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critical limb ischemia

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https://www.readbyqxmd.com/read/29349406/thrombolytic-therapy-for-critical-limb-ischemia-in-a-jehovah-s-witness-with-severe-anemia
#1
Jeremy D Kauffman, T Joseph Watson, Joseph J Campbell
A patient's refusal to receive blood products can pose both clinical and ethical challenges to the surgeon. In this report, we review the case of a Jehovah's Witness presenting with critical lower limb ischemia and severe anemia for whom the decision of whether to perform thrombolytic therapy was complicated by his refusal to accept blood products. The case demonstrates that thrombolytic therapy can produce favorable results in severely anemic patients even when transfusion is not an option. We conclude that offering thrombolytic therapy in this context is a reasonable therapeutic option from both a clinical and ethical perspective...
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349396/isolated-lower-extremity-vasculitis-leading-to-progressive-critical-limb-ischemia
#2
Pouria Parsa, Anthony Rios, Lisa N Anderson, John F Eidt, Dennis Gable, Brad Grimsley
Giant cell arteritis is a large- and medium-vessel vasculitis that has been described as a systemic disease process with disseminated vessel involvement. Advances in vascular imaging techniques have demonstrated that involvement of the large vessels of the upper and lower limbs may be more prevalent than was once thought, although the clinical implications of this are unknown. Isolated lower extremity claudication without systemic or classic cranial symptoms, especially as a primary manifestation of giant cell arteritis, is rare...
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29346331/growth-hormone-gh-and-cardiovascular-system
#3
REVIEW
Diego Caicedo, Oscar Díaz, Pablo Devesa, Jesús Devesa
This review describes the positive effects of growth hormone (GH) on the cardiovascular system. We analyze why the vascular endothelium is a real internal secretion gland, whose inflammation is the first step for developing atherosclerosis, as well as the mechanisms by which GH acts on vessels improving oxidative stress imbalance and endothelial dysfunction. We also report how GH acts on coronary arterial disease and heart failure, and on peripheral arterial disease, inducing a neovascularization process that finally increases flow in ischemic tissues...
January 18, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29329963/switch-to-ticagrelor-in-critical-limb-ischemia-antiplatelet-study-stt-clips
#4
Leonardo C Clavijo, Ashwat Dhillon, Noor Al-Asady, Ray V Matthews, Jorge Caro, Han Tun, Vincent Rowe, David M Shavelle
OBJECTIVE: To investigate platelet reactivity in patients with critical limb ischemia (CLI) after switching from clopidogrel to ticagrelor. BACKGROUND: High on-treatment platelet reactivity (HPR) is highly prevalent in patients with CLI treated with clopidogrel. The effect of ticagrelor in patients with CLI is not known, however. METHODS: We performed P2Y12 platelet receptor inhibition studies (VASP and VerifyNow) in 50 patients with CLI. Tests were performed before and 6±1h after daily 75mg clopidogrel dose...
September 5, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29329771/low-rate-of-revascularization-procedures-and-poor-prognosis-particularly-in-male-patients-with-peripheral-artery-disease-a-propensity-score-matched-analysis
#5
Eva Freisinger, Nasser M Malyar, Holger Reinecke, Michael Unrath
BACKGROUND: Few data discuss the impact of sex on diagnostic and therapeutic procedures and outcome of patients with peripheral artery disease (PAD). METHODS: We obtained data on 41,873 PAD patients between 2009 and 2011 (including a 4-year follow-up) from the largest German public health insurance (BARMER GEK). Propensity Score Matching (PSM) was performed to evaluate the impact of sex on treatment, complications, in-hospital and long-term outcome. RESULTS: Of 41,873 PAD patients, there were 23,282 (55...
December 26, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29327586/composite-hydrogel-modified-by-igf-1c-domain-improves-stem-cell-therapy-for-limb-ischemia
#6
Xiaomin Wang, Jimin Zhang, Weilong Cui, Yuan Fang, Li Li, Shenglu Ji, Duo Mao, Tingyu Ke, Xin Yao, Dan Ding, Guowei Feng, Deling Kong
Stem cell treatment for critical limb ischemia yields a limited therapeutic effect due to cell loss and dysfunction caused by local ischemic environment. Biomimetic scaffolds emerge as ideal cell delivery vehicles for regulating cell fate via mimicking the components of stem cell niche. Herein, we prepared a bioactive hydrogel by mixing chitosan and hyaluronic acid that is immobilized with C domain peptide of IGF-1 (IGF-1C), and examined whether this hydrogel could augment stem cell survival and therapeutic potential...
January 12, 2018: ACS Applied Materials & Interfaces
https://www.readbyqxmd.com/read/29327573/treating-complex-femoro-popliteal-lesions
#7
Rozemarijn J van der Vijver-Coppen, Yannick W 't Mannetje, Theo P Menting, Jan-Willem Lardenoije, Michel M Reijnen
Peripheral artery disease affects 202 million patients worldwide and may cause disabling intermittent claudication and critical limb ischemia. Next to life style changes, best medical treatment and supervised exercise therapy, it can be necessary to re-vascularise the limb. Treatment of femoro-popliteal lesions poses a challenge and a surgical bypass remains recommended in the guidelines for longer and more complex lesions. Bypass surgery is associated with substantial morbidity and even mortality. Endovascular alternatives are quickly evolving from plain balloon angioplasty to drug-eluting stents, drug-coated balloons, polytetrafluoroethylene covered stents and atherectomy...
January 9, 2018: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29326151/sex-based-assessment-of-patient-presentation-lesion-characteristics-and-treatment-modalities-in-patients-undergoing-peripheral-vascular-intervention
#8
Niveditta Ramkumar, Bjoern D Suckow, Jeremiah R Brown, Art Sedrakyan, Jack L Cronenwett, Philip P Goodney
BACKGROUND: Limited evidence suggests that women and men might be treated differently for peripheral arterial disease. This analysis evaluated sex-based differences in disease presentation and its effect on treatment modality among patients who underwent endovascular treatment for peripheral arterial disease. METHODS AND RESULTS: Using national registry data from the Vascular Quality Initiative between 2010 and 2013, we examined patient, limb, and artery characteristics by sex through descriptive statistics...
January 2018: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29317991/successful-recanalization-of-long-femoro-crural-occlusive-disease-after-failed-bypass-surgery
#9
Grigorios Korosoglou, Tom Eisele, Dorothea Raupp, Christoph Eisenbach, Sorin Giusca
Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb. Endovascular procedures are currently preferred for these patients. We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb. The patient had history of left femoral popliteal bypass surgery, femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago. Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery (SFA) and popliteal artery and of all three infra-popliteal arteries...
December 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/29290494/high-and-immeasurable-ankle-brachial-index-as-predictor-of%C3%A2-poor-amputation-free-survival-in-critical-limb-ischemia
#10
Marlon I Spreen, Hendrik Gremmels, Martin Teraa, Ralf W Sprengers, Jasper M Martens, Marianne C Verhaar, Jan J Wever, Gert J de Borst, Jan A Vos, Willem P Th M Mali, Hans van Overhagen
OBJECTIVE: The objective of this study was to assess the prognostic value of a high or immeasurable ankle-brachial index (ABI) at baseline for major amputation and amputation-free survival (AFS) in patients with critical limb ischemia (CLI). METHODS: Data from two recent trials in patients with CLI and proven infrapopliteal arterial obstructive disease were pooled. Patients were allocated to the low (<0.7), intermediate (0.7-1.4), or high (>1.4)/immeasurable ABI subgroup...
December 28, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29290082/an-overview-and-update-of-femorofemoral-crossover-bypass-surgery-as-an-extra-anatomic-bypass-procedure
#11
Ahmet Yuksel, Mustafa Cagdas Cayir, Gencehan Kumtepe, Yusuf Velioglu, Fahri Hayri Atli, Ayhan Muduroglu, Orcun Gurbuz
Femorofemoral crossover bypass is a surgical arterial revascularization modality which is commonly performed for unilateral aortoiliac occlusive disease. It is primarily applied to patients with intermittent claudication or critical limb ischemia in whom underlying anatomic constraints rule out endovascular means of restoring in-line flow and those who do not qualify for anatomic reconstruction due to the comorbid conditions that preclude a more invasive open surgical approach. This surgical procedure may be also used as a complementary component of endovascular repair of abdominal aortic aneurysms when one aortoiliac arterial system is occluded to ensure exclusion of the aortic aneurysm...
December 31, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/29288558/aggressive-infrainguinal-revascularization-in-renal-transplant-patients-is-justifiable
#12
Rebecca Craig-Schapiro, Besma Nejim, Isibor Arhuidese, Mahmoud B Malas
While studies demonstrate poor outcomes of lower extremity revascularization in end-stage renal disease patients, little is known about results in renal transplant patients. We analyzed 2-year primary patency and limb salvage outcomes and associated risk factors of transplant (N=202) and non-transplant patients (N=25,274) in the Vascular Quality Initiative database undergoing infrainguinal bypass from 2003-2016. Multivariable Cox regression analysis and coarsened exact matching with many-to-one were employed...
December 29, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/29279532/acute-type-a-aortic-dissection-with-iliac-malperfusion-in-a-patient-with-scimitar-syndrome
#13
Jae Hang Lee, Jin-Ho Choi, Eung-Joong Kim
We encountered a 35-year-old male patient with scimitar syndrome, acute type A aortic dissection, and severe iliac malperfusion. He presented with pain and weakness of the left lower extremity and underwent ascending aorta replacement through sternotomy and right anterior thoracotomy. Left iliac artery flow was recovered after the operation and the patient was discharged on the tenth day without any complication. The purpose of this report is to discuss the considerations in aortic surgery in patients with scimitar syndrome, and the surgical principles for treatment of aortic dissection with critical limb ischemia...
December 27, 2017: International Heart Journal
https://www.readbyqxmd.com/read/29276108/sex-based-outcomes-of-lower-extremity-bypass-surgery-in-hemodialysis-patients
#14
Isibor Arhuidese, Amber Kernodle, Besma Nejim, Satinderjit Locham, Caitlin Hicks, Mahmoud B Malas
OBJECTIVE: The objective of this study was to compare conduit use and surgical outcomes of hemodialysis-dependent men and women after open lower extremity bypass surgery. METHODS: Using the United States Renal Data System, we studied all hemodialysis patients in the United States who underwent infrainguinal bypass surgery between January 1, 2006, and December 31, 2011. Univariate methods (χ2, analysis of variance) were employed to compare patient and bypass characteristics between men and women...
December 21, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29275511/successful-limb-salvage-from-critical-limb-ischemia-with-bilateral-variant-anatomy-of-infrapopliteal-arteries
#15
Daisuke Miyawaki, Tetsuya Nomura, Hiroshi Kubota, Masakazu Kikai, Natsuya Keira, Tetsuya Tatsumi
No abstract text is available yet for this article.
December 23, 2017: Cardiovascular Intervention and Therapeutics
https://www.readbyqxmd.com/read/29250834/comparison-of-drug-eluting-balloon-angioplasty-to-infrapopliteal-artery-critical-lesions-with-or-without-additional-pedal-artery-angioplasty-in-patients-with-diabetes-mellitus-and-critical-limb-ischemia
#16
Burak Teymen, Süleyman Aktürk
BACKGROUND: The purpose of this study is to investigate the feasibility and outcome of balloon angioplasty for the treatment of below the ankle (BTA) lesions in addition to below the knee (BTK) lesions in diabetic patients with critical limb ischemia (CLI). METHODS: Inclusion criteria are diabetes mellitus (DM), CLI (Rutherford class 4 or higher) and revascularized significant stenosis or occlusion of at least 1 below-the-knee vessel with incomplete or no pedal loop...
December 17, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/29248245/outcomes-of-tibial-endovascular-intervention-in-patients-with-poor-pedal-runoff
#17
Hallie E Baer-Bositis, Taylor D Hicks, Georges M Haidar, Matthew J Sideman, Lori L Pounds, Mark G Davies
OBJECTIVE: Tibial interventions for critical limb ischemia are now commonplace. The aim of this study was to examine the impact of pedal runoff on patient-centered outcomes after tibial endovascular intervention. METHODS: A database of patients undergoing lower extremity endovascular interventions at a single urban academic medical center between 2006 and 2016 was retrospectively queried. Patients with critical ischemia (Rutherford 5 and 6) were identified. Preintervention angiograms were reviewed in all cases to assess pedal runoff...
December 13, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29248242/plasma-microbiome-modulated-indole-and-phenyl-derived-metabolites-associate-with-advanced-atherosclerosis-and-postoperative-outcomes
#18
Cori A Cason, Kyle T Dolan, Gaurav Sharma, Ming Tao, Rohan Kulkarni, Irene B Helenowski, Brendan M Doane, Michael J Avram, Mary M McDermott, Eugene B Chang, C Keith Ozaki, Karen J Ho
OBJECTIVE: Multiple studies have shown that gut microbes contribute to atherosclerosis, and there is mounting evidence that microbial metabolism of dietary nutrients influences pathophysiology. We hypothesized that indole- and phenyl-derived metabolites that originate solely or in part from bacterial sources would differ between patients with advanced atherosclerosis and age- and sex-matched controls without clinically apparent atherosclerosis. METHODS: Plasma from the advanced atherosclerosis cohort (n = 100) was from patients who underwent carotid endarterectomy, open infrainguinal leg revascularization, or major leg amputation for critical limb ischemia...
December 13, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29246911/three-year-outcomes-of-surgical-versus-endovascular-revascularization-for-critical-limb-ischemia-the-spinach-study-surgical-reconstruction-versus-peripheral-intervention-in-patients-with-critical-limb-ischemia
#19
Osamu Iida, Mitsuyoshi Takahara, Yoshimitsu Soga, Akio Kodama, Hiroto Terashi, Nobuyoshi Azuma
BACKGROUND: The aim of this study was to compare clinical outcomes between surgical reconstruction and endovascular therapy (EVT) for critical limb ischemia (CLI) in today's real-world settings. METHODS AND RESULTS: This multicenter, prospective, observational study registered and followed 548 Japanese CLI patients. The registration was in advance of revascularization; 197 patients were scheduled to receive surgical reconstruction, and the remaining 351 were scheduled to receive EVT...
December 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29242407/central-role-of-the-p53-pathway-in-the-noncoding-rna-response-to-oxidative-stress
#20
Paola Fuschi, Matteo Carrara, Christine Voellenkle, Jose Manuel Garcia-Manteiga, Paolo Righini, Biagina Maimone, Elena Sangalli, Francesco Villa, Claudia Specchia, Mario Picozza, Giovanni Nano, Carlo Gaetano, Gaia Spinetti, Annibale A Puca, Alessandra Magenta, Fabio Martelli
Oxidative stress plays a fundamental role in many conditions. Specifically, redox imbalance inhibits endothelial cell (EC) growth, inducing cell death and senescence. We used global transcriptome profiling to investigate the involvement of noncoding-RNAs in these phenotypes. By RNA-sequencing, transcriptome changes were analyzed in human ECs exposed to H2O2, highlighting a pivotal role of p53-signaling. Bioinformatic analysis and validation in p53-silenced ECs, identified several p53-targets among both mRNAs and long noncoding-RNAs (lncRNAs), including MALAT1 and NEAT1...
December 12, 2017: Aging
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