title: External aggression to the limb as a predictive factor in the evolution of patients undergoing arterial revascularization.
abstract: OBJECTIVE
  A variety of predictive factors for the evolution of arterial grafts in patients with critical ischemia have been well defined in clinical studies, including diabetes mellitus, dialytic renal insufficiency, smoking, and distal arterial runoff. The goal of this study was to determine whether patients with critical ischemia undergoing arterial reconstruction in which ischemic lesions appeared spontaneously, compared to those in which the ischemic lesion appeared following an external aggression to the limb present different patterns of evolution.
  
  
  METHODS
  From February 2002 to January 2004, 100 patients undergoing infra-inguinal arterial reconstruction were followed. They were divided into 2 groups: 1) the spontaneous group (n = 52), comprising individuals presenting with ischemic lesions of spontaneous origin and 2) the external aggression to the limb group (n = 48), comprising individuals for which an external causal mechanism for the appearance of the ischemic lesion was identified. The variables analyzed were limb salvage and graft functioning rates.
  
  
  RESULTS
  Patients with spontaneous lesions had rates of limb salvage and graft functioning significantly lower than those for patients with lesions that were secondary to external aggression (42.3% versus 87.5%, respectively for both outcomes; P <.001).
  
  
  CONCLUSIONS
  The absence of an external aggression as a contributing factor to a critical ischemic lesion in the lower limb may result in a poorer evolution of both graft function and limb salvage following arterial revascularization. However, this factor is not expected to directly influence the case conduct, since almost half of the patients without evident external aggression had good graft functioning and limb salvage. This prognostic factor should be used just as all others are, i.e., to give patients and doctors a better idea of the possible evolution in such cases.
authors.affiliation: Division of Vascular Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, SP, Brazil. nwolosker@yahoo.com
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.forename: Baptista
authors.initials: B
authors.lastname: Muraco Neto
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Munia
authors.forename: Ruben Ayzin
authors.initials: RA
authors.lastname: Rosoky
authors.forename: Rodrigo Santos
authors.initials: RS
authors.lastname: Ramos
authors.forename: Pedro
authors.initials: P
authors.lastname: Puech-Leão
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000098:blood supply* / Q000293:injuries; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors