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Critic limb ischemia

Satinderjit S Locham, Nawar Paracha, Hanaa Dakour Aridi, Besma Nejim, Muhammad Rizwan, Mahmoud B Malas
OBJECTIVE: Despite significant technical advancement in the last decade, the durability of endovascular management of critical limb ischemia (CLI) remains highly debatable. Drug eluting stents (DES) are being popularized for the management of CLI after its precedent success in coronary intervention. Initial reports on the durability of DES are promising. However little is known on the additional cost of this relatively newer technology. The aim of this study is to compare the cost of the traditional bare metal stents (BMS) to the newly introduced DES in a large cohort of CLI patients...
August 6, 2018: Annals of Vascular Surgery
Stavros Spiliopoulos, Konstantinos Moulakakis, Konstantinos Palialexis, Chrysostomos Konstantos, Lazaros Reppas, Ioannis Kakisis, Andreas Lazaris, George Geroulakos, Elias Brountzos
PURPOSE: To investigate the safety and efficacy of percutaneous stenting for the management of chronic ischemia caused by endograft limb occlusion following endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: This is a retrospective, single-centre study investigating all patients who underwent percutaneous endovascular covered or bare metal stent placement for the management of intermittent claudication (IC) or critical limb ischemia (CLI) following EVAR limb occlusion, between January 2010 and October 2017...
August 6, 2018: Annals of Vascular Surgery
Seung Woon Rha, Seung Hyuk Choi, Doo Il Kim, Dong Woon Jeon, Jae Hwan Lee, Kyung Soon Hong, Tae Joon Cha, Jang Hyun Cho, Sang Kon Lee, Yong Hwan Park, Woo Jung Park, Hyun Joo Kim, Young Joo Kim, Juneyoung Lee, Donghoon Choi
BACKGROUND AND OBJECTIVES: We aimed to investigate the history of medical resource consumption and quality of life (QoL) in peripheral arterial disease (PAD) patients in Korea. METHODS: This was a prospective, multi-center (23 tertiary-hospitals, division of cardiology), non-interventional study. Adult patients (age ≥20 years) suffering from PAD for the last 12-month were enrolled in the study if they met with any of following; 1) ankle-brachial index (ABI) ≤0...
June 18, 2018: Korean Circulation Journal
Sikandar Z Khan, Mariel Rivero, Gregory S Cherr, Linda M Harris, Maciej L Dryjski, Nader D Nader, Hasan H Dosluoglu
OBJECTIVE: The incidence of cardiovascular and limb-specific adverse outcomes is higher in PAD patients with diabetes. Metformin is associated with improved cardiovascular morbidity and mortality. However, the effect of metformin on limb-specific outcomes is unclear. The objective of this study was to assess the effect of metformin on outcomes following intervention for PAD. METHODS: Patients who underwent revascularization for chronic limb ischemia (Rutherford 3-6) between 06/2001-12/2014 were retrospectively identified...
August 3, 2018: Annals of Vascular Surgery
Tracy J Cheun, Lalithapriya Jayakumar, Maureen K Sheehan, Matthew J Sideman, Lori L Pounds, Mark G Davies
BACKGROUND: Critical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management. METHODS: A database of patients undergoing operative and nonoperative management for symptomatic below-the-elbow atherosclerotic disease between 2006 and 2016 was retrospectively queried...
July 28, 2018: Journal of Vascular Surgery
C Del Giudice, D Van Den Heuvel, J Wille, T Mirault, E Messas, R Ferraresi, S Kum, M Sapoval
The fifth author's name was incorrectly published as "M. Messas". The correct name is "E. Messas". The original article has been corrected.
July 30, 2018: Cardiovascular and Interventional Radiology
Pierre Abraham, Yongquan Gu, Lianrui Guo, Knut Kroeger, Nafi Ouedraogo, Paul Wennberg, Samir Henni
Exertional lower limb pain is a frequent diagnostic issue in elderly patients. Arterial claudication results from the mismatch between the oxygen requirement of, and oxygen delivery to the exercising muscles. Non-invasive vascular investigations (ultrasound imaging, plethysmography or segmental pressure) are used in routine at rest or following exercise, but none can be used during walking or to directly monitor cutaneous oxygen delivery to the limb. Here, we review the methods, tips and traps of the transcutaneous oxygen pressure measurement technique and potential applications...
July 19, 2018: Atherosclerosis
Charles A Andersen, Leo J Daab, Thuy-Duong Le, Dawn M Green, Renee L Tyminski, Mario Ponticello, Valerie Marmolejo
INTRODUCTION: Critical limb ischemia (CLI) is a leading cause of lower extremity amputation. When CLI is identified, revascularization should be performed if possible. When options for revascularization do not exist, use of a noninvasive intermittent pneumatic compression device (NPCD) can be considered. OBJECTIVE: Presented here are 2 cases of patients with nonreconstructable CLI at risk for limb loss who were serially assessed with indocyanine green fluorescence angiography (ICGFA) to determine the effects of NPCD use on local tissue perfusion...
July 2018: Wounds: a Compendium of Clinical Research and Practice
Takayasu Ohtake, Yasuhiro Mochida, Kunihiro Ishioka, Machiko Oka, Kyoko Maesato, Hidekazu Moriya, Sumi Hidaka, Satoshi Higashide, Tetsuya Ioji, Yasuyuki Fujita, Atsuhiko Kawamoto, Masanori Fukushima, Shuzo Kobayashi
Critical limb ischemia (CLI) is a devastating disease in patients undergoing hemodialysis (HD). Based on the unsatisfactory results of autologous mononuclear cell transplantation for patients with CLI undergoing HD, we conducted a phase II clinical trial to evaluate the safety and efficacy of granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood-derived autologous purified CD34 positive (CD34+) cell transplantation for CLI in patients undergoing HD. Six patients with CLI (two with Rutherford category 4 and four with Rutherford category 5) were enrolled...
July 30, 2018: Stem Cells Translational Medicine
Chung-Dann Kan, Jieh-Neng Wang, Wei-Peng Li, Shao-Hsien Lin, Wei-Ling Chen, Ya-Ping Hsu, Chen-Sheng Yeh
Peripheral Arterial Occlusive Disease (PAOD) is an aging disease that affecting the quality of life of many people by its intermittent claudication and critical limb ischemia presentations. Traditional treatment and management of PAOD are asking patients to make a life change and medication with antiplatelet, statins and cilostazol, which decrease the possibility of clot formation. Our strategy has employed a magnetic Fe3 O4 -PLGA polymersome to carry the cilostazol into the ischemic area by magnetic attraction following remote-control drug release through low-energy ultrasound exposure...
July 25, 2018: Nanomedicine: Nanotechnology, Biology, and Medicine
Francesca Persiani, Alessandra Paolini, Daniele Camilli, Luca Mascellari, Alessandro Platone, Alessandra Magenta, Sergio Furgiuele
OBJECTIVE: The aim of this study is to analyze the effects of peripheral blood mononuclear cells (PBMNCs) therapy in diabetic patients with critical limb ischemia (CLI), with particular regard to its application, as adjuvant therapy in patients underwent to endovascular revascularization. METHODS: Fifty diabetic patients affected by CLI were enrolled. All patients underwent to PBMNCs therapy. Thirty-two patients underwent to PBMNCs therapy associated to endovascular revascularization (adjuvant therapy group)...
July 24, 2018: Annals of Vascular Surgery
Erik Hanson-Viana, Mónica González-Rodríguez, Diego García-Vivanco, Mariel González-Calatayud
INTRODUCTION: Popliteal injuries are significant health risk that could induce permanent functional impairment, limb loss, and in some cases death. Currently, there is a controversy about the required treatment between amputation and a limb salvage surgery, which in some cases could cause more prominent functional impairment than the amputation. Different indicators help to predict, in some extent, the risk of amputation, however most of them were described two decades ago. PRESENTATION OF CASE: A patient with a prolonged hot ischemia and in critical conditions, which had no favorable clinical indicators for revascularization is shown and discussed...
June 20, 2018: International Journal of Surgery Case Reports
Alexander Meyer, Anne Schilling, Magdalena Kott, Ulrich Rother, Werner Lang, Susanne Regus
BACKGROUND: Evaluation of below-the-knee open revascularization (OR) versus endovascular revascularization (EVT) in patients with end-stage renal disease and critical limb ischemia (CLI) was performed. PATIENTS AND METHODS: Seventy-seven dialysis patients with CLI and infrapopliteal involvement from 2007 to 2017 were included. Thirty-five patients received OR and 42 patients were treated with EVT. Survival, amputation-free survival (AFS) and wound-healing were evaluated...
January 1, 2018: Vascular and Endovascular Surgery
C Del Giudice, D Van Den Heuvel, J Wille, T Mirault, E Messas, R Ferraresi, S Kum, M Sapoval
PURPOSE: To report our initial experience of fully percutaneous deep venous arterialization (pDVA) for the treatment of chronic critical limb ischemia (cCLI) after failed distal angioplasty. MATERIALS AND METHODS: pDVA was performed in five consecutive patients by creating an arteriovenous fistula (AVF) between a below the knee artery and its satellite deep vein. In this early experience, only patients with failed prior interventional attempts at establishing flow with no distal targets for an arterial bypass were selected...
July 17, 2018: Cardiovascular and Interventional Radiology
A Liew, C Baustian, D Thomas, E Vaughan, C Sanz-Nogués, M Creane, X Chen, S Alagesan, P Owens, J Horan, P Dockery, M D Griffin, A Duffy, T O'Brien
Intramuscular administration of mesenchymal stromal cells (MSCs) represents a therapeutic option for diabetic critical limb ischemia. Autologous or allogeneic approaches may be used but disease-induced cell dysfunction may limit therapeutic efficacy in the former. Our aim was to compare the efficacy of allogeneic and autologous MSC transplantation in a model of hindlimb ischemia in diabetes mellitus and to determine whether allogeneic transplantation would result in the activation of an immune response. MSCs were isolated from C57BL/6 (B6) and diabetic obese C57BKSdb/db mice...
August 2018: Cell Transplantation
Mitsuyoshi Takahara, Osamu Iida, Yoshimitsu Soga, Nobuyoshi Azuma, Shinsuke Nanto
BACKGROUND: The aim of the current study was to identify the distribution of length and cost of hospital stay and their associated risk factors in poor-risk Japanese critical limb ischemia (CLI) patients undergoing revascularization.Methods and Results:We analyzed prospectively collected data from 507 CLI patients who required assistance in their daily lives due to disability in activities of daily living and/or cognitive function impairment and who underwent revascularization. The median length and cost of hospital stay were 23 days (IQR, 9-52 days) and ¥2...
July 14, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Sébastien Perou, Augustin Pirvu, Jessica Morel, Jean-Luc Magne, Amandine Elie, Rafaelle Spear
OBJECTIVE: We evaluated the results of femoral bifurcation endarterectomy using the eversion technique with transection of the superficial femoral artery (FBEE). METHODS: We included all patients from January 2006 to December 2015 who underwent a femoral revascularization using the eversion technique, with or without antegrade or retrograde revascularization. Data were retrospectively collected. Primary and primary assisted patency of the femoral bifurcation were analyzed...
July 13, 2018: Annals of Vascular Surgery
Mehdi H Shishehbor, Jun Li
No abstract text is available yet for this article.
July 2018: Circulation. Cardiovascular Interventions
Yasuaki Takeji, Kyohei Yamaji, Yusuke Tomoi, Jin Okazaki, Kiyoshi Tanaka, Ayumu Nagae, Hiroyuki Jinnouchi, Seiichi Hiramori, Yoshimitsu Soga, Kenji Ando
BACKGROUND: The predictive ability of patient frailty on clinical outcomes after revascularization in patients with critical limb ischemia remains largely unknown. METHODS AND RESULTS: We enrolled 643 patients with critical limb ischemia treated with endovascular therapy (N=486) or bypass surgery (N=157) in January 2010 to January 2016, and prospectively assessed them using a 9-level clinical frailty scale (CFS). Patients were divided into 3 groups according to CFS levels: low (CFS level, 1-3; N=234), intermediate (CFS level, 4-6; N=196), and high (CFS level, 7-9; N=213) groups...
July 2018: Circulation. Cardiovascular Interventions
Tadashi Furuyama, Toshihiro Onohara, Sho Yamashita, Ryosuke Yoshiga, Keiji Yoshiya, Kentaro Inoue, Koichi Morisaki, Ryoichi Kyuragi, Takuya Matsumoto, Yoshihiko Maehara
Objective A multidisciplinary approach is required to treat critical limb ischemia. We determined the poor prognostic factors of ischemic ulcer healing after optimal arterial revascularization, and assessed the efficacy of the medication therapy using cilostazol, which is a selective inhibitor of phosphodiesterase 3. Methods In this retrospective, single-center, cohort study, 129 limbs that underwent infrainguinal arterial revascularization for Rutherford class 5 critical limb ischemia were reviewed. The primary end point was the ulcer healing time after arterial revascularization...
January 1, 2018: Vascular
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