CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 314 AFRICA Statistical analyses Descriptive data were used to define the variables (mean, standard deviation, frequencies, Kolmogorov–Smirnov test for data that showed normal distribution). Pearson’s correlation coefficient was calculated to determine the relationship between normally distributed continuous variables. As the parameters did not show a normal distribution, the Mann–Whitney U-test was used to identify the group that caused the difference. Differences between discrete variables were determined using chi-squared and Fisher’s exact tests. The results were evaluated at a 95% confidence interval and p < 0.05 significance level, and the statistical analyses were performed with PSPP 1.4.1 and Microsoft Excel 16.47.1 software. Results The mean age was 66.86 (53–75) years (group A: 68.1; group B: 65.6). The study group consisted of 32 males and 10 females (group A: 18 M, 6 F; group B: 14 M, 4 F). Aetiological factors and co-morbidities are shown in Table 1. Mean duration of hospital stay was 19.6 days (4–112) for group A and 5.6 days (4–14) for group B. The mean duration of hospital stay for group A, excluding patients with infection/revision, was 5.5 days (4–7). For group A, nine of the 24 patients had surgical site/ residue graft infections postoperatively. Eight of those needed surgical intervention and six patients underwent conversion of the amputation level. Prolonged antibiotic therapy regimens were carried out for two to five weeks according to growth in wound cultures in eight patients with VAC therapy, and six of those ended up with hip disarticulation. In only one patient with superficial wound infection, antibiotic therapy alone had a successful outcome. For group B, all 18 patients underwent total excision of the prosthetic graft simultaneously with AKA, and nine patients with a patent DFA in pre-operative CTA had saphenous vein patch-plasty to the common femoral artery in the same surgical session. Three patients in group B had superficial wound infection, and in one, VAC therapy with short-term antibiotic therapy was used after wound debridement surgery. None of the patients in group B had prolonged antibiotic therapy and needed conversion of the amputation level. Differences in positive wound cultures (p = 0.007), prolonged antibiotic therapy (p = 0.003), conversion to hip disarticulation (p = 0.029) and duration of hospital stay (p = 0.0001) between the two groups were found to be statistically significant (Table 2). Demographics, aetiological factors and co-morbidities showed no statistically significant correlation in either group (Table 3). Discussion The importance of DFA patency is a well-known fact for AKA patients since it is the major vascular supply of the thigh, and therefore the AKA stump.4 Several studies throughout the decades have shown the importance of the DFA for the viability of the stump and wound healing. In our study, even in the group with partial graft removal (group A), none of the patients with a patent DFA needed revision surgery or prolonged antibiotic therapy or had woundhealing problems. Most of the CLI patients had vascular interventions prior to end-stage disease, leading to amputation. The DFA should be evaluated thoroughly, not only in patients with prosthetic grafts but also in those with other vascular interventions such as endovascular stent or autogenous grafts. Table 1. Aetiological factors and co-morbidities Co-morbidities Total excision Partial excision Total p-value n % n % n % Diabetes mellitus No 7 38.90 7 29.20 14 33.30 0.51 Yes 11 61.10 17 70.80 28 66.70 Hyperlipidaemia No 12 66.70 13 54.20 25 59.50 0.41 Yes 6 33.30 11 45.80 17 40.50 Hypertension No 4 22.20 9 37.50 13 31.00 0.28 Yes 14 77.80 15 62.50 29 69.00 CAD No 12 66.70 16 66.70 28 66.70 0.99 Yes 6 33.30 8 33.30 14 33.30 Atrial fibrillation No 14 77.80 18 75.00 32 76.20 0.83 Yes 4 22.20 6 25.00 10 23.80 ASA use No 4 22.20 4 16.70 8 19.00 0.65 Yes 14 77.80 20 83.30 34 81.00 Tobacco No 5 27.80 9 37.50 14 33.30 0.51 Yes 13 72.20 15 62.50 28 66.70 CAD: coronary artery disease; ASA: acetylsalicylic acid. Table 3. Differences in age and hospital stay between the groups Variables Total excision Partial excision Total p-value Mean SD Mean SD Mean SD Age, years 65.67 4.47 68.13 5.53 67.07 5.19 0.058 Hospital stay, days 5.61 2.79 20.96 25.21 14.38 20.47 0.0001 SD, standard deviation. Table 2. Clinical differences between the groups Clinical differences Total excision Partial excision Total p-value n % n % n % Positive wound culture No 18 100.00 16 66.70 34 81.00 0.007 Yes 0 0.00 8 33.30 8 19.00 Antibiotic use No 18 100.00 15 62.50 33 78.60 0.003 Yes 0 0.00 9 37.50 9 21.40 VAC therapy No 17 94.40 16 66.70 33 78.60 0.055 Yes 1 5.60 8 33.30 9 21.40 Wound infection No 15 83.30 15 62.50 30 71.40 0.18 Yes 3 16.70 9 37.50 12 28.60 Wound revision No 17 94.40 16 66.70 33 78.60 0.055 Yes 1 5.60 8 33.30 9 21.40 Hip dysarticulation No 18 100.00 18 75.00 36 85.70 0.029 Yes 0 0.00 6 25.00 6 14.30 DFA No 9 50.00 19 79.20 28 66.70 0.047 Yes 9 50.00 5 20.80 14 33.30 VAC, vacuum-assisted closure; DFA, deep femoral artery.
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