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critical limb ischemia

Saroj Neupane, Sushruth Edla, Eesha Maidona, Matthew C Sweet, Susan Szpunar, Thomas Davis, Thomas A LaLonde, Rajendra H Mehta, Howard S Rosman, Hiroshi Yamasaki
OBJECTIVES: To evaluate the association of diabetes mellitus (DM) with clinical and angiographic characteristics and outcomes of patients with popliteal and infrapopliteal peripheral arterial disease (PAD) undergoing peripheral vascular intervention (PVI). BACKGROUND: Clinical features and outcomes in patients with DM and popliteal or infrapopliteal PAD undergoing PVI are not well described. METHODS: Using the data from the laser in popliteal and infrapopliteal stenosis study, we retrospectively examined the association of diabetes with clinical and angiographic characteristics and risk adjusted short- and intermediate term outcomes (all cause death, major adverse events (MAE) [composite of death, ipsilateral major amputation, or repeat revascularization]) in patients with popliteal and infrapopliteal PAD undergoing PVI for critical limb ischemia treated either with laser-assisted balloon angioplasty or balloon angioplasty alone...
March 14, 2018: Catheterization and Cardiovascular Interventions
Chakradhari Inampudi, Emmanuel Akintoye, Tomo Ando, Alexandros Briasoulis
Peripheral arterial disease (PAD) refers to narrowing of the peripheral arteries and atherosclerosis is the most important cause. In patients with PAD, revascularization is the preferred therapeutic strategy; nonetheless several patients are not deemed candidates for it due to advanced disease or several comorbidities. The main target of therapeutic angiogenesis is to promote development of new arterial vessels and improve perfusion of ischemic tissue. Angiogenic growth factors such as vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), hepatocyte growth factor (HGF), administered intramuscularly or intra-arterially, have been shown to promote angiogenesis and development of collateral vasculature in preclinical studies...
March 9, 2018: Current Opinion in Pharmacology
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. Restenosis and occlusion remain barriers to durability after intervention. The aim of this study was to examine the patient-centered outcomes of open and endovascular reintervention for symptomatic recurrent disease after a primary isolated tibial endovascular intervention. METHODS: A database of patients undergoing isolated primary lower extremity tibial endovascular interventions between 2006 and 2016 was retrospectively queried...
March 8, 2018: Journal of Vascular Surgery
Hong Kuan Kok, Shirish G Prabhudesai, Irfan Ahmed, Narayan Karunanithy, Said Abisi, Konstantinos Katsanos, Athanasios Diamantopoulos
PURPOSE: Endovascular treatment of infrapopliteal peripheral arterial disease (PAD) is an established and effective treatment strategy for patients with symptomatic PAD. Increasingly, complex infrapopliteal lesions are treated with an endovascular first approach, especially in the setting of critical limb ischemia for limb salvage, avoiding major amputations which impact on mobility and quality of life. However, many complex infrapopliteal lesions involving the bifurcation of the tibial arteries remain challenging to treat due to recoil or acute dissection following angioplasty and may require stenting using specialized techniques...
March 5, 2018: Annals of Vascular Surgery
Romeo Martini
In this review 14 studies were identified reporting the treatment strategy in 4891 patients with Critical Limb Ischemia (CLI) with the aim to investigate if the strategy of treatment of the first episode of CLI has changed during the last 15-20 years. A computer research has been performed on PubMed and Scopus databases on November 2016. The used terms for the investigation about studies evaluating the strategy of treatment of CLI at the first-time presentation, have been "critical leg ischemia", "critical limb ischemia", "critical lower limb ischemia" along with the terms "placebo", "medical treatment" and/or "conservative" revascularisation, surgical revascularisation, endovascular revascularisation, hybrid revascularisation and primary amputation...
March 1, 2018: Clinical Hemorheology and Microcirculation
Michael Creane, Mary Mc Elroy, Aoife Duffy, Chaansha Shaik Dawood, Timothy O'Brien
Critical limb ischemia (CLI) represents the severest manifestation of peripheral arterial disease and is a major unmet medical need. This disease occurs when the arterial blood supply within the limb fails to meet the metabolic demands of the resting muscle or tissue, resulting in chronic ischemic rest pain and/or tissue necrosis. Human mesenchymal stromal cells, termed hMSCs, represent an exciting therapeutic modality for the treatment of this disease due to their immunomodulatory and tissue reparative functions...
January 1, 2018: Toxicologic Pathology
S Keisin Wang, Linden A Green, Ashley R Gutwein, Natalie A Drucker, Clifford M Babbey, Alok K Gupta, Andres Fajardo, Raghu L Motaganahalli, Michael G Wilson, Michael P Murphy
OBJECTIVE: Ethnic minorities (nonwhites) with critical limb ischemia (CLI) have historically performed worse compared with whites with regard to major amputation risk reduction and amputation-free survival (AFS) after peripheral vascular intervention. This post hoc analysis was completed to determine whether this precedent also extended to treatment of CLI without a suitable revascularization option with intramuscular injections of concentrated bone marrow aspirate (cBMA). METHODS: The treatment arm of the randomized, double-blind, multicenter MarrowStim PAD Kit for the Treatment of Critical Limb Ischemia in Subjects with Severe Peripheral Arterial Disease (MOBILE) trial was stratified by ethnicity and evaluated for demographics, comorbidities, and outcomes...
March 1, 2018: Journal of Vascular Surgery
Atish Chopra, Amir F Azarbal, Enjae Jung, Cherrie Z Abraham, Timothy K Liem, Gregory J Landry, Gregory L Moneta, Erica L Mitchell
OBJECTIVE: Major lower extremity amputations (MLEAs) remain a significant source of disability. It is unknown whether postamputation functional outcomes and outcome predictability have changed with a population of increasingly aging and obese patients. Accordingly, we sought to evaluate contemporary trends. METHODS: A retrospective chart review was performed to identify patients undergoing MLEA using Current Procedural Terminology codes in a university hospital...
March 1, 2018: Journal of Vascular Surgery
Miroslav Špaček, Pavel Měřička, Libor Janoušek, Petr Štádler, Miloš Adamec, Robert Vlachovský, Igor Guňka, Pavel Navrátil, Filip Thieme, Petr Mitáš, Rudolf Špunda, Jaroslav Špatenka, Robert Staffa, Petr Němec, Jaroslav Lindner
The transplantation of fresh or cryopreserved vascular allografts in patients with a prosthetic graft infection or critical limb ischemia is necessary for their limb salvage and, in many cases, represents a lifesaving procedure. While transplantation of fresh allografts has a long history in the Czech Republic, the standard use of cryopreserved vascular allografts was introduced into the clinical practice in 2011 as a result of the implementation of EU Directive 2004/23/EC into national legislation (Human Cell and Tissue Act No...
March 3, 2018: Cell and Tissue Banking
Thermann F
Two cases of below- knee-bypasses using an arterialized cephalic vein are presented. Both patients had critical ischemia but no greater or lesser saphenous veins were useable. According to ultrasound, the cephalic veins were thin but regularly positioned. Four weeks after wrist fistula was created, ultrasound showed adequate maturation and the bypass operations were performed. Both patients had uneventful courses and were discharged after a few days with patent bypasses since then (35 and 18 months). As this report shows, creation of a fistula can be a useful option to gain autologous bypass material in case of critical limb ischemia...
March 1, 2018: Annals of Vascular Surgery
Nassiri N, Huntress LA
Endovascular salvage of failed surgical bypasses has been scantly reported for treatment of infrainguinal occlusive disease. While catheter-directed thrombolysis and/or mechanical thromboembolectomy have been the mainstay of endovascular salvage of previous bypass grafts, native vessel recanalization remains seldom attempted. Herein, we present a unique approach to native vessel recanalization of a chronically thrombosed popliteal artery aneurysm for non-healing distal ulceration.
March 1, 2018: Annals of Vascular Surgery
Anton A Khilchuk, Sergey V Vlasenko, Sergey G Scherbak, Andrey M Sarana, Vitaliy V Popov
Acute thrombotic occlusions of the large vessels, such as internal carotid artery, arms and legs arteries, and intracranial vessels, frequently require multiple techniques such as selective thrombolysis, manual aspiration, and stent retrievers for mechanical thrombectomy with combination of the mentioned techniques. Because of the massive thrombotic burden associated with these conditions, the response to systemic intravenous thrombolysis is poor. We present a case of a successful massive thrombi aspiration in a single attempt using an 8Fr guide catheter with aspiration syringe, subsequent ipsilateral middle cerebral artery mechanical thrombectomy, and axillary artery clot disruption attempt in a patient with acute ischemic stroke, right arm critical ischemia, and persistent atrial fibrillation...
February 2018: Radiology Case Reports
Toshio Takayama, Jon S Matsumura
BACKGROUND: Complete revascularization, achieving inline flow to the foot through at least 1 patent tibioperoneal artery, is considered to be desirable for treating critical limb ischemia (CLI). Hybrid procedure, combined femoral endarterectomy and endovascular treatment, is commonly performed on patients with CLI because they often present with complicated lower extremity lesions involving the common femoral artery. This study aimed to investigate the efficacy of complete revascularization (CR) achieved by hybrid procedure on limb salvage in patients with CLI...
January 1, 2018: Vascular and Endovascular Surgery
Fadi Saab, Michael R Jaff, Larry J Diaz-Sandoval, Gwennan D Engen, Theresa N McGoff, George Adams, Ashraf Al-Dadah, Philip P Goodney, Farhan Khawaja, Jihad A Mustapha
PURPOSE: To present the chronic total occlusion (CTO) crossing approach based on plaque cap morphology (CTOP) classification system and assess its ability to predict successful lesion crossing. METHODS: A retrospective analysis was conducted of imaging and procedure data from 114 consecutive symptomatic patients (mean age 69±11 years; 84 men) with claudication (Rutherford category 3) or critical limb ischemia (Rutherford category 4-6) who underwent endovascular interventions for 142 CTOs...
February 1, 2018: Journal of Endovascular Therapy
Yoshito Kadoya, Kan Zen, Yohei Oda, Satoaki Matoba
Tip separation of a Crosser catheter is a serious complication; however, there is limited information on bailout methods. Here, we describe a case of successful retrieval of the separated tip of a Crosser catheter using a 2-wire technique with a gooseneck snare. A 76-year-old woman with a history of hemodialysis and diabetes mellitus who developed ulcers on her right toes was diagnosed as having critical limb ischemia and underwent transfemoral antegrade endovascular treatment of the anterior tibial artery (ATA)...
January 1, 2018: Vascular and Endovascular Surgery
Samuel Fernández, Juan Carlos Parodi, Fabián Moscovich, Camilo Pulmari
BACKGROUND: Medical treatment of disabling intermittent claudication or critical limb threatening ischemia causing rest pain often fails or has partial response. METHODS: In this pilot study thirty-six patients (12 females) affected by disabling intermittent claudication or rest pain of the lower extremities were exposed to a daily 3 L water intake for up to six weeks. Cutaneous foot temperature, ankle/brachial index, time and distance of claudication and pain intensity were recorded before and at the completion of the hydration period...
February 23, 2018: Annals of Vascular Surgery
Nagy Mekhail, Ogi Visnjevac, Gerges Azer, Diana Sue Mehanny, Priya Agrawal, Victor Foorsov
To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization...
February 23, 2018: Regional Anesthesia and Pain Medicine
Jianming Guo, Lianrui Guo, Shijun Cui, Zhu Tong, Alan Dardik, Yongquan Gu
BACKGROUND: For patients with thromboangiitis obliterans (TAO), revascularization with bypass or angioplasty is frequently not feasible due to the poor outflow of the distal small vessels. We evaluated the long-term results of our experience treating patients with TAO with autologous bone marrow-derived mononuclear cells (ABMMNCs) to determine the safety and efficacy of ABMMNC therapy in patients with critical limb ischemia due to TAO. METHODS: This was a retrospective chart review from a single university hospital vascular surgery center between January 2005 and July 2006...
February 22, 2018: Stem Cell Research & Therapy
Yanbo Fan, Haocheng Lu, Wenying Liang, Minerva T Garcia-Barrio, Yanhong Guo, Ji Zhang, Tianqing Zhu, Yibai Hao, Jifeng Zhang, Y E Chen
<u>Rationale:</u> Post-ischemic angiogenesis is critical to limit the ischemic tissue damage and improve the blood flow recovery. The regulation and the underlying molecular mechanisms of post-ischemic angiogenesis are not fully unraveled. Transcription factor-EB (TFEB) is emerging as a master gene for autophagy and lysosome biogenesis. However, the role of TFEB in vascular disease is less understood. <u>Objective:</u> We aimed to determine the role of endothelial TFEB in post-ischemic angiogenesis and its underlying molecular mechanism...
February 21, 2018: Circulation Research
Berkan Ozpak, Sahin Bozok, Mustafa Cagdas Cayir
Objectives To evaluate 36-month outcomes of drug-eluting balloons in infrapopliteal (=below-the-knee) arterial segments, we made a prospective registry enrolling patients (Rutherford class 2 to 5, ankle-brachial index 0.4-0.7) who were revascularized with drug-eluting balloon from August 2011 to December 2014. Methods Three hundred and seven infrapopliteal arteries were revascularized only with drug-eluting balloon. Endpoints included target lesion revascularization, primary patency rate, and changes in ankle-brachial index and Rutherford class...
January 1, 2018: Vascular
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