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PubMed1999

Characterization and minimization of extremity doses during 32P metabolic cell labeling.

A study was performed to characterize hand extremity doses received by a laboratory researcher performing a metabolic cell labeling procedure using 10-cm-diameter cell culture dishes containing GBq amounts of 32P-orthophosphate. Specifically, the optimal location for placement of thermoluminescent dosimeters on the extremities was determined as was the phase (time frame) during the cell labeling procedure when the highest dose was received. The cell labeling procedure was divided into four phases. Thermoluminescent dosimeters were placed on three fingers of each hand at the start of each phase and after the completion of that phase, collected, and sent to the processor. It was determined that in the case of this right-handed worker, the left-hand index finger should be used for determining the maximum extremity dose. The time frame during which the highest extremity dose was received was the cell lysis phase. Acrylic shielding was fabricated, which significantly reduced worker extremity dose.

Cell Culture Techniques↗

PubMed2004

Autosomal recessive spastic ataxia of Charlevoix-Saguenay: upper extremity aptitudes, functional independence and social participation.

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is an early-onset ataxia with pyramidal, cerebellar and distal neuropathic involvement. A cross-sectional study with 24 subjects was carried out to examine upper extremity aptitudes in ARSACS by comparing scores between two age groups (<40 and > or =40) and with reference values. Upper extremity aptitude measures included coordination, gross and fine dexterity, upper extremity strength, muscle tone, kinaesthetic sensitivity and global upper extremity performance. Functional aptitudes were evaluated with part of the Functional Independence Measure (FIM) and social participation was measured with the Assessment of Life Habits. Data showed significant differences between younger and older participants for coordination, gross and fine finger dexterity, pinch strength and global performance. Even the younger group had lower scores when compared with reference values. Functional aptitudes and social participation also showed differences between the two groups but the younger group had near normal performance as compared with reference values. This study demonstrated that upper extremity aptitudes related to coordination are affected early in the course of the disease. Functional independence and social participation showed a decrease performance later on and a high level of variability.

Adult↗

PubMed1998

Evaluation of the triangular fibrocartilage and the scapholunate and lunotriquetral ligaments in cadavers with low-field-strength extremity-only magnet. Comparison of available imaging sequences and macroscopic findings.

RATIONALE AND OBJECTIVES: The authors assessed the ability of a low-field-strength extremity-only magnet to provide visualization of the triangular fibrocartilage and the scapholunate and lunotriquetral ligaments. METHODS: Twelve human wrists were examined with a 0.2 T extremity-only magnet. T1-weighted spin echo, proton density-weighted, and T2-weighted turbo spin echo, short-tau inversion recovery, and three-dimensional gradient recalled echo images were acquired, and sections of the specimens were then made that corresponded to the magnetic resonance images. Masked imaging analyses were correlated with macroscopic and limited histopathologic findings. RESULTS: Low-field-strength extremity-only magnet allowed consistent visualization of the triangular fibrocartilage and accurate assessment of a small number of complete tears of the triangular fibrocartilage. The scapholunate ligaments in all cases were identified using a combination of imaging sequences. Consistent visualization of the lunotriquetral ligament with a low-field-strength extremity magnet was difficult. CONCLUSIONS: Magnetic resonance imaging with a low-field-strength extremity-only magnet can be used to visualize the triangular fibrocartilage and the scapholunate ligament, but not the lunotriquetral ligament.

Aged↗

PubMed1990

Objective criteria accurately predict amputation following lower extremity trauma.

MESS (Mangled Extremity Severity Score) is a simple rating scale for lower extremity trauma, based on skeletal/soft-tissue damage, limb ischemia, shock, and age. Retrospective analysis of severe lower extremity injuries in 25 trauma victims demonstrated a significant difference between MESS values for 17 limbs ultimately salvaged (mean, 4.88 +/- 0.27) and nine requiring amputation (mean, 9.11 +/- 0.51) (p less than 0.01). A prospective trial of MESS in lower extremity injuries managed at two trauma centers again demonstrated a significant difference between MESS values of 14 salvaged (mean, 4.00 +/- 0.28) and 12 doomed (mean, 8.83 +/- 0.53) limbs (p less than 0.01). In both the retrospective survey and the prospective trial, a MESS value greater than or equal to 7 predicted amputation with 100% accuracy. MESS may be useful in selecting trauma victims whose irretrievably injured lower extremities warrant primary amputation.

Adult↗

PubMed1996

Is immediate decompression of high voltage electrical injuries to the upper extremity always necessary?

OBJECTIVE: To determine if immediate decompression is required for all high voltage injuries to the upper extremity. DESIGN: Retrospective review. MATERIALS AND METHODS: Charts reviewed of 62 patients who had upper extremity contact with >1,000 volts of electricity over a 10-year period. MAIN RESULTS: One hundred upper extremities were treated. Twenty-two percent were decompressed within 24 hours because of progressive nerve dysfunction, clinical compartment syndrome, or failure of resuscitation. This group required a mean of 4.2 operations with an amputation rate of 45%, similar to other series. Thirty-five percent of burned extremities had their first operative procedure delayed until resuscitation was complete. This group required a mean of 2.1 operations with no amputations. Forty-three percent of extremities did not require operations to achieve healing. Overall results show a 10.0% amputation rate and mean hospital stay of 27 days. CONCLUSIONS: We conclude that the need for amputation and multiple operations is determined by the injury itself and that immediate decompression is only required for the usual clinical signs of compartment syndrome. Selective decompression may actually preserve tissue and decrease the need for eventual amputation because fasciotomy can lead to soft tissue dessication by exposing viable tissue.

Adolescent↗

PubMed1998

A submaximal all-extremity exercise test to predict maximal oxygen consumption.

PURPOSE: Submaximal aerobic exercise testing is utilized with a variety of populations to assess fitness level and predict maximal oxygen uptake (VO2peak) when a maximal test is not possible or preferable. Many submaximal tests have been developed on traditional exercise equipment, such as the treadmill and the cycle ergometer, but are not available for newer equipment such as an all-extremity ergometer. The purpose of this study was to develop and validate a submaximal exercise test using the Pro II Power Trainer, an all-extremity ergometer, in women ages 30-60 without disability and with varying fitness levels. A secondary purpose was to compare VO2peak values achieved during the all-extremity maximal test and the treadmill test. METHODS AND RESULTS: A linear regression equation was developed to predict VO2peak from submaximal data using heart rates and power output at the sixth and ninth minutes of the submaximal test. The linear regression derived for the submaximal all-extremity test was VO2peak L.min-1 = -0.01 (age in years) - 0.0029 (HR 1) - 0.0099 (HR2) - 0.0029 (PO1) + 0.0151(PO2) + 3.010. Predicted residual sum of squares of the linear equation revealed an R2 value of 0.722 and standard error of estimate of 0.216 L.min-1. Treadmill VO2 speak values correlated strongly with all-extremity VO2 speak values (r = 0.918) and were not significantly different (P, 0.05). CONCLUSION: A similar submaximal test needs to be developed for field estimates of VO2peak for subpopulations of individuals with physical disabilities such as rheumatoid arthritis, head or spinal cord injury, cerebral vascular accident, multiple sclerosis, amputation, and cerebral palsy.

Adult↗

PubMed1988

Imbalanced adaptation of accommodation and vergence produces opposite extremes of the AC/A and CA/C ratios.

It is customary to describe abnormal interactions between accommodation and convergence according to the Duane-White classification of convergence excess and insufficiency or divergence excess and insufficiency. However, recent studies indicate that these extremely high and low categories of accommodative vergence may result from adaptive disorders of accommodation and convergence. The AC/A ratio is shown in this paper to vary inversely with adaptability of accommodation and to vary directly with adaptability of vergence. Extremely high AC/A ratios can result from an imbalance in which vergence adapts readily to prism, whereas accommodation does not adapt to minus lenses. Similarly, extremely high values for convergence accommodation (the CA/C ratio) are observed when there is robust adaptation of accommodation to lenses and little adaptation of vergence to prism. Furthermore, in these extreme cases the AC/A and CA/C ratios tend to be inversely related. For example, abnormally high AC/A ratios are often accompanied by extremely low CA/C ratios and vice versa. These observations suggest that equalizing the adaptability of accommodation and vergence with orthoptics may prove to be an effective means of restoring the AC/A and CA/C ratios to normal values.

Accommodation, Ocular↗

PubMed2000

Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome.

OBJECTIVE: To describe mortality, morbidity at discharge and neurodevelopmental outcome at 2 years corrected age in extremely low birth weight infants with systemic Candida infection during intensive care stay. METHOD: We identified all extremely low birth weight (birth weight <1000 g) infants diagnosed with Candida sepsis and/or meningoencephalitis between 1988 and mid-1996 in the tertiary neonatal intensive care centers of Toronto. The outcome of the infected infants at discharge and at 2 years corrected age was compared with a cohort of 470 extremely low birth weight infants born between 1990 and 1994. RESULTS: Forty-six extremely low birth weight infants with systemic Candida infection, mean (+/-SD) gestational age of 24.7 +/- 1.6 weeks and birth weight 699 +/- 135 g, were identified. Case fatality rate was 37% (17 of 46), not significantly different from the control group (35%). Data on 27 infected survivors were available at discharge. All had chronic lung disease compared with 33% in the control cases (P = 0.0001), a high incidence of periventricular leukomalacia (26% vs. 12%, P = 0.06) and an increase in severe retinopathy of prematurity (22% vs. 9%, P = 0.04); 60% had adverse neurologic outcomes at 2 years corrected age compared with 35% in the control group, and 41% vs. 12% had severe disabilities (P = 0.005). Cranial ultrasound examination was the only diagnostic modality in 5 of 13 (38%) cases with central nervous system Candida involvement. All infants with brain parenchymal lesions detected by cranial ultrasound had poor outcome. Early diagnosis and commencement of antifungal treatment favorably affected the outcome. CONCLUSIONS: Systemic Candida infection is associated with increased short and long term morbidity in extremely low birth weight infants. Candida infection of the central nervous system has a significant impact on long term neurodevelopmental outcome. Performance of cranial ultrasound examination is recommended as a part of the diagnostic investigation in these infants. Detection of brain parenchymal involvement might provide further information to predict outcome.

Candidiasis↗

PubMed1998

Reconstruction of the extremity with the dorsal thoracic fascia free flap.

The dorsal thoracic fascia is the anatomic layer that contains the blood supply to the scapular and parascapular fasciocutaneous flaps. The cutaneous vascular territory of the circumflex scapular artery and its parascapular branches is well known. During the past 8 years, the authors have employed the dorsal thoracic fascia free flap for extremity reconstruction in 17 patients (upper extremity, n = 9; lower extremity, n = 8). The indications for using this free flap included primary coverage after trauma (n = 10), resurfacing of "unstable" scar (n = 3), coverage of plantar foot ulceration (n = 3), and coverage of an exposed lower extremity distal arterial bypass graft (n = 1). The large anatomic boundaries of this flap, the consistent vascular anatomy, and the thin yet durable quality of the tissue make this flap an excellent choice for the reconstruction of upper and lower extremity defects.

Adult↗

PubMed1999

Salvage after severe lower-extremity trauma: are the outcomes worth the means?

Advances in reconstructive surgery have allowed for impressive salvage after severe lower-extremity trauma but not without complications when compared with immediate below-knee amputation. Several amputation index scores have been developed to help predict successful salvage as defined by a viable rather than a functional extremity. The purpose of this study was to evaluate retrospectively the predictive value of the amputation index scores and to assess prospectively overall health status and specific dysfunction in successful limb salvage and primary and secondary amputation by administering standardized generic and specific outcomes questionnaires (Medical Outcomes Study 36-Item Short-Form Health Survey, Western Ontario and MacMaster Universities Osteoarthritis Index). A retrospective chart review identified 55 severe lower-extremity injuries (Gustilo Type IIIB and IIIC) over a 12-year period (1984 to 1996). Forty-six severe open tibial fractures in 45 patients underwent attempted salvage. All required soft-tissue coverage by either local or free flap or vascular repair for leg salvage. The attempted-salvage group was subdivided into successful salvage and secondary amputation. The other nine patients underwent a primary amputation. There were no statistically significant differences in terms of patient demographics or other injuries (Injury Severity Score) in the three groups. Forty-eight of 54 patients with an average 5-year follow-up completed a validated generic and specific outcomes health questionnaire. In the attempted-salvage group, 89 percent of patients had a successful salvage and 11 percent came to a secondary amputation. The amputation index scores correctly predicted an amputation in 32 percent of patients. The magnitude of the amputation index scores did not correlate with the physical outcomes scores and were not found to add any significant value of information to the surgeon's decision making. Patients undergoing primary and secondary amputation had a worse physical outcomes score (28 versus 38) than successful salvage (p < 0.007). Even so, the SF-36 (physical component score) outcomes score for this group of injured extremities, regardless as to whether salvaged or amputated, was as low as or lower than that of many serious medical illnesses, suggesting that severe lower-extremity trauma impairs health as much as or more than being seriously ill. The mental component score in this group was comparable to that of a healthy population (49 versus 50), which implies the disability is primarily physical rather than psychological. Ninety-two percent of patients preferred their salvaged leg to an amputation at any stage of their injury, and none would have preferred a primary amputation.

Activities of Daily Living↗

PubMed1999

Algorithm for recipient vessel selection in free tissue transfer to the lower extremity.

The proper selection of a recipient vessel is essential for the success of free tissue transfer, especially when the transfer is to the lower extremity. However, a general agreement on which vessel to use has not been reached yet. Conflicting data have been reported on the survival and outcome of the transferred flaps, depending on the vessel used or the location of anastomosis. The aim of this study was to identify the patterns and problems in the selection of recipient vessels for free tissue transfer to the lower extremity and to establish a general guideline for proper selection. From September of 1990 to December of 1997, 50 consecutive, microvascular, free tissue transfers were performed on the lower extremity. The causes requiring soft-tissue coverage included trauma (25), unstable scar (11), chronic osteomyelitis (7), and tumors (7). The mean follow-up period was 22.4 months (range, 2 to 41 months). In 25 cases, the posterior tibial vessel was used as the recipient vessel. The microvascular anastomosis was done proximal to the zone of injury in 45 cases. The two most important factors in the selection of a recipient vessel are the site of injury and the vascular status of the lower extremity. Less important factors include the flap to be used, method, and site of microvascular anastomosis. All the currently feasible options for recipient vessels are included, and the opinions of other surgeons are reviewed. A general guideline is established, and an algorithm for the proper selection of a recipient vessel is proposed. This algorithm is a fast and convenient guide for evaluating the wound and planning the free flap to the lower extremity.

Adolescent↗

PubMed2001

Lower extremity microsurgical reconstruction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the indications for the use of free-tissue transfer in lower extremity reconstruction. 2. Understand modalities to enhance the healing and care of soft tissue and bone before free-tissue transfer. 3. Understand the lower extremity reconstructive ladder and the place of free-tissue transfer on the ladder. 4. Understand the specific principles of leg, foot, and ankle reconstruction. 5. Understand the factors that influence the decision to perform an immediate versus a delayed reconstruction. Free-tissue transfer using microsurgical techniques is now routine for the salvage of traumatized lower extremities. Indications for microvascular tissue transplantation for lower extremity reconstruction include high-energy injuries, most middle and distal-third tibial wounds, radiation wounds, osteomyelitis, nonunions, and tumor reconstruction. The authors discuss the techniques and indications for lower extremity reconstruction.

Bone Neoplasms↗

PubMed2002

Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction.

Limb salvage after extremity tumor ablation may include the use of allograft bone. The primary complication of this method is infection of the allograft, which can lead to limb loss in up to 50 percent of cases. The purpose of this study is to evaluate the efficacy of primary muscle flap coverage in the setting of allograft bone limb salvage surgery. This study is a prospective review of all patients with flap coverage of extremity allografts over the 10-year period 1991 to 2001. There were 20 patients (11 male and nine female patients) with an average age of 28 years (range, 6 to 72 years). Flap coverage was primary in 16 patients and delayed in four. Delayed coverage was performed for failed wounds that did not have a primary soft-tissue flap. Pathologic findings included osteosarcoma in nine patients, Ewing sarcoma in five patients, malignant fibrohistiocytoma in two patients, chondrosarcoma in two patients, synovial sarcoma in one patient, and leiomyosarcoma in one patient. Allograft reconstruction was performed for the upper extremity in 12 patients and for the lower extremity in eight patients. Flap reconstruction was accomplished with 20 pedicle flaps in 17 patients (latissimus dorsi, 12; gastrocnemius, four; soleus, three; and fasciocutaneous flap, one) and four free flaps (rectus abdominis, three; latissimus dorsi, one) in four patients. All pedicled flaps survived. There was one flap failure in the entire series, which was a free rectus abdominis flap. This case resulted in the only limb loss noted. The follow-up period ranged from 1 to 50 months (average, 12.35 months). At the time of final follow-up, three patients were dead of disease and 17 were alive with intact extremities. The overall limb salvage rate in the setting of bone allograft and soft-tissue flap coverage was 95 percent (19 of 20). Reoperation for bone-related complications was required in 50 percent (two of four) of cases receiving delayed flap coverage compared with 19 percent (three of 16) of patients with primary flap coverage (statistically not significant). The results of this study support the use of soft-tissue flap coverage for allograft limb reconstruction. In this series, no limb was lost in the setting of a viable flap. Reoperation was markedly reduced in the setting of primary flap coverage. Pedicled or microvascular transfer of well-vascularized muscle can be used to wrap the allograft and minimize devastating wound complications potentially leading to loss of allograft and limb.

Adolescent↗

PubMed1994

Magnetic stimulation of the spine to produce lower extremity EMG responses. Significance of coil position and the presence of bone.

STUDY DESIGN: Magnetic stimulation of the spinal cord in 14 pigs was performed, and compound muscle action potentials (CMAPs) were recorded from lower extremities before and after nerve root and spinal cord lesioning. OBJECTIVES: The authors determined whether magnetic stimulation of the spinal cord produced lower extremity CMAPs. SUMMARY OF BACKGROUND DATA: Previous studies indicated that the magnetic stimulation of the spinal cord would result in lower extremity CMAP if appropriate amounts of spinal bone were removed to expose the spinal cord. RESULTS: Our findings demonstrated that the presence of intervening bone did not affect the reliability or presence of lower extremity CMAPs. Additionally, magnetic stimulation did not result in spinal cord activation but produced activity in nerve roots lateral to nerve root foramen. Lesioning of the spinal cord and complete rhizotomies did not affect magnetically elicited CMAPs. CONCLUSIONS: Magnetic stimulation of the spinal canal does not result in activation of spinal cord motor tracts. Lower extremity CMAPs were elicited by stimulation of nerve roots lateral to nerve root foramen and not of the spinal cord. Magnetic stimulation of the spinal cord is not appropriate for monitoring spinal cord motor tract function.

Animals↗

PubMed2002

Functional performance deficits in athletes with previous lower extremity injury.

OBJECTIVE: To evaluate the influence of previously treated, though clinically resolved, lower extremity injury on performance in a timed 20-meter shuttle run. DESIGN: Case control study. SETTING: National Collegiate Athletic Association (NCAA) Division I college during the 2000/2001 preparticipation physicals. PARTICIPANTS: NCAA Division I athletes (n = 213) participated in this research study. Athletes were excluded if they presently had an unresolved lower extremity injury or low back pain. MAIN OUTCOME MEASURES: Time to complete a 20-meter shuttle run was recorded. Previous lower extremity injury and college year were recorded via a short questionnaire. RESULTS: A significantly slower response time on the 20-meter shuttle run was observed in freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in non-freshman collegiate athletes regardless of injury history (p = 0.98). CONCLUSION: Kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. The slower shuttle run times observed in freshmen with previous lower extremity injury may be a manifestation of insufficient treatment received at the high school level or the benefit of a mandatory core strengthening program in returning athletes. Further study is necessary to identify and validate the cause-and-effect relationship. CLINICAL RELEVANCE: This study may support residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting.

Adolescent↗

PubMed2002

Ergonomic and psychosocial factors affect daily function in workers' compensation claimants with persistent upper extremity disorders.

Pain and other symptoms associated with work-related upper extremity disorders (WRUEDs) can lead to significant distress, lost function, and disability. Identifying factors associated with decreased upper extremity function may lead to the development of more effective interventions. In this study, participants were 165 government employees (127 female, 38 male) with an accepted workers' compensation claim (< 90 days from claim filing) for a WRUED who were unable to perform their normal work. Participants completed baseline measures of upper extremity functional limitation, symptoms, general health status, problem solving orientation, pain coping, and workplace factors. After controlling for pain and gender in a multiple regression analysis, greater functional limitation was further explained by: (1) upper extremity symptoms other than pain (e.g., sleep disturbance, numbness and tingling), (2) symptoms in one or both hands, (3) feeling overwhelmed by pain, (4) low confidence in problem solving abilities, and (5) higher ergonomic risk factor exposures at work. The final model accounted for 47.4% of the variance in upper extremity function, F(7157) = 4.33, P < 0.05. Mental health status was related to functional limitation in univariate, but not multivariate analyses. These results suggest that improving function in this population may require: (1) pain coping techniques and active problem solving to overcome functional barriers, and (2) reduction of workplace ergonomic risk exposure.

Adult↗

PubMed2005

Extreme parity and the risk of stillbirth.

OBJECTIVE: We examined the relationship between extreme parity and risk for stillbirth in the United States. METHODS: Singleton deliveries at 20 weeks of gestation or later in the United States from 1989 through 2000 were analyzed. Risk for stillbirth in women with 1-4 (moderate parity, category I), 5-9 (high parity, category II), 10-14 (very high parity, category III), and 15 or more (extremely high parity, category IV) prior live births were computed using logistic regression. RESULTS: Overall, 27,069,385 births, including 1,206 to extremely high parity mothers, were analyzed. Of the 81,386 stillbirths, 71,623 (2.8/1,000), 9,206 (5.0/1,000), 531 (14.4/1,000), and 26 (21.6/1,000) cases occurred among category I, category II, category III, and category IV gravidas, respectively. With category I as referent category, the odds ratio for stillbirth increased consistently with ascending parity after adjusting for potential confounders: category II (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.07), category III (OR 1.97, 95% CI 1.81-2.15), and category IV (OR 2.31, 95% CI 1.56-3.42) (P for trend < .001). Among extremely high parity women (category IV), the odds ratio for stillbirth also increased with unit increment in the number of prior live births: 15 (OR 2.72, 95% CI 1.29-5.74), 16 (OR 3.14, 95% CI 1.17-8.41), 17 (OR 6.11, 95% CI 2.56-16.5), and 18 or more prior live births (OR 16.17, 95% CI 8.77-29.82) (P for trend < .001). CONCLUSIONS: The risk for stillbirth is substantially elevated among very high and extremely high parity women, and care providers may consider these groups for targeted periconceptional counseling. LEVEL OF EVIDENCE: II-2.

Adult↗

PubMed2003

Impact of renal insufficiency on short-term morbidity and mortality after lower extremity revascularization: data from the Department of Veterans Affairs' National Surgical Quality Improvement Program.

Few data are available on the impact of renal insufficiency on short-term operative outcomes after lower extremity surgical revascularization. We used prospectively collected data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to explore the association with renal dysfunction of adverse outcomes occurring within 30 d of lower extremity surgical revascularization in a cohort of all patients undergoing at least one lower extremity surgical revascularization from 1/1/94 to 9/30/01 (n = 18,217). Even moderate renal insufficiency (estimated GFR 30-59cc/min/1.73m(2)) was associated with an increased incidence of postoperative death (adjusted odds ratio (OR) 1.44, 95% confidence interval (CI), 1.17 to 1.77, P = 0.001), cardiac arrest (OR 1.43, CI 1.09 to 1.88, P = 0.011), myocardial infarction (OR 1.68, 1.39 to 2.16, P < 0.001), unplanned intubation (OR 1.69, CI 1.39 to 2.07, P < 0.001) and prolonged intubation (OR 1.57, CI 1.28 to 1.94, P < 0.001) within 30 d of lower extremity revascularization. However, the incidence of wound infection and graft failure requiring return to the operating room did not appear to be substantially higher in this group. Our data also show that patients with renal insufficiency undergoing revascularization were more likely to require distal procedures and to present with limb-threatening infection compared to those with normal renal function. Efforts to improve pre-and post-operative care in patients with renal insufficiency undergoing lower extremity revascularization should take into account the increased incidence of postoperative death and cardiopulmonary complications in this group in addition to more traditional concerns about operative site complications. Further studies are needed to explore reasons for the higher rate of limb-threatening infection in patients with renal insufficiency undergoing revascularization.

Acute Kidney Injury↗