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Critic limb ischemia

V Goshchynsky, O Lugoviy, P Goshchynsky, S Lugoviy, U Lugoviy
A retrospective analysis of the results of endovascular operations on the arteries of the lower extremities was performed in 209 patients, of which 45 (21.5%) were patients with chronic ischemia of the 2nd stage, category 4, 138 (66.1%) of patients with ischemia of the lower extremities of the third stag, category 5 and 26 (12.4%) of patients with IV stage, category 6 (by classification Rutherford et al., 1997) 17, 187 men, 22 women. The average age of patients was 63.7±9.3 years. Based on clinical and angiographic data, several variants of endovascular revascularization of the lower extremities were used: the vasoballoone segmentation followed by its stenting with a self-expanding stent of Terumo Misago (Japan) or a stent of Palmas Cordis (USA), one stent or two end-to-end stents (the stenting of the artery was supplemented by vasoballoone dilatation of the segment over the stents, between stents or under stents), sub intimal angioplasty was performed under the condition of Re-Entry Outback (Cordis, USA), balloon angioplasty was used using IN cylinders...
October 2018: Georgian Medical News
Stavros Spiliopoulos, Panagiotis M Kitrou, Elias N Brountzos
Patients with below-the-knee arterial disease are primarily individuals suffering from critical limb ischemia (CLI), while a large percentage of these patients are also suffering from diabetes or chronic renal failure or both. Available data from randomized controlled trials and their meta-analysis demonstrated that the use of infrapopliteal drug-eluting stents (DES), in short- to medium- length lesions, obtains significantly better results compared to plain balloon angioplasty and bare metal stenting with regards to vascular restenosis, target lesion revascularization, wound healing and amputations...
November 26, 2018: World Journal of Cardiology
Erik Groot Jebbink, Suzanne Holewijn, Michel Versluis, Frederike Grimme, Jan Willem Hinnen, Sebastian Sixt, John F Angle, Walter Dorigo, Michel M P J Reijnen
PURPOSE: To evaluate short- and long-term technical and clinical outcomes after kissing stent treatment of aortoiliac occlusive disease (AIOD) based on an individual participant data (IPD) meta-analysis. MATERIALS AND METHODS: A search of the Scopus database identified 156 articles on KS treatment of AIOD; of these 22 met the inclusion criteria. Authors of 19 articles with contact information were approached to join an IPD consortium. Eight author groups responded and 5 provided anonymized data for merging into an IPD database...
November 30, 2018: Journal of Endovascular Therapy
Houman Khalili, Haekyung Jeon-Slaughter, Ehrin J Armstrong, Amutharani Baskar, Ishita Tejani, Nicolas W Shammas, Anand Prasad, Mazen Abu-Fadel, Emmanouil S Brilakis, Subhash Banerjee
BACKGROUND: Use of atherectomy for the treatment of peripheral arterial disease (PAD) is increasing as an adjunctive treatment to either conventional or drug-coated balloon angioplasty. There is limited data on atherectomy outcomes in below-the-knee (BTK) endovascular interventions. METHODS: Data from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were analyzed to examine predictors of atherectomy use and its associated 1-year patency rate...
November 30, 2018: Catheterization and Cardiovascular Interventions
Jessica P Simons, Andres Schanzer, Julie M Flahive, Nicholas H Osborne, Joseph L Mills, Andrew W Bradbury, Michael S Conte
OBJECTIVE: Accurate survival prediction critically influences decision-making in caring for patients with chronic limb-threatening ischemia (CLTI). The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial demonstrated that in patients who survived >2 years, there was a significant advantage to infrainguinal bypass compared with endovascular intervention, which increased with time. Validated survival models for patients with CLTI are lacking. METHODS: The Vascular Quality Initiative was interrogated for patients who underwent infrainguinal bypass or endovascular intervention for CLTI (January 2003-February 2017)...
November 26, 2018: Journal of Vascular Surgery
Beau M Hawkins, Herbert D Aronow, Sahil A Parikh, Kenneth Rosenfield, Srihari S Naidu, Brian Fennel, Kristin Fontenot, Mary Nicolosi, Christopher Tieche
The aim of this article is to discuss the poor outcomes associated with critical limb ischemia (CLI) and the required knowledge needed for optimal care. There is an opportunity for the Society for Cardiovascular Angiography and Interventions (SCAI) to assist interventional cardiologists in enhancing CLI care through creation of training standards and development of educational content.
November 29, 2018: Catheterization and Cardiovascular Interventions
Sanne M Schreuder, M Nieuwdorp, Marc J W Koelemay, Shandra Bipat, Jim A Reekers
Objective: There is evidence from the literature that dysfunctionality of the sympathetic nervous system of the foot with subsequent loss of local autoregulation could be a predictor of early amputation in patients with diabetes with a neuroischemic ulcer. To confirm this we tested the functionality of the sympathetic nervous system in the foot in a consecutive group of 31 patients with diabetes with critical limb ischemia and non-healing neuroischemic ulcer. Research design and methods: Prospective cohort with retrospective analysis after 12 months of routinely acquired clinical data...
2018: BMJ Open Diabetes Research & Care
Tetsuro Miyata, Yukihito Higashi, Hiroshi Shigematsu, Hideki Origasa, Masatoshi Fujita, Hiroshi Matsuo, Hiroaki Naritomi, Hiroaki Matsuda, Masahide Nakajima, Satoshi Yuki, Hideto Awano
Surveillance of cardiovascular Events in Antiplatelet-treated arterioSclerosis Obliterans patients in JapaN (SEASON) is a 2-year, prospective, real-world, registry study conducted in Japan from 2009 to 2013. This post hoc analysis evaluated risk factors for limb ischemia in patients with peripheral arterial disease (PAD) and ankle-brachial index (ABI) <0.90. Vascular events were adjudicated by an Efficacy Endpoint Review Committee. Cox regression identified predictors of limb-specific peripheral vascular events (amputation, development of critical limb ischemia, and acute limb ischemia)...
November 26, 2018: Angiology
Yang Woo Kwon, Seung Jun Lee, Soon Chul Heo, Tae Wook Lee, Gyu Tae Park, Jung Won Yoon, Seung-Chul Kim, Ho Jin Shin, Sang Chul Lee, Jae Ho Kim
Circulating angiogenic cells (CACs) have been implicated in the repair of ischemic tissues, and their mobilization from bone marrow is known to be regulated by the activations of chemokine receptors, including CXCR2 and CXCR4. This study was conducted to investigate the role of N-acetylated proline-glycine-proline (Ac-PGP; a collagen-derived chemotactic tripeptide) on CAC mobilization and its therapeutic potential for the treatment of peripheral artery diseases. Ac-PGP was administered daily to a murine hind limb ischemia model, and the effects of Ac-PGP on blood perfusion and CAC mobilization (Sca1+ Flk1+ cells) into peripheral blood were assessed...
November 26, 2018: Stem Cells Translational Medicine
Isibor Arhuidese, Besma Nejim, Rebecca Craig-Schapiro, Muhammad Rizwan, Mahmoud B Malas
OBJECTIVE: Outcomes of infrainguinal bypass surgery (IBS) in patients with renal transplants are largely undescribed. This study evaluated perioperative and long-term outcomes of IBS using autogenous and prosthetic conduits in a large population-based cohort of renal transplantation patients. METHODS: A retrospective review of all renal transplantation patients who underwent IBS between January 2007 and December 2011 in the United States Renal Data System was performed...
December 2018: Journal of Vascular Surgery
Anna Z Fashandi, J Hunter Mehaffey, Robert B Hawkins, Irving L Kron, Gilbert R Upchurch, William P Robinson
OBJECTIVE: Major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) at 30 days provide standardized metrics for comparison and have been adopted by the Society for Vascular Surgery's objective performance goals for critical limb ischemia. However, MALEs and MACEs have not been widely adopted within the claudication population, and the comparative outcomes after lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) remain unclear. The purpose of this study was to compare MALEs and MACEs after LEB and IEI in a contemporary national cohort and to determine predictors of MALEs and MACEs after revascularization for claudication...
December 2018: Journal of Vascular Surgery
K Houdek, J Zeithaml, V Třeška
INTRODUCTION: Cardiovascular disorders and their complications are the leading causes of death all over the world. The number of patients with critical limb ischemia and in risk of amputation is increasing together with increased incidence of cardiovascular diseases. In comparison with comparable population, the prognosis of patients after limb amputation is much worse. In case with no possible revascularisation, stem cell therapy offers a possible option for limb salvage. METHODS: We collected relevant informations from published and accessible studies available on internet database Pubmed in period of 2007-2017...
2018: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Naoki Hayakawa, Satoshi Kodera, Noriyoshi Ohki, Syunichi Kushida, Hiroyuki Morita, Junji Kanda, Issei Komuro
A high percentage of patients with critical limb ischemia have concurrent chronic kidney disease (CKD). However, endovascular therapy (EVT) can be problematic in CKD patients. Thus, we developed a method of EVT using digital subtraction angiography (DSA) with diluted contrast medium (low-concentration DSA), wherein DSA parameters were adjusted for diluted contrast angiography (1:10 dilution). Herein, we report the case of an 88-year-old woman with a foot wound and severe CKD. Her estimated glomerular filtration rate was 7...
November 20, 2018: International Heart Journal
Peter Lang, Daniel Contractor, Sreedhar Kallakuri
No abstract text is available yet for this article.
February 1, 2018: American Surgeon
Joël Constans, Alessandra Bura-Rivière, Adriana Visona, Marianne Brodmann, Pierre Abraham, Dan-Mircea Olinic, Juraj Madaric, Sabine Steiner, Isabelle Quéré, Lucia Mazzolai, Jill Belch, Christian Heiss, Zsolt Pécsvárady, Karel Roztocil, Mary-Paula Colgan, Dragan Vasic, Anders Gottsäter, Evangelos Dimakakos, Ali Chraim, Pavel Poredoš, Patrick H Carpentier, Jean-Claude Wautrecht, Agata Stanek, Vinco Boc
Chronic critical lower limb ischemia (CLI) has been defined as ischemia that endangers the leg. An attempt was made to give a precise definition of CLI, based on clinical and hemodynamic data (Second European Consensus). CLI may be easily defined from a clinical point of view as rest pain of the distal foot or gangrene or ulceration. It is probably useful to add leg ulcers of other origin which do not heal because of severe ischemia, and to consider the impact of frailty on adverse outcome. From a hemodynamic viewpoint there is no consensus and most of the existing classifications are not based upon evidence...
November 19, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Ukachukwu Okoroafor Abaraogu, Elochukwu Fortune Ezenwankwo, Philippa Margaret Dall, Chris Andrew Seenan
BACKGROUND: Peripheral arterial disease (PAD) has a significant negative impact on the quality of life of individuals. Understanding the experiences of people living with PAD will be useful in developing comprehensive patient-centred secondary prevention therapies for this population. AIM: The aim of this study is to identify first-hand accounts of patients' experiences of living with PAD. METHODS: Six databases (CINALH, PsyclNFO, MEDLINE, AMED, EMBASE, Social citation index/Science citation index via Web of Science (WOS)) and reference lists of identified studies were searched until September 2017 (updated February 2018)...
2018: PloS One
Kazunori Ono, Kenji Yanishi, Makoto Ariyoshi, Satoshi Kaimoto, Motoki Uchihashi, Keisuke Shoji, Satoaki Matoba
BACKGROUND: Therapeutic angiogenesis with basic fibroblast growth factor (bFGF) with atelocollagen was confirmed in a study using a limb ischemia mouse model. Because the number of elderly patients with critical limb ischemia (CLI) is increasing, particularly that caused by arteriosclerosis obliterans (ASO), the development of less invasive angiogenesis therapies desired. Methods and Results: This first-in-man clinical study was designed to assess the safety and efficacy of i.m. injection of bFGF with atelocollagen...
November 9, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Kimihiko Kichikawa, Shigeo Ichihashi, Hiroyoshi Yokoi, Takao Ohki, Masato Nakamura, Kimihiro Komori, Shinsuke Nanto, Erin E O'Leary, Aaron E Lottes, Scott A Snyder, Michael D Dake
PURPOSE: A prospective, multicenter post-market surveillance study in Japan evaluated the 2-year safety and effectiveness of the DES in real-world patients with complex femoropopliteal artery lesions. METHODS: There were no exclusion criteria, and consecutive symptomatic patients with femoropopliteal lesions treated with the DES were enrolled in the study. Clinically driven target lesion revascularization (TLR) was defined as reintervention performed for > 50% diameter stenosis after recurrent clinical symptoms of peripheral arterial disease...
November 8, 2018: Cardiovascular and Interventional Radiology
Ziyou Yu, Yizuo Cai, Mingwu Deng, Dong Li, Xiangsheng Wang, Hongjie Zheng, Yuda Xu, Wei Li, Wenjie Zhang
BACKGROUND: The proangiogenic capacity of adipose tissue and its derivatives has been demonstrated in a variety of studies. The paracrine mechanism of the cellular component is considered to play a critical role in the regenerative properties of these tissues. However, cell-based therapy for clinical application has been hindered by limitations such as safety, immunogenicity issues, and difficulties in cell preservation, transportation, and phenotype control. In the current study, we aimed to produce a cell-free extract directly from human fat tissue and evaluate its potential therapeutic efficacy...
November 8, 2018: Stem Cell Research & Therapy
Chung Ho Leung, Christopher A Caldarone, Rui Guan, Xiao-Yan Wen, Menachem Ailenberg, Andras Kapus, Katalin Szaszi, Ori D Rotstein
AIMS: Remote ischemic conditioning (RIC) protects against organ ischemia/reperfusion injury in experimental and clinical settings. We have demonstrated that RIC prevents liver and lung inflammation/injury following hemorrhagic shock/resuscitation (S/R). In the current study, we used a murine model of S/R to investigate the role of Nrf2 in mediating hepatoprotection. RESULTS: The combination of RIC with S/R caused a synergistic rise in Nrf2 and its translocation to the nucleus in the liver...
November 7, 2018: Antioxidants & Redox Signaling
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