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Diabetic limb salvage

Eric Klingelhoefer, Hendrik Bergert, Stephan Kersting, Stefan Ludwig, Norbert Weiss, Frank Schönleben, Robert Grützmann, Gabor Gäbel
BACKGROUND: Peripheral arterial disease (PAD) is one of the most underestimated diseases because of its high prevalence and unfavorable prognosis. Many PAD patients without suitable autologous veins or options for endovascular treatment receive prosthetic above-knee femoropopliteal bypass (PAKB). Until now predictors of prosthetic bypass failure and of increased amputation risk remain indistinct. This study aimed to identify predictive factors associated with better bypass patency and limb salvage to achieve a more favorable outcome after PAKB reconstruction...
August 2016: Journal of Vascular Surgery
E Saarinen, P Kauhanen, M Söderström, A Albäck, M Venermo
INTRODUCTION: As the population ages and the incidence of diabetes increases, the expected number of patients with critical limb ischaemia (CLI) requiring distal revascularization will remain high or even increase. The aim of this study was to investigate the long-term results of inframalleolar bypass. MATERIAL AND METHODS: A total of 352 inframalleolar bypasses for CLI performed between 2002 and 2013 were included. Risk factors were evaluated and patency (both clinical and imaging based), leg salvage, survival, and amputation free survival (AFS) assessed...
October 2, 2016: European Journal of Vascular and Endovascular Surgery
Michele Ammendola, Rosario Sacco, Lucia Butrico, Giuseppe Sammarco, Stefano de Franciscis, Raffaele Serra
Diabetic foot ulcerations may determine minor or major amputation, with a high impact on patients' life expectation and quality of life and on economic burden. Among minor amputations, transmetatarsal amputation (TMA) appears to be the most effective in terms of limb salvage rates and in maintaining foot and ankle biomechanics. In spite of this, TMA needs particular pre- and postoperative management in order to avoid the frequent failure rates. A systematic review was undertaken of studies concerning TMA and its care in diabetic foot gangrene...
October 3, 2016: International Wound Journal
Luca Dalla Paola, Anna Carone, Giulio Boscarino, Giuseppe Scavone, Lucian Vasilache
Diabetic hindfoot ulcers, complicated by osteomyelitis, are associated with a high risk of major amputation. Partial calcanectomy, preceded by an effective management of the infection and of the eventual peripheral artery disease, can be considered as valid therapeutic option. We have evaluated a therapeutic protocol for diabetic hindfoot ulcers complicated by osteomyelitis, which, besides an adequate surgical debridement, considers a reconstructive pathway assisted by the positioning of a circular external fixator...
September 29, 2016: International Journal of Lower Extremity Wounds
Hyun Suk Suh, Tae Suk Oh, Ho Seung Lee, Seung Hwan Lee, Yong Pil Cho, Joong Ryul Park, Joon Pio Hong
BACKGROUND: Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved. METHODS: Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43...
October 2016: Plastic and Reconstructive Surgery
S D Patel, L Biasi, I Paraskevopoulos, J Silickas, T Lea, A Diamantopoulos, K Katsanos, H Zayed
BACKGROUND: Both infrapopliteal (IP) bypass surgery and percutaneous transluminal angioplasty have been shown to be effective in patients with critical limb ischaemia (CLI). The most appropriate method of revascularization has yet to be established, as no randomized trials have been reported. The aim of this study was to compare the outcomes of patients with similar characteristics treated using either revascularization method. METHODS: Consecutive patients undergoing IP bypass and IP angioplasty for CLI (Rutherford 4-6) at a single institution were compared following propensity score matching...
September 21, 2016: British Journal of Surgery
Lingyun Xiong, Emre Gazyakan, Matthias Wähmann, Amir Bigdeli, Thomas Kremer, Leila Harhaus, Jiaming Sun, Ulrich Kneser, Christoph Hirche
BACKGROUND: Lower leg microsurgical reconstruction in the elderly is challenging, especially for post - traumatic defects. The present study aimed to evaluate the risk factors, management and outcome of free tissue transfer in patients older than 65 years of post-traumatic defects. METHODS: Retrospective chart review was performed for all patients older than 18 years undergoing free tissue transfer for post-traumatic lower leg reconstruction from April 2000 to November 2014...
September 6, 2016: Injury
Stephan Morbach, Gerhard Rümenapf
No abstract text is available yet for this article.
September 2016: Plastic and Reconstructive Surgery
Dane K Wukich, Katherine M Raspovic
BACKGROUND: Patients with diabetic foot disease are at an increased risk for lower extremity amputation (LEA), premature mortality, and reduced health-related quality of life. In the setting of chronic infection, significant tissue loss, and/or an unstable deformity, limb salvage may not be possible, and major amputation is necessary. METHODS: The primary goal of this study was to review the literature with an emphasis on the functional aspects associated with successful limb salvage versus major LEA...
September 2016: Plastic and Reconstructive Surgery
Zhiyou Peng, Xinrui Yang, Jinbao Qin, Kaichuang Ye, Xin Wang, Huihua Shi, Mier Jiang, Xiaobing Liu, Xinwu Lu
: : Adipose-derived stem cell (ADSC)-based therapy is promising for critical limb ischemia (CLI) treatment, especially in patients with diabetes. However, the therapeutic effects of diabetic ADSCs (D-ADSCs) are impaired by the diabetes, possibly through intracellular reactive oxygen species (ROS) accumulation. The objective of the present study was to detect whether overexpression of methylglyoxal-metabolizing enzyme glyoxalase-1 (GLO1), which reduces ROS in D-ADSCs, can restore their proangiogenic function in a streptozotocin-induced diabetic mice model of CLI...
August 15, 2016: Stem Cells Translational Medicine
Kum Ju Chae, Jin Yong Shin
PURPOSE: Given that the efficacy of employing angiosome-targeted angioplasty in the treatment of diabetic foot remains controversial, this study was conducted to examine its efficacy. METHODS: We performed a systematic literature review and meta-analysis using core databases, extracting the treatment modality of angiosome-targeted angioplasty as the predictor variable, and limb salvage, wound healing, and revision rate as the outcome variables. We used the Newcastle-Ottawa Scale to assess the study quality, along with the Cochrane Risk of Bias Tool...
2016: PloS One
Marie Pavé, Laurent Benadiba, Ludovic Berger, Djeloul Gouicem, Maxime Hendricks, Didier Plissonnier
PURPOSE: To evaluate the long-term clinical results of Below-the-Knee Percutaneous Transluminal Angioplasty (BTK-PTA) with or without stenting, in patients with Critical Limb Ischemia (CLI), and to determine factors affecting clinical results including the role of the angiosome concept. METHODS: All patients undergoing primary BTK-PTA from January 2007 to December 2011 were included. Primary patency, assisted patency, limb salvage, survival and wound healing were assessed using the Kaplan-Meier method...
July 14, 2016: Annals of Vascular Surgery
Yusuke Tomoi, Yoshimitsu Soga, Masahiko Fujihara, Osamu Iida, Yoshiaki Shintani, Kan Zen, Kenji Ando
PURPOSE: To investigate the clinical outcomes of endovascular therapy (EVT) for upper extremity peripheral artery disease (PAD) with critical hand ischemia (CHI). METHODS: A subanalysis was performed of multicenter registry data on 36 consecutive patients (mean age 65.7±10.3 years; 19 men) who underwent EVT from January 2003 to December 2013 for angiographically diagnosed de novo upper limb PAD with CHI in 40 limbs. Fifty percent of patients had diabetes, and two-thirds were on hemodialysis...
October 2016: Journal of Endovascular Therapy
J P Goltz, M Planert, M Horn, M Wiedner, M Kleemann, J Barkhausen, E Stahlberg
PURPOSE: To evaluate the safety and technical and clinical success of endovascular below-the-knee (BTK) artery revascularization by a retrograde transpedal access. MATERIALS AND METHODS: We retrospectively identified 16/172 patients (9.3 %) with endovascular BTK revascularization in whom a transfemoral approach had failed and transpedal access had been attempted. The dorsal pedal (n = 13) or posterior tibial (n = 3) artery was accessed using a dedicated access set and ultrasound guidance...
October 2016: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Marco Meloni, Laura Giurato, Valentina Izzo, Matteo Stefanini, Enrico Pampana, Roberto Gandini, Luigi Uccioli
AIM: To evaluate the outcomes of diabetic dialysis patients with critical limb ischemia and foot ulcer. METHODS: The study group included 599 diabetic, 99 dialyzed (Ds) (16.5%) and 500 not dialyzed (NDs) (83%) patients with critical limb ischemia and foot ulcers identified as stage C (ischemia) or D (ischemia plus infection) of Texas Wound Classification. All patients were treated by endovascular revascularization. Outcomes were expressed as healing, major amputation, death and non healing after 12months...
June 2016: Diabetes Research and Clinical Practice
Julie Brouillet, Koen Deloose, Yann Goueffic, Mathieu Poirier, Dominique Midy, Caroline Caradu, Eric Ducasse
BACKGROUND: Recent advances in endovascular techniques have made it a seductive choice in the management of TASC C and D lesions. Currently, this tendency remains controversial, despite high success rates. The aim of the study was to regroup and harmo nize the results of three surgical teams in 5 centers in order to obtain the largest series ever published on TASC C and D femoro-popliteal lesions primary stenting. METHODS: 203 patients and 209 lower limbs were included from March 2008 to October 2013...
June 7, 2016: Journal of Cardiovascular Surgery
Konstantinos Spanos, Vasileios Saleptsis, Athanasios Athanasoulas, Christos Karathanos, Alexandra Bargiota, Philip Chan, Athanasios D Giannoukas
A prospective nonrandomized cohort study on consecutive diabetic patients with foot ulcer was undertaken to assess the factors associated with the healing process or limb salvage and evaluate the impact of their treatment on their quality of life. Quality of life was evaluated using Diabetic Foot Ulcer Scale-Short Form (DFS-SF) questionnaire before and after treatment. A total of 103 diabetic patients with ulcer (mean age 69.7 ± 9.6 years, 77% male) were treated and followed up for 12 months. Ulcer healing, minor amputation, and major amputation rates were 41%, 41%, and 18%, respectively, while the mortality rate was 18%...
May 25, 2016: Angiology
Konstantinos Spanos, Georgios Antoniou, Vasileios Saleptsis, Athanasios Athanasoulas, Aikaterini Drakou, Stylianos Koutsias, Athanasios D Giannoukas
BACKGROUND: To report the long term outcome of hybrid (combined open and endovascular) procedures for the management of multisegmental chronic peripheral arterial disease. METHODS: A retrospective analysis from a single center during the period 2009- 2013. Patency rates, survival and limb salvage were the primary outcomes. Univariate and multivariate analyses were used to assess the association with various factors. RESULTS: A total of 132 patients (116 males) with mean age of 69±1...
April 15, 2016: International Angiology: a Journal of the International Union of Angiology
T B Katrien Santema, Paul P C Poyck, Dirk T Ubbink
Skin substitutes are increasingly used in the treatment of various types of acute and chronic wounds. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness of skin substitutes on ulcer healing and limb salvage in the treatment of diabetic foot ulcers. Randomized clinical trials were searched and assessed following the methodology of The Cochrane Collaboration. We included 17 trials, totaling 1655 randomized participants. Risk of bias was variable among included trials...
July 2016: Wound Repair and Regeneration
Marlin W Causey, Ayman Ahmed, Bian Wu, Warren J Gasper, Alex Reyzelman, Shant M Vartanian, Jade S Hiramoto, Michael S Conte
OBJECTIVE: Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization...
June 2016: Journal of Vascular Surgery
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