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Lower limb ischemia

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https://www.readbyqxmd.com/read/28922142/reduced-amputation-rate-with-isovolemic-hemodilution-in-critical-limb-ischemia-patients
#1
Doosang Kim, Daniel J Cho, Young I Cho
AIMS: Critical limb ischemia (CLI) patients are characterized by intractable pain in spite of medication, non-healing ulcers, and gangrene. The objective of this study was to investigate whether or not isovolemic hemodilution treatment can reduce the rate of major amputations in CLI. METHODS: 28 patients were studied who had tissue loss on Rutherford Grade III, Category 5 or 6. The subjects were divided into two arms: standard-of-care, conventional therapy (CT) (n = 15) as a control group and hemodilution therapy (HT) (n = 13) as a study group...
September 11, 2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/28920529/surgical-interventions-for-organ-and-limb-ischemia-associated-with-primary-and-secondary-antiphospholipid-antibody-syndrome-with-arterial-involvement
#2
Carlos A Hinojosa, Javier E Anaya-Ayala, Karla Bermudez-Serrato, Ramón García-Alva, Hugo Laparra-Escareno, Adriana Torres-Machorro, Rene Lizola
OBJECTIVE: The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. METHODS: Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28902715/protecting-the-heart-from-ischemia-reperfusion-injury-an-update-on-remote-ischemic-preconditioning-and-postconditioning
#3
Martín Donato, Pablo Evelson, Ricardo J Gelpi
PURPOSE OF REVIEW: The most effective strategy for reducing acute myocardial ischemic injury is timely and effective reperfusion. However, myocardial reperfusion can induce further cardiomyocyte death (reperfusion injury). Interventions that protect the heart from ischemia/reperfusion injury, reducing infarct size, can involve remote ischemic preconditioning and postconditioning. These interventions have a promising potential clinical application, and have been the focus of recent research...
September 11, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28901993/vascular-complications-and-use-of-a-distal-perfusion-cannula-in-femorally-cannulated-patients-on-extracorporeal-membrane-oxygenation
#4
David N Ranney, Ehsan Benrashid, James M Meza, Jeffrey E Keenan, Desiree Bonadonna, Leila Mureebe, Mitchell W Cox, Mani A Daneshmand
Femoral arterial cannulation in adult venoarterial (VA) extracorporeal membrane oxygenation (ECMO) predisposes patients to ipsilateral limb ischemia. Placement of a distal perfusion catheter (DPC) is one of few techniques available to prevent or manage this complication. Although frequently used, the indications for and timing of DPC placement are poorly characterized, and no guidelines are available to guide its use. The purpose of this study was to compare the incidences of vascular complications and limb ischemia between patients who did and did not receive a DPC at the time of primary ECMO cannulation...
September 7, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28900672/extracorporeal-membrane-oxygenation-in-adult-patients-with-acute-fulminant-myocarditis-clinical-outcomes-and-risk-factor-analysis
#5
X Liao, B Li, Z Cheng
BACKGROUND: Our study aimed to summarize the clinical outcomes of extracorporeal membrane oxygenation (ECMO) in adult patients with acute fulminant myocarditis and to investigate the risk factors associated with its application. PATIENTS AND METHODS: We retrospectively examined patients with cardiogenic shock and acute fulminant myocarditis. The following data were collected: patients' preoperative general condition, related clinical factors during ECMO, complications, and outcomes of ECMO...
September 12, 2017: Herz
https://www.readbyqxmd.com/read/28890062/national-utilization-and-outcomes-of-redo-lower-extremity-bypass-vs-endovascular-intervention-after-previous-failed-bypass-redo-lower-extremity-bypass-superior-to-endovascular-intervention
#6
J Hunter Mehaffey, Alexander Shannon, Robert B Hawkins, Anna Fashandi, Margret C Tracci, Irving L Kron, Gilbert R Upchurch, William P Robinson
BACKGROUND: Redo Lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) are options to treat critical limb ischemia after a failed prior lower extremity bypass but the utilization and outcomes of each are poorly described. The purpose of this study was to compare 30-day Major Adverse Limb Events (MALE) and Major Adverse Cardiovascular Events (MACE) after LEB and IEI in patients with a failed prior ipsilateral LEB and determine risk factors for each composite outcome...
September 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28887250/analysis-of-patients-undergoing-major-lower-extremity-amputation-in-the-vascular-quality-initiative
#7
Joshua Gabel, Brice Jabo, Sheela Patel, Sharon Kiang, Christian Bianchi, Jason Chiriano, Theodore Teruya, Ahmed M Abou-Zamzam
BACKGROUND: Despite an aggressive climate of limb salvage and revascularization, 7% of patients with peripheral artery disease undergo major lower extremity amputation (LEA). The purpose of this study was to describe the current demographics and early outcomes of patients undergoing major LEA in the Vascular Quality Initiative (VQI). METHODS: The VQI amputation registry was reviewed to identify patients who underwent major LEAs. Patient factors, limb characteristics, procedure type, and intraoperative variables were analyzed by level of amputation...
September 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28876565/pattern-and-distribution-of-peripheral-arterial-disease-in-diabetic-patients-with-critical-limb-ischemia-rutherford-clinical-category-4-6
#8
M J Motsumi, N G Naidoo
BACKGROUND: This study investigated the pattern and distribution of peripheral arterial disease in diabetic patients with critical limb ischaemia (CLI) and to stratify the findings according to the patients' risk factor profile, gender and age group. METHOD: We conducted a one-year prospective descriptive study (January 2014 to December 2014) at Groote Schuur Hospital, University of Cape Town. The research protocol and the informed consent were approved by the Institutional Review Board, and all subjects included in this study gave an informed consent...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28872035/prevalence-and-severity-of-peripheral-arterial-disease-among-patient-with-heel-pressure-ulcer-a-retrospective-study-of-42-patients
#9
Guillaume Tisserand, Nora Zenati, Christophe Seinturier, Sophie Blaise, Gilles Pernod
Heel pressure ulcer is a major complication in elderly hospitalized patients. The association with peripheral arterial disease (PAD) which is also a frequent disease in this population is poorly known. The aim of this study was to assess the prevalence of PAD and critical limb ischemia (CLI) in patients with heel pressure ulcer. Patients referred to the vascular medicine department for heel pressure ulcer from October 2014 to June 2015 were included in the study. The assessment of peripheral arterial disease was made with the results of ankle brachial index and/or doppler ultra sound of lower limb arteries...
September 1, 2017: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/28870682/association-of-arterial-calcification-with-chronic-limb-ischemia-in-patients-with-peripheral-artery-disease
#10
Sara L Zettervall, Andre P Marshall, Paul Fleser, Raul J Guzman
OBJECTIVE: Arterial calcification is associated with an increased risk of limb events, including amputation. The association between calcification in lower extremity arteries and the severity of ischemia, however, has not been assessed. We thus sought to determine whether the extent of peripheral artery calcification (PAC) was correlated with Rutherford chronic ischemia categories and hypothesized that it could independently contribute to worsening limb status. METHODS: We retrospectively reviewed all patients presenting with symptomatic peripheral artery disease who underwent evaluation by contrast and noncontrast computed tomography scan of the lower extremities as part of their assessment...
September 1, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28869535/mitochondrial-targeted-antioxidant-maintains-blood-flow-mitochondrial-function-and-redox-balance-in-old-mice-following-prolonged-limb-ischemia
#11
Shunsuke Miura, Shu-Ichi Saitoh, Tomoki Kokubun, Takashi Owada, Hiroyuki Yamauchi, Hirofumi Machii, Yasuchika Takeishi
Aging is a major factor in the decline of limb blood flow with ischemia. However, the underlying mechanism remains unclear. We investigated the role of mitochondrial reactive oxygen species (ROS) with regard to limb perfusion recovery in aging during ischemia. We performed femoral artery ligation in young and old mice with or without treatment with a scavenger of mitochondrial superoxide, MitoTEMPO (180 μg/kg/day, from pre-operative day 7 to post-operative day (POD) 21) infusion using an implanted mini-pump...
September 4, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28868311/occlusive-shrinkage-of-ovation-endograft-presenting-as-acute-lower-limb-ischemia-effective-endovascular-management
#12
Paolo Bianchi, Filippo Scalise, Andrea Mortara, Guido Lanzillo, Giuseppe Scardina, Santi Trimarchi, Gianfranco Parati, Valerio Tolva
The aim of this report is to describe the imaging and successful treatment of an acute shrinkage of the Ovation Abdominal Stent Graft System. The Ovation Prime system utilizes a polymer-filled sealing ring that is cast in situ at the margin of the aneurysm; however, the residual endograft inner volume after ring filling may reduce volume and graft flow. Nevertheless, there are no reports about severe complications using the Ovation Prime system. A 75-year-old male presented to our hospital for acute lower limb ischemia...
February 2017: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28866449/fractional-flow-reserve-in-below-the-knee-arteries-with-critical-limb-ischemia-and-validation-against-gold-standard-morphologic-functional-measures-and-long-term-clinical-outcomes
#13
Zoltán Ruzsa, Szilárd Róna, Gábor G Tóth, Péter Sótonyi, Olivier F Bertrand, Balázs Nemes, Béla Merkely, Kálmán Hüttl
INTRODUCTION: The aim of this study was to assess the applicability of fractional flow reserve measurement (FFR) in below-the-knee (BTK) arteries and to evaluate its correlation with non-invasive functional parameters before and after angioplasty. METHODS: We enrolled 39 patients with severe BTK arterial lesions. Inclusion criteria were critical limb ischemia (Rutherford 4-6) and angiographically proven arterial stenosis of the distal lower limb (percent diameter stenosis ≥70%)...
July 18, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28852591/the-effects-of-allogenic-stem-cells-in-a-murine-model-of-hind-limb-diabetic-ischemic-tissue
#14
Jesús Álvarez García, Soledad García Gómez-Heras, Luis Riera Del Moral, Carlota Largo, Damián García-Olmo, Mariano García-Arranz
BACKGROUND: Diabetes is one of the major risk factors for peripheral arterial disease. In patients in whom surgery cannot be performed, cell therapy may be an alternative treatment. Since time is crucial for these patients, we propose the use of allogenic mesenchymal cells. METHODS: We obtained mesenchymal cells derived from the fat tissue of a healthy Sprague-Dawley rat. Previous diabetic induction with streptozotocin in 40 male Sprague-Dawley rats, ligation plus left iliac and femoral artery sections were performed as a previously described model of ischemia...
2017: PeerJ
https://www.readbyqxmd.com/read/28852403/recovery-of-sympathetic-nerve-function-after-lumbar-sympathectomy-is-slower-in-the-hind-limbs-than-in-the-torso
#15
Zhi-Fang Zheng, Yi-Shu Liu, Xuan Min, Jian-Bing Tang, Hong-Wei Liu, Biao Cheng
Local sympathetic denervation by surgical sympathectomy is used in the treatment of lower limb ulcers and ischemia, but the restoration of cutaneous sympathetic nerve functions is less clear. This study aims to explore the recovery of cutaneous sympathetic functions after bilateral L2-4 sympathectomy. The skin temperature of the left feet, using a point monitoring thermometer, increased intraoperatively after sympathectomy. The cytoplasm of sympathetic neurons contained tyrosine hydroxylase and dopamine β-hydroxylase, visualized by immunofluorescence, indicated the accuracy of sympathectomy...
July 2017: Neural Regeneration Research
https://www.readbyqxmd.com/read/28845831/early-rehabilitative-treatment-after-infrainguinal-lower-limb-bypass-surgery
#16
Ettore Carlisi, Patrick Caspani, Paola Morlino, Maria Teresa Bardoni, Claudio Lisi, Maurizio Bejor, Elena Dalla Toffola
BACKGROUND AND AIM OF THE WORK: Functional activity may remain limited in patients affected by critical limb ischemia, despite successful infrainguinal lower limb bypass surgery (ILLBS). The aim of the work was to evaluate the impact of a rehabilitative intervention on postoperative ambulatory status and pain. METHODS: In an observational study, data were collected on 34 patients undergoing ILLBS for critical limb ischemia or end-stage peripheral arterial disease...
August 23, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/28844467/patient-selection-and-perioperative-outcomes-of-bypass-and-endovascular-intervention-as-first-revascularization-strategy-for-infrainguinal-arterial-disease
#17
Thomas C F Bodewes, Jeremy D Darling, Sarah E Deery, Thomas F X O'Donnell, Alexander B Pothof, Katie E Shean, Frans L Moll, Marc L Schermerhorn
OBJECTIVE: The optimal initial revascularization strategy remains uncertain for patients with peripheral arterial disease. The purpose of this study was to evaluate current nationwide selection and perioperative outcomes of patients undergoing bypass or endovascular intervention for infrainguinal disease in those with no prior ipsilateral revascularization. METHODS: Patients undergoing nonemergent first-time infrainguinal revascularization were identified in the Targeted Vascular module of the National Surgical Quality Improvement Program (NSQIP) for 2011 to 2014 and stratified by symptom status (chronic limb-threatening ischemia [CLTI] or claudication)...
August 22, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28839998/high-rate-of-arterial-complications-in-patients-supported-with-extracorporeal-life-support-for-drug-intoxication-induced-refractory-cardiogenic-shock-or-cardiac-arrest
#18
Matteo Pozzi, Catherine Koffel, Camelia Djaref, Daniel Grinberg, Jean Luc Fellahi, Elisabeth Hugon-Vallet, Cyril Prieur, Jacques Robin, Jean François Obadia
BACKGROUND: Cardiac failure is still a leading cause of death in drug intoxication. Extracorporeal life support (ECLS) could be used as a rescue therapeutic option in patients developing refractory cardiogenic shock or cardiac arrest. The aim of this report is to present our results of ECLS in the setting of poisoning from cardiotoxic drugs. METHODS: We included in this analysis consecutive patients who received an ECLS for refractory cardiogenic shock or in-hospital cardiac arrest due to drug intoxication...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28836900/a-nationwide-analysis-of-30-day-readmissions-related-to-critical-limb-ischemia
#19
Reza Masoomi, Zubair Shah, Clay Quint, Kirk Hance, Karthik Vamanan, Anand Prasad, Andrew Hoel, Buddhadeb Dawn, Kamal Gupta
Objectives There is paucity of information regarding critical limb ischemia-related readmission rates in patients admitted with critical limb ischemia. We studied 30-day critical limb ischemia-related readmission rate, its predictors, and clinical outcomes using a nationwide real-world dataset. Methods We did a secondary analysis of the 2013 Nationwide Readmissions Database. We included all patients with a primary diagnosis of extremity rest pain, ulceration, and gangrene secondary to peripheral arterial disease...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28835590/association-between-preoperative-frailty-and-mortality-in-patients-with-critical-limb-ischemia-following-infrainguinal-bypass-surgery%C3%A3-usefulness-of-the-barthel-index
#20
Akio Kodama, Akio Koyama, Masayuki Sugimoto, Kiyoaki Niimi, Hiroshi Banno, Kimihiro Komori
BACKGROUND: Most patients with critical limb ischemia (CLI) exhibit severe comorbidities accompanied by frailty. This study assessed and risk-stratified mortality after infrainguinal bypass (IB) in CLI and investigated the effects of frailty.Methods and Results:The study retrospectively reviewed 107 consecutive CLI patients who had undergone de novo IB due to atherosclerotic disease. Data regarding patient age, comorbidities, laboratory data, and functional status were collected; functional status was evaluated using the Barthel index (BI) and nutritional status was evaluated using albumin concentrations and body mass index (BMI)...
August 23, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
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