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Diabetic limb salvage

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https://www.readbyqxmd.com/read/28887250/analysis-of-patients-undergoing-major-lower-extremity-amputation-in-the-vascular-quality-initiative
#1
Joshua Gabel, Brice Jabo, Sheela Patel, Sharon Kiang, Christian Bianchi, Jason Chiriano, Theodore Teruya, Ahmed M Abou-Zamzam
BACKGROUND: Despite an aggressive climate of limb salvage and revascularization, 7% of patients with peripheral artery disease undergo major lower extremity amputation (LEA). The purpose of this study was to describe the current demographics and early outcomes of patients undergoing major LEA in the Vascular Quality Initiative (VQI). METHODS: The VQI amputation registry was reviewed to identify patients who underwent major LEAs. Patient factors, limb characteristics, procedure type, and intraoperative variables were analyzed by level of amputation...
September 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28876595/acute-upper-limb-ischaemia-in-diabetic-patients-a-recent-experience
#2
R du Toit, A T O Abdool-Carrim, T Monareng
BACKGROUND: The outcome of acute upper limb ischaemia in diabetic patients is not well known. We report our recent experience with 5 patients. METHOD: Retrospective case reviews. RESULTS: All patients presented with Rutherford 2b ischaemia at a median 1.6 days after symptom onset. Age range: 43-76 years. M:F 1:4. Mean HbA1c: 10.1% (range 6.1 - 14.0) Mean LDL cholesterol: 3.1g/dL (range 1.61 - 4.80) Other comorbidities included: Ischaemic heart disease, atrial fibrillation, dyslipidaemia, hypertension, morbid obesity...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28807382/association-between-statin-therapy-and-amputation-free-survival-in-patients-with-critical-limb-ischemia-in-the-critisch-registry
#3
Konstantinos Stavroulakis, Matthias Borowski, Giovanni Torsello, Theodosios Bisdas
OBJECTIVE: Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity and mortality. Nonetheless, current recommendations are extrapolated from other high-risk populations because of the lack of CLI-dedicated trials. The aim of this explorative study was to evaluate the association of statin therapy with the outcomes of CLI patients. METHODS: The First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) registry is a prospective multicenter registry analyzing the effectiveness of all available treatment strategies in 1200 CLI patients...
August 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28756043/impact-of-angiosome-and-non-angiosome-targeted-peroneal-bypass-on-limb-salvage-and-healing-in-patients-with-chronic-limb-threatening-ischemia
#4
Jean-Baptiste Ricco, Mauro Gargiulo, Andrea Stella, Mohammad Abualhin, Enrico Gallitto, Mathieu Desvergnes, Romain Belmonte, Fabrice Schneider
BACKGROUND: Direct (DIR) or indirect (IND) revascularization of pedal angiosomes in patients with chronic limb-threatening ischemia (CLTI) has an unclear impact on limb salvage and healing. The aim of this study was to evaluate the outcomes of DIR and IND revascularization in patients with a peroneal bypass and tissue loss. METHODS: We conducted a retrospective study of a prospectively maintained database in two European university centers from 2004 to 2015. We extracted from this database all patients with CLTI and tissue loss who had received a bypass to the peroneal artery...
July 26, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28705338/-femoropopliteal-angioplasty-short-and-mid-term-results
#5
M Ben Hammamia, M Ben Mrad, B Derbel, R Miri, J Ziadi, F Ghedira, R Denguir, T Kalfat
BACKGROUND: Percutaneous endovascular therapy is becoming a primary option for managing femoropopliteal occlusive disease. The purpose of this study was to evaluate the mid-term results of endovascular treatment of femoropopliteal arterial disease. METHODS: Femoropopliteal percutaneous transluminal angioplasty was performed on 162 consecutive limbs (160 patients) from January 2006 to January 2016. RESULTS: In our study, 87.6% of patients had critical limb ischemia...
July 2017: J Med Vasc
https://www.readbyqxmd.com/read/28697694/midterm-outcomes-from-a-pilot-study-of-percutaneous-deep-vein-arterialization-for-the-treatment-of-no-option-critical-limb-ischemia
#6
Steven Kum, Yih Kai Tan, Michiel A Schreve, Roberto Ferraresi, Ramon L Varcoe, Andrej Schmidt, Dierk Scheinert, Jihad A Mustapha, Darryl M Lim, Derek Ho, Tjun Y Tang, Vlad-Adrian Alexandrescu, Pramook Mutirangura
PURPOSE: To report the initial clinical experience with percutaneous deep vein arterialization (PDVA) to treat critical limb ischemia (CLI) via the creation of an arteriovenous fistula. METHODS: Seven patients (median age 85 years; 5 women) with CLI and no traditional endovascular or surgical revascularization options (no-option CLI) were recruited in a pilot study to determine the safety of PDVA. All patients were diabetic; 4 had Rutherford category 6 ischemia...
July 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28648324/drug-coated-balloon-angioplasty-for-the-management-of-recurring-infrapopliteal-disease-in-diabetic-patients-with-critical-limb-ischemia
#7
Luis M Palena, Larry J Diaz-Sandoval, Efren Gòmez Jabalera, Olga Peypoch Perez, Enrico Sultato, Cesare Brigato, Enrico Brocco, Marco Manzi
OBJECTIVE: To describe the 1-year outcomes of recurring infrapopliteal disease after endovascular revascularization with the Lutonix drug-coated balloons (LDCB) in diabetic patients with critical limb ischemia (CLI), and to benchmark our findings with previously published objective performance goals (OPG) addressing safety and efficacy of new catheter-based therapies for CLI. METHODS: The present study was a retrospective, single-center, and single-arm trial of symptomatic diabetic patients with CLI, who underwent LDCB-angioplasty for recurring infrapopliteal disease...
June 20, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28630829/are-we-justified-doing-salvage-or-amputation-procedure-based-on-mangled-extremity-severity-score-in-mangled-upper-extremity-injury
#8
R Siva Kumar, Prahalad Kumar Singhi, M Chidambaram
INTRODUCTION: Mangled upper limb injuries are at surge because of industrialization, modernization, and severe motor vehicle accidents. The utility of various scoring systems are meant for decision making in mangled lower limb injuries, and the same have been extrapolated for mangled upper limb injuries to make a decision of salvage or amputation for the lack of separate scoring system. MATERIALS AND METHODS: We applied mangled extremity severity score (MESS) and mangled extremity syndrome index (MESI) scoring systems to 10 cases of mangled upper limb injuries during the period of November 2010 to September 2012 presented at our tertiary trauma care center...
January 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28578624/outcomes-after-endovascular-revascularization-in-octogenarians-and-non-octogenarians-with-critical-limb-ischemia
#9
Christian Uhl, Markus Steinbauer, Giovanni Torsello, Theodosios Bisdas
PURPOSE: To determine the outcome and periprocedural risk of endovascular revascularization in octogenarians with critical limb ischemia (CLI) compared with their younger counterparts. METHODS: The multicenter, prospective registry for First-line Treatments in Patients With Critical Limb Ischemia (CRITISCH) enrolled 642 patients treated with endovascular techniques ( ClinicalTrials.gov identifier NCT01877252). The patients were dichotomized according to age <80 years (n=421; mean age 69 years, 292 men; group 1) or ≥80 years (n=221; mean age 85 years, 113 men; group 2)...
August 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28567565/promoting-limb-salvage-through-multi-disciplinary-care-of-the-diabetic-patient
#10
REVIEW
Nichol L Salvo, Mark D Walsh, Luke P Brewster
Despite an explosion in the number of options available for helping diabetic patients heal wounds, major amputation remains a critical issue for these persons. Since diabetes prematurely ages tissues and no organ system is immune to its presence, it makes inherent sense that multi-disciplinary team approaches to these patients is necessary to make significant strides forward. Here, we present literature from the fields of podiatric surgery/medicine, vascular and plastic surgery and introduce the successes that a multi-disciplinary limb salvage center can have on the lives and limbs of patients with diabetes...
July 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28553572/think-before-chopping-a-diabetic-foot-insight-to-vascular-intervention
#11
EDITORIAL
Ahsan Zil-E-Ali, Saadia Shafi, Muhammad Hammad Ali
Diabetes mellitus is a most commonly occurring chronic disease around the world, resulting in damage to multiple organs. One of the consequences of poorly controlled diabetes is vascular damage resulting in peripheral artery disease, leading to inadequate perfusion of the foot and eventually gangrene and amputation. Research over the past decade or so has provided us with the statistics that vascular intervention has better clinical outcomes including patient mortality, morbidity, quality of life, and patient satisfaction...
April 25, 2017: Curēus
https://www.readbyqxmd.com/read/28541016/pedal-arch-patency-and-not-direct-angiosome-revascularization-predicts-outcomes-of-endovascular-interventions-in-diabetic-patients-with-critical-limb-ischemia
#12
Nicola Troisi, Filippo Turini, Emiliano Chisci, Leonardo Ercolini, Pierfrancesco Frosini, Renzo Lombardi, Francesca Falciani, Cristiana Baggiore, Roberto Anichini, Stefano Michelagnoli
BACKGROUND: Aim of this study was to evaluate the impact of pedal arch status and direct-angiosome revascularization (DAR) on clinical outcomes in diabetic patients with foot wounds undergoing endovascular revascularization. METHODS: Between January 2014 and June 2015 93 diabetic patients with foot wounds underwent endovascular revascularization of at least one below-the-knee vessel. Patients were divided into three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA) and absent pedal arch (APA)...
May 24, 2017: International Angiology: a Journal of the International Union of Angiology
https://www.readbyqxmd.com/read/28507873/inferior-limb-salvage-by-combined-free-tissue-transfer-and-the-crane-principle-revisited
#13
Alessandro Thione, Pedro C Cavadas
Aggressive treatment of ischemia of the lower extremities has decreased the number of amputations in both diabetic and nondiabetic patients; combined vascular reconstruction and microvascular free-flap transfer has been used to improve distal perfusion and cover large tissue defects caused by the critical limb ischemia during the past 30 years. We present our experience with a 71-year-old diabetic patient who underwent revascularization with a vascular bypass and a simultaneous microvascular flap reconstruction for limb salvage after domestic trauma...
April 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28502546/cryopreserved-saphenous-vein-as-a-last-ditch-conduit-for-limb-salvage
#14
Leigh Ann O'Banion, Bian Wu, Charles M Eichler, Linda M Reilly, Michael S Conte, Jade S Hiramoto
OBJECTIVE: In patients lacking autogenous vein suitable for infrainguinal bypass, cryopreserved saphenous vein (CSV) allograft (CryoLife, Inc, Kennesaw, Ga) may be an acceptable alternative. The purpose of this study was to examine outcomes of CSV conduit for infrainguinal revascularization. METHODS: Between February 2008 and August 2015, 70 patients underwent infrainguinal bypass grafts in 73 limbs using CSV. All patients lacked suitable arm or leg vein. Demographic data and patient outcomes were retrospectively collected using electronic medical records...
September 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28488101/impact-of-chronic-renal-failure-on-safety-and-effectiveness-of-paclitaxel-eluting-stents-for-femoropopliteal-artery-disease-subgroup-analysis-from-zilver-ptx-post-market-surveillance-study-in-japan
#15
Yukihisa Ogawa, Hiroyoshi Yokoi, Takao Ohki, Kimihiko Kichikawa, Masato Nakamura, Kimihiro Komori, Shinsuke Nanto, Erin E O'Leary, Aaron E Lottes, Alan T Saunders, Michael D Dake
PURPOSE: Favorable long-term outcomes of the Zilver PTX drug-eluting stent (DES) in femoropopliteal lesions have been demonstrated. Chronic renal failure (CRF) has been shown to be a risk factor for restenosis and decreased limb salvage. The results of the DES in patients with CRF have not previously been reported. This study compares the results with the DES in patients with CRF and those without CRF. METHODS: This retrospective analysis from the Zilver PTX Japan Post-Market Surveillance Study included 321 patients with CRF and 584 patients without CRF...
May 9, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28480286/the-association-between-geographic-density-of-infectious-disease-physicians-and-limb-preservation-in-patients-with-diabetic-foot-ulcers
#16
Meghan B Brennan, Glenn O Allen, Patrick D Ferguson, Joseph A McBride, Christopher J Crnich, Maureen A Smith
BACKGROUND: Avoiding major (above-ankle) amputation in patients with diabetic foot ulcers is best accomplished by multidisciplinary care teams with access to infectious disease specialists. However, access to infectious disease physicians is partially influenced by geography. We assessed the effect of living in a hospital referral region with a high geographic density of infectious disease physicians on major amputation for patients with diabetic foot ulcers. We studied geographic density, rather than infectious disease consultation, to capture both the direct and indirect (eg, informal consultation) effects of access to these providers on major amputation...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28479467/the-natural-history-and-outcomes-of-endovascular-therapy-for-claudication
#17
Julia T Saraidaridis, Emel A Ergul, W Darrin Clouse, Virendra I Patel, Richard P Cambria, Mark F Conrad
BACKGROUND: The natural history of claudication is well-characterized and traditional therapy includes risk factor modification and exercise protocols with revascularization reserved for patients who are severely impaired. However, the reduced periprocedural morbidity with endovascular therapy has led physicians to broaden the indications for intervention for peripheral artery disease, and more claudicants are undergoing procedures for disease that is moderately limiting to their lifestyle...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28479446/laser-atherectomy-for-the-treatment-of-peripheral-arterial-disease
#18
Alexandros Mallios, John Blebea, Bryan Buster, Ryan Messiner, Kevin Taubman, Harry Ma
OBJECTIVE: To investigate the clinical results of laser atherectomy in the treatment of peripheral arterial disease. METHODS: Retrospective analysis of consecutive patients undergoing laser atherectomy at a single institution during a seven year period by vascular surgeons and interventional cardiologists in a tertiary university-affiliated hospital. Clinical data was retrieved from patient charts and hospital electronic medical records along with the associated arteriograms...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28479423/treating-peripheral-artery-disease-in-the-wake-of-rising-costs-and-protracted-length-of-stay
#19
Grace J Wang, Benjamin M Jackson, Paul J Foley, Scott M Damrauer, Venkat Kalapatapu, Michael A Golden, Ronald M Fairman
OBJECTIVE: There has been growing scrutiny in the treatment of patients with peripheral artery disease (PAD) due to the utilization of resources to manage this complex patient population. The purpose of this study was to determine the factors associated with prolonged length of stay (LOS>7 days) following lower extremity bypass using data from the Vascular Quality Initiative (VQI) as well as to define the additional costs incurred due to prolonged LOS in our health system. METHODS: Summary statistics were performed of patients undergoing lower extremity bypass from 2010-2015...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28389295/a-meta-analysis-of-long-term-mortality-and-associated-risk-factors-following-lower-extremity-amputation
#20
REVIEW
Jordan R Stern, Christopher K Wong, Marina Yerovinkina, Stephanie J Spindler, Ashley S See, Samira Panjaki, Sarah L Loven, Rick F D'Andrea, Roman Nowygrod
BACKGROUND: A majority of patients undergoing lower limb amputations have diabetes or peripheral artery disease. Despite improvements in care, there remains a substantial perioperative mortality associated with these procedures. Less well-defined is the mortality risk to these patients going forward, once outside the perioperative period. The aim of this systematic review is to summarize and pool the available data to determine the long-term mortality associated with amputation in the diabetic and peripheral vascular patient, as well as to define specific factors associated with increased mortality risk...
April 5, 2017: Annals of Vascular Surgery
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