CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 316 AFRICA Economic and psychological consequences are non-negligible factors in the course of amputations.11,12 The duration of hospital stay has an integral impact on these factors. Restoring daily function as soon as possible and minimising the duration of hospital stay will decrease the costs to the healthcare system and psychological decline of the patient. The mean duration of hospital stay in patients with infection/ revision was 43.2 days, and that of the rest of the patients was 5.7 days. The mean duration of hospital stay in group B patients with complications was 11.2 days, whereas that of group B patients with no complications was 4.7 days. These results were found to be statistically significant (p = 0.0001) and show that an elaborate multidisciplinary approach is helpful in these aspects. Prolonged antibiotic therapy is another economic and medical aspect in these patient groups since multiple co-morbidities are present and multidrug regimens are carried out. In our study, the duration of antibiotic therapy was found to be longer for group A than for group B, and the difference was statistically significant (p = 0.003). In consideration of these aspects, amputations and the management of these patients in our institution are joint decisions by the orthopaedic and cardiovascular surgery departments. All patients are clinically and radiologically evaluated by the two departments before a procedural decision is made. Conclusion Treatment management and surgical planning in PAD patients with failed prosthetic vascular grafts are complicated processes. To avoid undesirable outcomes and even more complicated medical, functional and economic situations, all planning and treatment steps should be taken in a multidisciplinary manner. Meticulous planning that includes the excision of the total prosthetic vascular graft while ensuring the continuity of the vascular supply is essential. References 1. Kinlay S. Management of critical limb ischemia. Circ Cardiovasc Interv 2016; 9(2): e001946. 2. Engelhardt M, Boos J, Bruijnen H, et al. Critical limb ischaemia: Initial treatment and predictors of amputation-free survival. Eur J Vasc Endovasc Surg 2012; 43(1): 55–61. 3. Dillingham TR, Pezzin LE, Shore AD. Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations. Arch Phys Med Rehabil 2005; 86(3): 480–486. 4. Susak Z, Pikielny S, Najenson T. The ınfluence of the deep femoral artery on wound healing in amputees. Acta Orthop 1978; 49(5): 420–423. 5. Van der Windt DAWM, Pieterson I, van der Eijken JW, et al. Energy expenditure during walking in subjects with tibial rotationplasty, aboveknee amputation, or hip disarticulation. Arch Phys Med Rehabil 1992; 73(12): 1174–1180. 6. Saleem BR, Meerwaldt R, Tielliu IFJ, et al. Conservative treatment of vascular prosthetic graft infection is associated with high mortality. Am J Surg 2010; 200(1): 47–52. 7. Hasse B, Husmann L, Zinkernagel A, et al. Vascular graft infections. Swiss Med Wkly 2013; 143(January): 1–7. 8. Rubin JR, Marmen C, Rhodes RS. Management of failed prosthetic grafts at the time of major lower extremity amputation. J Vasc Surg 1988; 7(5): 673–676. 9. Shenouda M, Molena E, Maftei N, et al. Remnant prosthetic graft in revision or limb-salvage surgery: Routine complete excision? Ann Vasc Surg 2014; 28(6): 1566.e11–1566.e15. 10. Varma P, Stineman MG, Dillingham TR. Epidemiology of limb loss. Phys Med Rehabil Clin N Am 2014; 25(1): 1–8. 11. Bhutani S, Bhutani J, Chhabra A, et al. Living with amputation: Anxiety and depression correlates. J Clin Diagnostic Res 2016; 10(9): RC09–RC12. 12. Ergin Ö, Şahin K, Kocazeybek E, et al. Effect of amputation level to hospital costs and hospital stay durations in diabetic foot disease. Anadolu Klin Tıp BilimDerg 2020; 1–3. … continued from page 312 of reperfusion therapy. The introduction of haemorrhage within the at-risk area might in some cases nearly negate in total the benefits of reperfusion therapy. He said that for physicians, having an awareness of the role reperfusion can play on continued muscle death can help in providing better treatment to patients in the future. ‘This all means that although we might not be able to do much when it comes to lost time before a patient arrives at the hospital, minimising the effects of haemorrhage after reperfusion can give us a new opportunity to reduce the size of infarction, and downstream negative consequences, in nearly half a million heart attack patients in the United States alone,’ he said. Next for the study, he said that his team would expand the findings to a larger patient population, working to develop greater insight into how haemorrhage drives expansion of infarction and testing strategies to halt the effects of those haemorrhages. According to Dr Subha Raman, chief of the Division of Cardiology and director of the Cardiovascular Institute at IU School of Medicine and IU Health, the future real-world applications of this study showcase the research leadership of Dharmakumar and the Krannert Cardiovascular Research Centre. ‘The work being done by our researchers at the Krannert Cardiovascular Research Centre, under the leadership of Dr Dharmakumar, is truly ground-breaking and will fundamentally improve how we take care of patients suffering heart attacks, improving the health of patients,’ said Raman. ‘I am proud of the high-impact cardiovascular science happening in our research labs, and look forward to seeing that work pay real dividends in the future of heart health.’ Source: MedicalBrief 2022
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