortalidade e de amputação, esta foi, estatisticamente, significativamente superior no grupo com alteração da função renal (17% e 27% vs 5% e 7%, p=0.004; no grupo com hipoalbuminemia e hipoproteinemia (19% e 29% vs 4% e 6%, p=0.03; no grupo com elevação da proteína c-reativa (17% e 31% vs 6% e 7%, p=0.02 e no grupo com isquemia Grau IV segundo a classificação de Leriche Fontaine (14% e 25% vs 5% e 4%).
Conclusão: Existem determinados parâmetros analíticos que, quando alterados, em doentes com doença arterial periférica, acarretam prognósticos desfavoráveis, pelo que deverão ser tidos em consideração e, se possível, corrigidos atempadamente.
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21. Pasqualini L, Schillaci G, Pirro M, et al. Renal dysfunction predicts long-term mortality in patients with lower extremity
arterial disease. J Intern Med. 2007;262(6):668–677;
22. Liew JP, Bartholomew JR, Demirjian S, Michaels J, Schreiber MJ Jr. Combined effect of chronic kidney disease and peripheral arterial disease on all-cause mortality in a high-risk population. Clin J Am Soc Nephrol. 2008;3(4):1084–1089;
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24. Murata N, Soga Y, Iida O, Yamauchi Y, Hirano K, Kawasaki D, et al. Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing endovascular treatment. Eur J Vasc Endovasc Surg 2015;49:297e305;
25. Boitano LT , Wang EC, Kibbe MR. Differential effect of nutritional status on vascular surgery outcomes in a Veterans Affairs versus private hospital setting. Am J Surg 2012;204:e27-37;
26. Zhang JQ, Curran T, McCallum JC, Wang L, Wyers MC, Hamdan AD, et al. Risk factors for readmission after lower extremity bypass in the American College of Surgeons National Surgery Quality Improvement Program. J Vasc Surg 2014;59:1331–9;
27. T.P. Singh et al; Systematic Review and Meta-Analysis of the Association Between C-Reactive Protein and Major Cardiovascular Events in Patients withPeripheral Artery Disease; Eur J Vasc Endovasc Surg (2017) 54, 220–233;
28. Natalia Egorova, MPHaAgeliki G.Vouyouka MDbJacquelyn-Quin MD, MPHcStephanieGuillerme MSaAlanMoskowitz MDaMichael MarinMDbPeter L.FariesMD, Analysis of gender-related differences in lower extremity peripheral arterial disease, Journal of Vascular Surgery, Volume 51, Issue 2, February 2010, Pages 378–379;
29. Andrew W. Bradbury et all, Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A survival prediction model to facilitate clinical decision making, J Vas Surg, May 2010 Volume 51, Issue 5, Supplement, Pages 52S–68S
30. Schanzer A et al, Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation-
-free survival using multicenter surgical outcomes data. Mega J, Meadows J, Samson RH, Bandyk DF, Conte MS, J Vasc Surg. 2008 Dec; 48(6):1464–71;
31. Akai T et al, Usefulness of the Bollinger scoring method in evaluating peripheral artery angiography with 64-low computed tomography in patients with peripheral arterial disease; Int Angiol.2014 Oct;33(5):426–33
32. Vainas T et al, C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events.J Vasc Surg. 2005 Aug; 42(2):243–51;
33. Bosevski M, Bosevska G, Stojanovska LInfluence of fibrinogen and C-RP on progression of peripheral arterial disease in type 2 diabetes: a preliminary report; Cardiovasc Diabetol. 2013 Feb 1;12:29. doi: 10.1186/1475-2840-12-29;
34. Garofolo L, Ferreira SR, Miranda Júnior F; Association between peripheral arterial disease and C-reactive protein
in the Japanese-Brazilian population; Rev Col Bras Cir. 2014 May-Jun;41(3):168–75;
35. Thomas E. Brothers et al, Predicting outcomes for infrapopliteal limb-threatening ischemia using the Society for Vascular Surgery Vascular
36. Quality Initiative; J Vasc Surg 2016 Jan;63(1):114–24.e5. doi: 10.1016/j.jvs.2015.08.063. Epub 2015 Oct 1.
2. Rein P, Saely CH, Silbernagel G, Vonbank A, Mathies R, Drexel H, et al. Systemic inflammation is higher in peripheral artery disease than in stable coronary artery disease. Atherosclerosis 2015; 239: 299–303;
3. Miyuki Yokoyama et al; Impact of Objective Malnutrition Status on the Clinical Outcomes in Patients With Peripheral Artery Disease Following Endovascular Therapy; Circ J. 2018 Feb 23;82(3):847–856. doi: 10.1253/circj.CJ-17-0731. Epub 2017 Nov 30;
4. M.G.E. Tellez-Plaza, R.R. Fabsitz, et al., Cadmium exposure and incident peripheral arterial disease, Circulation 6 (6) (2013) 626e633
5. Natalie LY et al; Environmental tobacco smoke and peripheral arterial disease: A review; Atherosclerosis 266 (2017) 113e120
6. Desormais I, Aboyans V, Bura A, et al. Anemia, an independent predictive factor for amputation and mortality in patients
hospitalized for peripheral artery disease. Eur J Vasc Endovasc Surg. 2014;48(2):202–207
7. Paulina Perez et al; Anemia and Outcome in Outpatients With Peripheral Artery Disease; Angiology. 2016 May;67(5):484–9. doi: 10.1177/0003319715599864. Epub 2015 Aug 13
8. Victor Aboyans et al; Editor's Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS); E J Vasc and Endovascular Surgery, March 2018 Volume 55; Issue 3, Pages 305–368;
9. F. Becker et al; Chapter I: Definitions, Epidemiology, Clinical Presentation and Prognosis; December 2011 Volume 42, Suplllement 2, Pages S4-S12;
10. Juszczak MT et al; Total psoas area predicts medium-term mortality after lower limb revascularization; J Vasc Surg, 2018 Oct;68(4):1114–1125.e1. doi: 10.1016/j.jvs.2018.01.040. Epub 2018 Jul 29;
11. Zander N et al; Development and validation of the Patient Benefit Index for peripheral arterial disease; Vasa. 2018 Apr;47(3):219–226. doi: 10.1024/0301–1526/a000687. Epub 2018 Jan 25;
12. Ali T Z et al; Modified Frailty Index C an Be Used to Predict Adverse Outcomes and Mortality after Lower Extremity Bypass Surgery; Ann Vasc Surg. 2018 Jan;46:168–177. doi: 10.1016/j.avsg.2017.07.007. Epub 2017 Jul 21;
13. https://www.msdmanuals.com/professional/resources/normal-laboratory-values/normal-laboratory-values
14. Blanc B, Finch CA, Hallberg L, et al. Nutritional anaemias. Report of a WHO scientific group. World Health Organization technical report series. 1968;405:5–37;
15. Andress Schanzer et al; Risk stratification in critical limb ischemia: Derivation and validation of a model to predict amputation-free survival using multicenter surgical outcomes data; J Vasc Surg Volume 48, Issue 6, December 2008, Pages 1464–1471;
16. Paulina Perez et el; Anemia and outcome in outpatients with peripheral artery disease; Angiology. 2016 May; 67 /5): 484–9. doi 10.1177/0003319715599864. Epub 2015 Aug 13;
17. Ambulgekar NV et al; Association of Anemia With Outcomes in Patients Undergoing Percutaneous Peripheral Vascular Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2 VIC); J Invasive Cardiol. 2018 Jan;30(1):35–42;
18. Toor IS, Jaumdally RJ, Moss MS, Babu SB. Preprocedural hemoglobin predicts outcome in peripheral vascular disease patients undergoing percutaneous transluminal angioplasty. J Vasc Surg. 2009;50:317–321;
19. Malyar N, Fu¨rstenberg T, Wellmann J, et al. Recent trends in morbidity and in-hospital outcomes of in-patients with
peripheral arterial disease: a nationwide population-based analysis. Eur Heart J. 2013;34(34):2706–2714;
20. Mathieu Bourrier et al; Peripheral artery disease: its adverse consequences with and without CKD, AM J Kidney Dis. 2020 May; 75 /5): 705–712;
21. Pasqualini L, Schillaci G, Pirro M, et al. Renal dysfunction predicts long-term mortality in patients with lower extremity
arterial disease. J Intern Med. 2007;262(6):668–677;
22. Liew JP, Bartholomew JR, Demirjian S, Michaels J, Schreiber MJ Jr. Combined effect of chronic kidney disease and peripheral arterial disease on all-cause mortality in a high-risk population. Clin J Am Soc Nephrol. 2008;3(4):1084–1089;
23. Galal W, van Gestel YR, Hoeks SE, Sin DD, Winkel TA, Bax JJ, et al. The obesity paradox in patients with peripheral arterial disease. Chest 2008;134:925e30;
24. Murata N, Soga Y, Iida O, Yamauchi Y, Hirano K, Kawasaki D, et al. Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing endovascular treatment. Eur J Vasc Endovasc Surg 2015;49:297e305;
25. Boitano LT , Wang EC, Kibbe MR. Differential effect of nutritional status on vascular surgery outcomes in a Veterans Affairs versus private hospital setting. Am J Surg 2012;204:e27-37;
26. Zhang JQ, Curran T, McCallum JC, Wang L, Wyers MC, Hamdan AD, et al. Risk factors for readmission after lower extremity bypass in the American College of Surgeons National Surgery Quality Improvement Program. J Vasc Surg 2014;59:1331–9;
27. T.P. Singh et al; Systematic Review and Meta-Analysis of the Association Between C-Reactive Protein and Major Cardiovascular Events in Patients withPeripheral Artery Disease; Eur J Vasc Endovasc Surg (2017) 54, 220–233;
28. Natalia Egorova, MPHaAgeliki G.Vouyouka MDbJacquelyn-Quin MD, MPHcStephanieGuillerme MSaAlanMoskowitz MDaMichael MarinMDbPeter L.FariesMD, Analysis of gender-related differences in lower extremity peripheral arterial disease, Journal of Vascular Surgery, Volume 51, Issue 2, February 2010, Pages 378–379;
29. Andrew W. Bradbury et all, Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A survival prediction model to facilitate clinical decision making, J Vas Surg, May 2010 Volume 51, Issue 5, Supplement, Pages 52S–68S
30. Schanzer A et al, Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation-
-free survival using multicenter surgical outcomes data. Mega J, Meadows J, Samson RH, Bandyk DF, Conte MS, J Vasc Surg. 2008 Dec; 48(6):1464–71;
31. Akai T et al, Usefulness of the Bollinger scoring method in evaluating peripheral artery angiography with 64-low computed tomography in patients with peripheral arterial disease; Int Angiol.2014 Oct;33(5):426–33
32. Vainas T et al, C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events.J Vasc Surg. 2005 Aug; 42(2):243–51;
33. Bosevski M, Bosevska G, Stojanovska LInfluence of fibrinogen and C-RP on progression of peripheral arterial disease in type 2 diabetes: a preliminary report; Cardiovasc Diabetol. 2013 Feb 1;12:29. doi: 10.1186/1475-2840-12-29;
34. Garofolo L, Ferreira SR, Miranda Júnior F; Association between peripheral arterial disease and C-reactive protein
in the Japanese-Brazilian population; Rev Col Bras Cir. 2014 May-Jun;41(3):168–75;
35. Thomas E. Brothers et al, Predicting outcomes for infrapopliteal limb-threatening ischemia using the Society for Vascular Surgery Vascular
36. Quality Initiative; J Vasc Surg 2016 Jan;63(1):114–24.e5. doi: 10.1016/j.jvs.2015.08.063. Epub 2015 Oct 1.
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2021-09-10
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Sousa PP. MARCADORES ANALÍTICOS QUE CONDICIONAM OS RESULTADOS DE CIRURGIA DE REVASCULARIZAÇÃO EM DOENTES COM DOENÇA ARTERIAL PERIFÉRICA. Angiol Cir Vasc [Internet]. 10 de Setembro de 2021 [citado 23 de Novembro de 2024];17(2):117-24. Disponível em: https://acvjournal.com/index.php/acv/article/view/288
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