Surgical revascularization is performed to preserve limb and to maintain functional status of patients with critical limb ischemia (CLI). The PREVENT III risk score helps to predict the postoperative course of CLI. However, this score is not available to estimate the risk of amputation or death properly in patients with hemodialysis (HD) and tissue loss (HD: 4 points, Tissue loss: 3 points), because they are classified as a high-risk group. Therefore, we investigated 213 patients with revascularized HD for CLI and proposed prognosis amputation or death for patients with HD risk score (PAD for HD risk score). PAD for HD risk score (non-ambulation: 3 points, ulcer/gangrene: 2 points, GNRI<92: 2 points, CRP>0.3 mg/dl: 1 point, Age≥75: 1 point) is more accurate for the prediction of amputation or death than the PREVENT III risk score (area under the curve [AUC]: 0.79 [95% confidence interval: CI: 0.71–0.87], p<0.01 vs. AUC: 0.63 [95%CI: 0.56–0.71]). The patients were stratified into three groups by total score in ascending order. The rate of 1-year amputation-free survival and independent ambulatory status were significantly different among three groups. PAD for HD risk score is useful for rehabilitation planning in patients with HD and CLI.
The patient who underwent an axilloaxillary bypass at the age of 19 years using a great saphenous vein graft. Surprisingly, after 23 years of surgery, the examination of computed tomography revealed a pseudoaneurysm of the anastomotic part of the axilloaxillary bypass at the age of 43 years. Covered stent grafts were placed in the right subclavian and axillary arteries. As the size of the mass was 8 cm in diameter, pseudoaneurysmectomy was performed. There was a fistula found in the venous graft proximal to the anastomotic region of the bypass. It was later removed and the venous graft was closed. The patient’s postoperative course was good.
A 72-year-old man underwent endovenous treatment of the right great saphenous vein using radiofrequency ablation (RFA). On day 7 postoperation, he noticed a tumor on the medial aspect of his thigh around the puncture site. Ultrasonography showed a hypoechoic lesion in the subcutaneous space. Incision and drainage under local anesthesia on day 10 revealed lymph fluid, and the tumor was diagnosed as lymphocele. On the day 27, only lymphocele was resolved with wound treatment.