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critical limb ischemia

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https://www.readbyqxmd.com/read/28325567/microvascular-surgery-in-the-congenital-cardiac-patient-a-case-series-exploring-feasibility-and-practical-applications
#1
John A LoGiudice, Karri Adamson, Nancy Ghanayem, Ronald K Woods, Michael E Mitchell
BACKGROUND: Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques. METHODS: A retrospective chart review of patients aged 0-18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015...
February 17, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28303468/human-very-small-embryonic-like-cells-support-vascular-maturation-and-therapeutic-revascularization-induced-by-endothelial-progenitor-cells
#2
Coralie L Guerin, Elisa Rossi, Bruno Saubamea, Audrey Cras, Virginie Mignon, Jean-Sébastien Silvestre, David M Smadja
Very small embryonic-like stem cells (VSELs) are major pluripotent stem cells defined as cells of small size being Lineage- negative, CD133-positive, and CD45-negative. We previously described that human bone marrow VSELs were able to differentiate into endothelial cells and promoted post-ischemic revascularization in mice with surgically induced critical limb ischemia. In the present work, we isolated bone marrow VSELs from patients with critical limb ischemia and studied their ability to support endothelial progenitor cells therapeutic capacity and revascularization potential...
March 16, 2017: Stem Cell Reviews
https://www.readbyqxmd.com/read/28298297/angiogenic-mechanisms-of-human-cd34-stem-cell-exosomes-in-the-repair-of-ischemic-hindlimb
#3
Prabhu Mathiyalagan, Yaxuan Liang, David Kim, Sol Misener, Tina Thorne, Christine Kamide, Ekaterina Klyachko, Douglas W Losordo, Roger J Hajjar, Susmita Sahoo
Rationale: Paracrine secretions appear to mediate therapeutic effects of human CD34(+) stem cells locally transplanted in patients with myocardial and critical limb ischemia as well as in animal models. Earlier, we had discovered that paracrine secretion from human CD34(+) cells contains pro-angiogenic, membrane-bound nano-vesicles called exosomes (CD34Exo). Objective: Here, we investigated the mechanisms of CD34Exo-mediated ischemic tissue repair and therapeutic angiogenesis by studying their miRNA content and uptake...
March 15, 2017: Circulation Research
https://www.readbyqxmd.com/read/28297569/administration-of-adult-human-bone-marrow-derived-cultured-pooled-allogeneic-mesenchymal-stromal-cells-in-critical-limb-ischemia-due-to-buerger-s-disease-phase-ii-study-report-suggests-clinical-efficacy
#4
Pawan K Gupta, Murali Krishna, Anoop Chullikana, Sanjay Desai, Rajkumar Murugesan, Santanu Dutta, Uday Sarkar, Radhakrishnan Raju, Anita Dhar, Rajiv Parakh, Lakshmanan Jeyaseelan, Pachaiyappan Viswanathan, Prasanth Kulapurathu Vellotare, Raviraja N Seetharam, Charan Thej, Mathiyazhagan Rengasamy, Sudha Balasubramanian, Anish S Majumdar
Critical limb ischemia (CLI) due to Buerger's disease is a major unmet medical need with a high incidence of morbidity. This phase II, prospective, nonrandomized, open-label, multicentric, dose-ranging study was conducted to assess the efficacy and safety of i.m. injection of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (BMMSC) in CLI due to Buerger's disease. Patients were allocated to three groups: 1 and 2 million cells/kg body weight (36 patients each) and standard of care (SOC) (18 patients)...
March 2017: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/28295971/mid-term-outcomes-of-orbital-atherectomy-combined-with-drug-coated-balloon-angioplasty-for-treatment-of-femoropopliteal-disease
#5
T Raymond Foley, Ryan P Cotter, Damianos G Kokkinidis, Daniel D Nguyen, Stephen W Waldo, Ehrin J Armstrong
PURPOSE: To assess the intraprocedural and mid-term outcomes of orbital atherectomy (OA) combined with drug-coated balloon (DCB) angioplasty for the treatment of calcified femoropopliteal disease. METHODS: In this single-center cohort, 89 patients (139 lesions) were treated with DCB angioplasty for claudication or critical limb ischemia (CLI). Angiographic characteristics and procedural outcomes were reviewed for patients treated with or without adjunctive OA. Lesion calcification was graded using two previously published scoring systems, the angiographic calcium score (ACS) and the peripheral artery calcification scoring system (PACSS)...
March 15, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28292886/optical-probing-of-gastrocnemius-in-patients-with-peripheral-artery-disease-characterizes-myopathic-biochemical-alterations-and-correlates-with-stage-of-disease
#6
Ryan A Becker, Kim Cluff, Nithyanandhi Duraisamy, Hootan Mehraein, Hussam Farhoud, Tracie Collins, George P Casale, Iraklis I Pipinos, Jeyamkondan Subbiah
Peripheral artery disease (PAD) is a condition caused by atherosclerotic blockages in the arteries supplying the lower limbs and is characterized by ischemia of the leg, progressive myopathy, and increased risk of limb loss. The affected leg muscles undergo significant changes of their biochemistry and metabolism including variations in the levels of many key proteins, lipids, and nucleotides. The mechanisms behind these changes are poorly understood. The objective of this study was to correlate the severity of the PAD disease stage and associated hemodynamic limitation (determined by the ankle brachial index, ABI) in the legs of the patients with alterations in the biochemistry of chronically ischemic leg muscle as determined by ATR-Fourier transform infrared micro-spectroscopy...
March 2017: Physiological Reports
https://www.readbyqxmd.com/read/28288436/cell-therapy-of-critical-limb-ischemia-in-diabetic-patients-state-of-art
#7
REVIEW
Michal Dubský, Alexandra Jirkovská, Robert Bem, Andrea Nemcová, Vladimira Fejfarová, Edward B Jude
In this review we report on the state of cell therapy of critical limb ischemia (CLI) with respect to differences between diabetic and non-diabetic patients mainly from the clinical point of view. CLI is the most severe form of peripheral arterial disease and its diagnosis and treatment in diabetic patients is very difficult. The therapeutic effect of standard methods of CLI treatment is only partial - more than one third of diabetic patients are not eligible for standard revascularization; therefore, new therapeutic techniques such as cell therapy have been studied in clinical trials...
February 27, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28287292/-long-term-results-after-invasive-treatment-of-critical-limb-ischemia
#8
Zoltán Ruzsa, Ferenc Kuti, Balázs Berta, Károly Tóth, Zoltán Bánsághi, Zoltán Vámosi, Kálmán Hüttl
INTRODUCTION AND AIM: Surgical tibial bypass for critical limb ischemia is associated with significant morbidity, mortality, and graft failure, whereas percutaneous angioplasty and stenting has promising results. The objective of this study was the investigation of the long term results of below-knee percutaneous angioplasty for restoring straight inline arterial flow in patients with critical limb ischemia. METHOD: The clinical and angiographic data of 281 consecutive patients with critical limb ischemia treated by PTA between 2008 and 2011 was evaluated in a prospective register...
March 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28287126/pet-cell-tracking-using-18-f-flt-is-not-limited-by-local-reuptake-of-free-radiotracer
#9
Mark G MacAskill, Adriana S Tavares, Junxi Wu, Christophe Lucatelli, Joanne C Mountford, Andrew H Baker, David E Newby, Patrick W F Hadoke
Assessing the retention of cell therapies following implantation is vital and often achieved by labelling cells with 2'-[(18)F]-fluoro-2'-deoxy-D-glucose ((18)F-FDG). However, this approach is limited by local retention of cell-effluxed radiotracer. Here, in a preclinical model of critical limb ischemia, we assessed a novel method of cell tracking using 3'-deoxy-3'-L-[(18)F]-fluorothymidine ((18)F-FLT); a clinically available radiotracer which we hypothesise will result in minimal local radiotracer reuptake and allow a more accurate estimation of cell retention...
March 13, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28279748/burden-of-readmissions-among-patients-with-critical-limb-ischemia
#10
Shikhar Agarwal, James M Pitcavage, Karan Sud, Badal Thakkar
BACKGROUND: Readmissions constitute a major healthcare burden among critical limb ischemia (CLI) patients. We aimed to study the incidence of readmission and factors affecting readmission in CLI patients. METHODS: All adult hospitalizations with a diagnosis code for CLI were included from State Inpatient Databases from Florida (2009-2013), New York (2010-2013) and California (2009-2011). Data were merged with the directory available from the American Hospital Association to obtain detailed information on hospital related characteristics...
March 3, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28279747/readmissions-for-critical-limb-ischemia-hear-no-evil
#11
EDITORIAL
Mehdi H Shishehbor, Herbert D Aronow
No abstract text is available yet for this article.
March 2, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28279723/physiologic-cryoamputation-in-managing-critically-ill-patients-with-septic-advanced-acute-limb-ischemia
#12
Samuel L Chen, Isabella J Kuo, Nii-Kabu Kabutey, Roy M Fujitani
OBJECTIVES: Certain critically ill patients with advanced acute limb ischemia with a non-viable extremity may be unsuitable for transport to the operating room to undergo definitive amputation. In these unstable patients, rapid regional cryotherapy allows for prompt infectious source control and correction of hemodynamic and metabolic abnormalities, thereby lessening the risk associated with definitive surgical amputation. We describe our refined technique for lower extremity physiologic cryoamputation and review our institutional experience...
March 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28265729/quality-control-of-the-foot-revascularization-using-indocyanine-green-fluorescence-imaging
#13
Nicla Settembre, Petteri Kauhanen, Anders Albäck, Kristyna Spillerova, Maarit Venermo
OBJECTIVES: Critical limb ischemia (CLI) is a clinical diagnosis, confirmed by objective tests, usually ankle-brachial index (ABI), toe pressure (TP) and TcPO2. Furthermore, the anatomical lesions in patients affected by CLI were visualized by ultrasound, angiography, CTA, or MRA. Indocyanine green fluorescence imaging (ICG-FI) is a diagnostic modality for assessing foot perfusion. We aimed to study the usefulness of ICG-FI in the quality control of revascularization. MATERIALS AND METHODS: One hundred and four CLI limbs in 101 patients were studied with ICG-FI using SPY Elite before and after open or endovascular revascularization...
March 6, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28259571/preoperative-inflammatory-status-as-a-predictor-of-primary-patency-after-femoropopliteal-stent-implantation
#14
Kenneth R Nakazawa, Sean P Wengerter, John R Power, Robert A Lookstein, Rami O Tadros, Windsor Ting, Peter L Faries, Ageliki G Vouyouka
OBJECTIVE: The purpose of this study was to evaluate the impact of preoperative inflammatory status, as determined by complete blood count test parameters, on 12- and 24-month patency of femoropopliteal stenting for peripheral arterial disease. METHODS: We retrospectively analyzed baseline clinical and angiographic data among 138 patients (median age, 73 years; 46% female) from 2005 to 2014 at our institution with preoperative complete blood count test values and information of patency for at least 12 months after first-time femoropopliteal stenting...
March 1, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28259568/chloroquine-improves-the-response-to-ischemic-muscle-injury-and-increases-hmgb1-after-arterial-ligation
#15
Jun Xu, Xiangdong Cui, Jiehua Li, Panagiotis Koutakis, Iraklis Pipinos, Edith Tzeng, Alex Chen, Ulka Sachdev
OBJECTIVE: We have previously shown that exogenous administration of the nuclear protein high mobility group box 1 (HMGB1) improves angiogenesis after tissue ischemia. Antagonizing HMGB1 prolongs muscle necrosis and deters regeneration. In this study, we evaluated HMGB1 expression in peripheral arterial disease (PAD) and the mechanisms that promote its release in a murine model of hindlimb ischemia. Specifically, we investigated how chloroquine (CQ), a commonly employed disease-modifying antirheumatic drug, promotes HMGB1 release from muscle...
March 1, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28259239/long-term-comparative-outcomes-of-patients-with-peripheral-artery-disease-with-and-without-concomitant-coronary-artery-disease
#16
Debbie C Chen, Gagan D Singh, Ehrin J Armstrong, Stephen W Waldo, John R Laird, Ezra A Amsterdam
There are limited contemporary data on guideline-directed medical therapy (GDMT) utilization and long-term clinical outcomes in patients with peripheral artery disease (PAD) with and without concomitant coronary artery disease (CAD). From 2006 to 2013, 879 patients with claudication or critical limb ischemia (CLI) underwent diagnostic angiography or therapeutic endovascular intervention at our multidisciplinary vascular center. GDMT use was assessed at the time of angiography, and major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality were determined during 5 years of follow-up...
January 25, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28257776/endovascular-treatment-of-peripheral-artery-disease-and-critical-limb-ischemia
#17
EDITORIAL
Ehrin J Armstrong
No abstract text is available yet for this article.
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257774/angiosome-guided-intervention-in-critical-limb-ischemia
#18
REVIEW
Matthew C Bunte, Mehdi H Shishehbor
The goals of treatment for critical limb ischemia (CLI) are alleviation of ischemic rest pain, healing of arterial insufficiency ulcers, and improving quality of life, thereby preventing limb loss and CLI-related mortality. Arterial revascularization is the foundation of a contemporary approach to promote amputation-free survival. Angiosome-directed revascularization has become a popular theory of reperfusion, whereby anatomically directed arterial flow is restored straight to the wound bed. Innovations in endovascular revascularization combined with a multidisciplinary strategy of wound care accelerate progress in CLI management...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257773/inframalleolar-intervention-for-limb-preservation
#19
REVIEW
Javier A Valle, Andrew F Prouse, Robert K Rogers
Critical limb ischemia (CLI) is a relatively prevalent and highly morbid condition. Patients with CLI have a poor prognosis, especially in the setting of incomplete revascularization. Traditionally, achieving optimal revascularization has been limited by the high prevalence of small-vessel disease in this population. More recently, advanced endovascular techniques, increased operator experience, and new technologies have enabled complete revascularization of inframalleolar disease with encouraging clinical results...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257772/contemporary-outcomes-of-endovascular-intervention-for-critical-limb-ischemia
#20
REVIEW
Pratik K Dalal, Anand Prasad
Critical limb ischemia (CLI) remains a significant cause of morbidity and mortality in patients with peripheral arterial disease. Optimal treatment strategies for CLI remain controversial. The only randomized trial comparing surgical with endovascular revascularization suggests no significant difference in limb salvage between open surgical bypass and angioplasty. Although novel endovascular strategies are now available, their efficacies remain largely untested in a randomized fashion. This review provides an overview of the data surrounding contemporary outcomes of endovascular therapy with an emphasis on current knowledge gaps...
April 2017: Interventional cardiology clinics
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