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Lower limb ischemia

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https://www.readbyqxmd.com/read/28630829/are-we-justified-doing-salvage-or-amputation-procedure-based-on-mangled-extremity-severity-score-in-mangled-upper-extremity-injury
#1
R Siva Kumar, Prahalad Kumar Singhi, M Chidambaram
INTRODUCTION: Mangled upper limb injuries are at surge because of industrialization, modernization, and severe motor vehicle accidents. The utility of various scoring systems are meant for decision making in mangled lower limb injuries, and the same have been extrapolated for mangled upper limb injuries to make a decision of salvage or amputation for the lack of separate scoring system. MATERIALS AND METHODS: We applied mangled extremity severity score (MESS) and mangled extremity syndrome index (MESI) scoring systems to 10 cases of mangled upper limb injuries during the period of November 2010 to September 2012 presented at our tertiary trauma care center...
January 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28630267/a-structured-review-of-antithrombotic-therapy-in-peripheral-artery-disease-with-a-focus-on-revascularization-a-tasc-intersociety-consensus-for-the-management-of-peripheral-artery-disease-initiative
#2
REVIEW
Connie N Hess, Lars Norgren, Gary M Ansel, Warren H Capell, John P Fletcher, F Gerry R Fowkes, Anders Gottsäter, Kerry Hitos, Michael R Jaff, Joakim Nordanstig, William R Hiatt
Peripheral artery disease affects >200 million people worldwide and is associated with significant limb and cardiovascular morbidity and mortality. Limb revascularization is recommended to improve function and quality of life for symptomatic patients with peripheral artery disease with intermittent claudication who have not responded to medical treatment. For patients with critical limb ischemia, the goals of revascularization are to relieve pain, help wound healing, and prevent limb loss. The baseline risk of cardiovascular and limb-related events demonstrated among patients with stable peripheral artery disease is elevated after revascularization and related to atherothrombosis and restenosis...
June 20, 2017: Circulation
https://www.readbyqxmd.com/read/28629353/lipid-emulsion-mitigates-impaired-pulmonary-function-induced-by-limb-ischemia-reperfusion-in-rats-through-attenuation-of-local-cellular-injury-and-the-subsequent-systemic-inflammatory
#3
Fangfang Xia, Yun Xia, Sisi Chen, Lulu Chen, Weijuan Zhu, Yuanqing Chen, Thomas J Papadimos, Xuzhong Xu, Le Liu
BACKGROUND: Limb ischemia/reperfusion causes inflammation and elicits oxidative stress that may lead to local tissue damage and remote organ such as lung injury. This study investigates pulmonary function after limb ischemia/reperfusion and the protective effect of a lipid emulsion (Intralipid). METHODS: Twenty-four rats were divided into three groups: sham operation group (group S), ischemia/reperfusion group (group IR), and lipid emulsion treatment group (group LE)...
June 19, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28623098/acquired-inhibition-of-microrna-124-protects-against-spinal-cord-ischemia-reperfusion-injury-partially-through-a-mitophagy-dependent-pathway
#4
Kun Liu, Lihui Yan, Xiaojing Jiang, Yang Yu, Hongbo Liu, Tianxiang Gu, Enyi Shi
OBJECTIVE: Mitophagy results in selective clearance of damaged mitochondria. We investigated whether mitophagy was involved in the neuroprotection by inhibiting microRNA (miRNA)-124 on ischemic spinal cords. METHODS: Inhibition of miRNA-124 was conducted by intrathecal injection of lentivirus vectors containing antagomiR-124. Spinal cord ischemia was induced in rats by crossclamping the descending aorta just distal to the left subclavian artery for 14 minutes. Hind-limb motor function was assessed with the motor deficit index (MDI)...
May 23, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28603176/autologous-bone-marrow-mononuclear-cell-implantation-and-its-impact-on-the-outcome-of-patients-with-critical-limb-ischemia%C3%A3-results-of-a-randomized-double-blind-placebo-controlled-trial
#5
Bernard Pignon, Marie-Antoinette Sevestre, Lukshe Kanagaratnam, Gilles Pernod, Dominique Stephan, Joseph Emmerich, Claude Clement, Gabrielle Sarlon, Carine Boulon, Claire Tournois, Philippe Nguyen
BACKGROUND: Cell therapy is a therapeutic option for patients presenting with nonrevascularizable critical limb ischemia (CLI). However there is a lack of firm evidence on its efficacy because of the paucity of randomized controlled trials.Methods and Results:The BALI trial was a multicenter, randomized, controlled, double-blind clinical trial that included 38 patients. For all of them, 500 mL of bone marrow were collected for preparation of a BM-MNC product that was implanted in patients assigned to active treatment...
June 10, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28593656/clinical-outcome-and-its-predictors-in-hemodialysis-patients-with-critical-limb-ischemia-undergoing-endovascular-therapy
#6
Shohei Kataoka, Junichi Yamaguchi, Masashi Nakao, Kentaro Jujo, Nobuhisa Hagiwara
OBJECTIVES: This study aimed to examine prognosis and causes of death in hemodialysis (HD) patients with critical limb ischemia (CLI) after endovascular therapy (EVT). BACKGROUND: EVT is becoming a first-line treatment in patients with CLI. Nonetheless, only a few studies have examined prognosis and its predictors in HD patients with CLI undergoing EVT, who are known to be at high-risk. Moreover, causes of death in this population are not clarified to date. METHODS: We examined 175 consecutive patients who underwent EVT for CLI between March 2009 and March 2014...
June 8, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28592707/endothelial-nitric-oxide-synthase-independent-pleiotropic-effects-of-pitavastatin-against-atherogenesis-and-limb-ischemia-in-mice
#7
Takeshi Mitsuhashi, Ryoko Uemoto, Kazue Ishikawa, Sumiko Yoshida, Yasumasa Ikeda, Shusuke Yagi, Toshio Matsumoto, Masashi Akaike, Ken-Ichi Aihara
AIM: Statins have a protective impact against cardiovascular diseases through not only lipid-lowering effects but also pleiotropic effects, including activation of the endothelial nitric oxide synthase (eNOS) system. We aimed to clarify the protective effects of a statin against atherogenesis and ischemia in eNOS(-/-) mice. METHODS: Study 1. eNOS(-/-) Apolipoprotein E (ApoE)(-/-) mice were treated with a vehicle or pitavastatin (0.3 mg/kg/day) for 4 weeks...
June 6, 2017: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/28587531/dapagliflozin-for-the-treatment-of-type-1-diabetes-mellitus
#8
Kalliopi Pafili, Efstratios Maltezos, Nikolaos Papanas
In 2017, the management of type 1 diabetes mellitus (T1DM) remains intriguing for the clinician, who has to balance between adequate glycemic control and untoward events related to insulin up-titration. Thus, agents that will complement insulin actions and reduce adverse effects are highly welcome. Areas covered: In this review, the authors summarize results from studies on the sodium glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin in T1DM. Expert opinion: In T1DM, dapagliflozin is associated with significant antihyperglycemic and metabolic properties, which are achieved with reduction or stabilization of insulin dose and with a very low trend for hypoglycemia...
June 12, 2017: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/28571881/radial-artery-access-for-peripheral-endovascular-procedures
#9
Avnee J Kumar, Lauren E Jones, Kenneth R Kollmeyer, Robert W Feldtman, Craig A Ferrara, Michelle N Moe, Julia F Chen, Jasmine L Richmond, Sam S Ahn
OBJECTIVE: The radial artery is often used for coronary angiography, with a demonstrated decrease in local complications and an increase in postoperative mobility of the patient. Data on radial artery access for peripheral endovascular procedures, however, are limited. We describe our experience with radial artery access for diagnostic and endovascular interventions. METHODS: Between February 2012 and March 2015, there were 95 endovascular procedures performed using radial artery access in 80 unique patients...
May 29, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28562573/predictors-of-secondary-amputation-in-patients-with-grade-iiic-lower-limb-injuries-a-retrospective-analysis-of-35-patients
#10
Wenhao Song, DongSheng Zhou, Jinlei Dong
The aim of this study was to identify risk factors for failure of limb salvage surgery in grade IIIC lower extremity injuries.A single-institution, retrospective review was performed of all patients with grade IIIC lower limb injuries presenting from January 2009 to April 2014. We gathered the data on each patient who underwent limb salvage and analyzed the final outcome for these patients (limb salvage vs secondary amputation).Grade IIIC lower limb injuries were identified in 41 patients. Primary amputation was performed in 6 patients (15%) as the initial procedure...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28559976/quantitative-photoacoustic-imaging-for-early-detection-of-muscle-ischemia-injury
#11
Liang Chen, Hengheng Ma, Hong Liu, Kangquan Shou, Xun Zheng, Quli Fan, Aixi Yu, Xiang Hu
Acute lower extremity ischemia is a limb-and life-threatening problem. The timing of clinical intervention is critical to achieving optimal outcomes. However, there has been a lack of effective techniques capable of evaluating muscle and limb damage. Microcirculatory injury is the initial pathological change during ischemic muscle injury. Here, we performed photoacoustic imaging (PAI) in real time to quantitatively detect the degree of microcirculatory injury of ischemic muscles in a rat model in which Evans blue (EB), which strongly binds to albumin in blood, was used as a nontoxic molecular PA probe...
2017: American Journal of Translational Research
https://www.readbyqxmd.com/read/28559173/surgeon-not-institution-case-volume-is-associated-with-limb-outcomes-after-lower-extremity-bypass-for-critical-limb-ischemia-in-the-vascular-quality-initiative
#12
Lily E Johnston, Margaret C Tracci, John A Kern, Kenneth J Cherry, Irving L Kron, Gilbert R Upchurch, William P Robinson
OBJECTIVE: Studies from large administrative databases have demonstrated associations between institutional case volume and outcomes after lower extremity bypass (LEB). We hypothesized that increased institutional and surgeon volume would be associated with improved outcomes after LEB. Using a national, prospectively collected clinical database, the objective of this study was to determine the effects of both surgeon and institutional volume on outcomes after LEB. METHODS: The Vascular Quality Initiative (VQI) was queried to identify all LEBs for critical limb ischemia or claudication between 2004 and 2014...
May 27, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28558502/six-month-results-from-the-initial-randomized-study-of-the-ranger-paclitaxel-coated-balloon
#13
Yvonne Bausback, Andrea Willfort-Ehringer, Horst Sievert, Volker Geist, Michael Lichtenberg, Costantino Del Giudice, Antoine Sauguet, Juan Diaz-Cartelle, Claudia Marx, Armin Ströbel, Ingolf Schult, Dierk Scheinert
PURPOSE: To evaluate the performance of the Ranger paclitaxel-coated balloon vs uncoated balloon angioplasty for femoropopliteal lesions. METHODS: Between January 2014 and October 2015, the prospective, randomized RANGER SFA study ( ClinicalTrials.gov identifier NCT02013193) enrolled 105 patients with symptomatic lower limb ischemia (Rutherford category 2-4) and stenotic lesions in the nonstented femoropopliteal segment at 10 European centers. Seventy-one patients (mean age 68±8 years; 53 men) were enrolled in the Ranger drug-coated balloon (DCB) arm and 34 patients (mean age 67±9 years; 23 men) were assigned to the control group...
May 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28549963/the-role-of-the-profundoplasty-in-the-modern-management-of-patient-with-peripheral-vascular-disease
#14
Maurizio Taurino, Francesca Persiani, Roberta Ficarelli, Federico Filippi, Raffaele Dito, Luigi Rizzo
OBJECTIVE: The occlusion of superficial femoris artery (SFA), is a common feature in peripheral vascular disease, so the profunda femoris artery (PFA) is a crucial collateral pathway for the perfusion of the lower limb. The purpose of this study is to discuss the safety, clinical and hemodynamic efficacy of profundoplasty on the basis of limb salvage, patency and freedom from reintervention rates. Furthermore this study aims to identify the risk factors linked to the failure of the procedure...
May 23, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28527930/outcomes-of-open-and-endovascular-lower-extremity-revascularization-in-active-smokers-with-advanced-peripheral-arterial-disease
#15
Samuel L Chen, Matthew D Whealon, Nii-Kabu Kabutey, Isabella J Kuo, Michael D Sgroi, Roy M Fujitani
OBJECTIVE: Concern over perioperative and long-term durability of lower extremity revascularizations among active smokers is a frequent deterrent for vascular surgeons to perform elective lower extremity revascularization. In this study, we examined perioperative outcomes of lower extremity endovascular (LEE) revascularization and open lower extremity bypass (LEB) in active smokers with intermittent claudication (IC) and critical limb ischemia (CLI). METHODS: Active smokers undergoing LEE or LEB from 2011 to 2014 were identified in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) targeted vascular data set...
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28520446/-diabetic-foot-syndrome-importance-of-calf-muscles-mr-spectroscopy-in-the-assessment-of-limb-ischemia-and-effect-of-revascularization
#16
Andrea Němcová, Michal Dubský, Alexandra Jirkovská, Petr Šedivý, Miloslav Drobný, Milan Hájek, Monika Dezortová, Robert Bém, Vladimíra Fejfarová, Anna Pyšná
AIM: The standard method for assessment of effect of revascularization in patients with diabetic foot (DF) and critical limb ischemia (CLI) is transcutaneous oxygen pressure (TcPO2). Phosphorus magnetic resonance spectroscopy (31P MRS) enables to evaluate oxidative muscle metabolism that could be impaired in patients with diabetes and its complications. The aim of our study was to compare MRS of calf muscle between patients with DF and CLI and healthy controls and to evaluate the contribution of MRS in the assessment of the effect of revascularization...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28515746/veno-arterial-extracorporeal-membrane-oxygenation-as-cardiogenic-shock-therapy-support-in-adult-patients-after-heart-surgery
#17
Robert Musiał, Krystyna Ochońska, Andrzej Proc, Jarosław Stoliński, Dariusz Plicner, Bogusław Kapelak, Rafał Drwiła
INTRODUCTION: The authors present their personal experience in qualifying and treating adult patients using veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) in postcardiotomy cardiogenic shock. AIM: The aim of this study was to analyze the results of VA ECMO in patients with postcardiotomy cardiogenic shock. An analysis of the risk factors of postoperative mortality was also performed. MATERIAL AND METHODS: We analyzed the perioperative results of survivors and non-survivors of treatment using VA ECMO...
March 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28508973/phlegmasia-cerulean-dolens-complication-of-femoral-vein-catheterization
#18
M Hari Krishna Reddy, B Sangeetha, M Aruna, V Sarat Chandra, Anil C Venkata Kumar, R Ram, V Sivakumar
There are three less frequent manifestations of acute massive venous thrombosis and obstruction of the venous drainage of an extremity. They are phlegmasia alba dolens, phlegmasia cerulean dolens (PCD), and venous gangrene. The term PCD differentiates ischemia-associated massive venous thrombosis from phlegmasia alba dolens, which describes fulminant venous thrombosis without ischemia. We present a 55-year-old hypertensive, who presented with paedal oedema and breathlessness at rest. About a month prior to this admission, she suffered dislocation of left patella...
November 2016: CEN Case Reports
https://www.readbyqxmd.com/read/28508349/the-contemporary-role-of-stents-and-angioplasty-for-the-treatment-of-infrapopliteal-disease-in-critical-limb-ischemia
#19
REVIEW
Tarek A Hammad, Anand Prasad
PURPOSE OF REVIEW: Critical limb ischemia (CLI) is associated with significant morbidity, mortality, and increased health care expenses. Revascularization has a central role in the treatment of CLI. Following publication of BASIL (bypass versus angioplasty in severe ischemia of the leg) trial a decade ago, an "endovascular first" approach had gained momentum and the technologies available for endovascular therapy have exponentially increased. Both the development of technology and technique, highlighted in this review, have allowed operators to treat complex infrapopliteal lesions which are central to CLI pathology...
July 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28507873/inferior-limb-salvage-by-combined-free-tissue-transfer-and-the-crane-principle-revisited
#20
Alessandro Thione, Pedro C Cavadas
Aggressive treatment of ischemia of the lower extremities has decreased the number of amputations in both diabetic and nondiabetic patients; combined vascular reconstruction and microvascular free-flap transfer has been used to improve distal perfusion and cover large tissue defects caused by the critical limb ischemia during the past 30 years. We present our experience with a 71-year-old diabetic patient who underwent revascularization with a vascular bypass and a simultaneous microvascular flap reconstruction for limb salvage after domestic trauma...
April 2017: Plastic and Reconstructive Surgery. Global Open
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