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Limb ischemia

Douglas W Jones, Kirsten Dansey, Allen D Hamdan
Patients with end-stage renal disease (ESRD) who present with critical limb ischemia (CLI) have become an increasingly common and complex treatment problem for vascular surgeons. Dialysis patients have high short-term mortality rates regardless of whether revascularization is pursued. ESRD patients with CLI can be managed with: local wound care, endovascular or surgical revascularization, or amputation. Some patients may heal small foot wounds with local wound care alone, even if distal perfusion is marginal, as long as any infectious process has been controlled...
October 20, 2016: Vascular and Endovascular Surgery
Marc P Bonaca, Mark A Creager, Jeffrey Olin, Benjamin M Scirica, Ian C Gilchrist, Sabina A Murphy, Erica L Goodrich, Eugene Braunwald, David A Morrow
OBJECTIVES: The aim of this study was to determine whether the reduction in peripheral revascularization with vorapaxar in patients with peripheral artery disease (PAD) is directionally consistent across indications, including acute limb ischemia, progressively disabling symptoms, or both. BACKGROUND: The protease-activated receptor-1 antagonist vorapaxar reduces peripheral revascularization in patients with PAD. METHODS: The TRA 2°P-TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50) trial randomized 26,449 patients with histories of myocardial infarction, stroke, or symptomatic PAD to vorapaxar or placebo on a background of standard therapy...
October 24, 2016: JACC. Cardiovascular Interventions
Roberto Gandini, Costantino Del Giudice
OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of percutaneous catheter-delivered ultrasound energy to improve local paclitaxel delivery effects in patients with critical limb ischemia (CLI) treated for femoral-popliteal arterial disease. BACKGROUND: Treatment of patients with CLI continues to be the greatest challenge in peripheral artery disease; in particular, treatment of femoral-popliteal chronic total occlusion is characterized by poor primary patency...
October 24, 2016: JACC. Cardiovascular Interventions
Jason T Nieves, Gagan Singh, John Laird, William Pevec, Misty Humphries
No abstract text is available yet for this article.
August 2016: Journal of Vascular Surgery
Samuel L Chen, Matthew D Whealon, Nii-Kabu Kabutey, Isabella J Kuo, Roy M Fujitani
No abstract text is available yet for this article.
August 2016: Journal of Vascular Surgery
Radhakrishnan Raju, Kapil Mathur, Makkathai Kanakasabai Ayyappan, Jayanth Vijayakumar, Vishnukumar Venkatesan, Bhaskar Venkatachalapathy
Patients with long-segment occlusions of the iliac and femoral arteries often undergo sequential bypass procedures. There exists a subgroup of patients who have no suitable vessels in the groin. We report our experience with a new technique of using the profunda vein as a hitchhike point in our series of seven patients (eight limbs) with critical ischemia and occlusion at the iliac or aortic level with reformation of infrageniculate arteries and no reformation in the groin. The proximal graft was anastomosed to the profunda vein, which was ligated proximal to the anastomosis...
August 2016: Journal of Vascular Surgery
Eric Klingelhoefer, Hendrik Bergert, Stephan Kersting, Stefan Ludwig, Norbert Weiss, Frank Schönleben, Robert Grützmann, Gabor Gäbel
BACKGROUND: Peripheral arterial disease (PAD) is one of the most underestimated diseases because of its high prevalence and unfavorable prognosis. Many PAD patients without suitable autologous veins or options for endovascular treatment receive prosthetic above-knee femoropopliteal bypass (PAKB). Until now predictors of prosthetic bypass failure and of increased amputation risk remain indistinct. This study aimed to identify predictive factors associated with better bypass patency and limb salvage to achieve a more favorable outcome after PAKB reconstruction...
August 2016: Journal of Vascular Surgery
Gian B Danzi, Roberto Ferraresi
No abstract text is available yet for this article.
December 2016: Minerva Cardioangiologica
Jun Tanno, Yodo Gatate, Takatoshi Kasai, Shintaro Nakano, Takaaki Senbonmatsu, Osamu Sato, Shigeru Ichioka, Makoto Kuro-O, Shigeyuki Nishimura
In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD...
2016: PloS One
Umit Kervan, Sinan Sabit Kocabeyoglu, Dogan Emre Sert, Emre Aygün, Kemal Kavasoglu, Mehmet Karahan, Ertekin Utku Unal, Mustafa Pac
OBJECTIVES: The common femoral artery is the standard site for immediate vascular access when initiating adult venoarterial extracorporeal membrane oxygenation. However, this approach is fraught with problems such as femoral artery occlusion, distal limb ischemia, reperfusion injury resulting in compartment syndrome, retroperitoneal hemorrhage, thrombosis, embolization, and most importantly, pulmonary edema. Here, we show our preference of using the subclavian artery with a side graft as a different cannulation technique for outflow of extracorporeal membrane oxygenation, which can avoid complications associated with different access techniques...
October 14, 2016: Experimental and Clinical Transplantation
Yohsuke Honda, Keisuke Hirano, Masahiro Yamawaki, Shinsuke Mori, Shigemitsu Shirai, Kenji Makino, Takahiro Tokuda, Takuro Takama, Masakazu Tsutumi, Yasunari Sakamoto, Hideyuki Takimura, Norihiro Kobayashi, Motoharu Araki, Yoshiaki Ito
We assessed wound healing in patients on hemodialysis (HD) with critical limb ischemia (CLI). This study enrolled 267 patients (including 120 patients on HD and 147 patients not on HD) who underwent endovascular therapy (EVT) for CLI. The primary endpoint was wound-healing rate at two years. Secondary endpoints were time to wound healing, wound recurrence rate, and limb salvage at two years. The percentage of male and young patients was higher in the HD patients (p < 0.01). A lower patency of the pedal arch after EVT was observed frequently in HD patients (p < 0...
October 6, 2016: Vascular
Alyssa R Golas, Jamie P Levine, Justin Ream, Eduardo D Rodriguez
An accurate and comprehensive understanding of lower extremity arterial anatomy is essential for the successful harvest and transfer of a free fibula osteoseptocutaneous flap (FFF). Minimum preoperative evaluation includes detailed history and physical including lower extremity pulse examination. Controversy exists regarding whether preoperative angiographic imaging should be performed for all patients. Elevation of an FFF necessitates division of the peroneal artery in the proximal lower leg and eradicates its downstream flow...
October 14, 2016: Journal of Craniofacial Surgery
Puneet Kaur Randhawa, Amteshwar Singh Jaggi
Remote ischemic preconditioning (RIPC) treatment strategy is a breakthrough in the field of cardiovascular pharmacology as it has the potential to attenuate myocardial ischemia-reperfusion injury. However, the underlying intracellular pathways have not been widely explored. The present study intends to explore the possible role of TRPV1 channels in mediating remote hind limb preconditioning-induced cardioprotection. Remote hind limb preconditioning stimulus (4 cycles in succession) was delivered by tying the blood pressure cuff at the inguinal level of the rat...
October 17, 2016: Naunyn-Schmiedeberg's Archives of Pharmacology
J J Jiang, H K Qing, X M Zhang, X M Zhang, W Li, C Y Shen, Q L Li, Y Jiao
OBJECTIVE: To compare total percutaneous access using preclose technique with femoral artery cut-down in endovascular aneurysm repair (EVAR) and assess the safety and feasibility of preclose technique. METHODS: In the study, 81 cases undergoing EVAR from Dec. 2011 to Nov. 2014 in Peking University People's Hospital were retrospectively reviewed. Preoperative CT angiography (CTA) showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Afshar Zomorrodi, Shakeri Abolhassan, Abbas Jabbari, Sahar Zomorrodi, Monazzah Farzin Sheikh
Renal transplantation is the best treatment for end-stage renal disease. Vascular complications of renal transplantation can be hazardous. Bleeding from the anastomotic site in external iliac artery is a nightmare for kidney transplant surgeons. Ligation of the external iliac artery might possibly lead to the loss of the lower limbs. We present two cases of postallograft nephrectomy bleeding, in which the external iliac artery was ligated without consequent ischemia.
September 2016: Saudi Journal of Kidney Diseases and Transplantation
Raghu L Motaganahalli, Matthew R Smeds, Michael P Harlander-Locke, Peter F Lawrence, Naoki Fujimura, Randall R DeMartino, Giovanni De Caridi, Alberto Munoz, Sherene Shalhub, Susanna H Shin, Kwame S Amankwah, Hugh A Gelabert, David A Rigberg, Jeffrey J Siracuse, Alik Farber, E Sebastian Debus, Christian Behrendt, Jin H Joh, Naveed U Saqib, Kristofer M Charlton-Ouw, Catherine M Wittgen
BACKGROUND: Adventitial cystic disease (ACD) is an unusual arteriopathy; case reports and small series constitute the available literature regarding treatment. We sought to examine the presentation, contemporary management, and long-term outcomes using a multi-institutional database. METHODS: Using a standardized database, 14 institutions retrospectively collected demographics, comorbidities, presentation/symptoms, imaging, treatment, and follow-up data on consecutive patients treated for ACD during a 10-year period, using Society for Vascular Surgery reporting standards for limb ischemia...
October 14, 2016: Journal of Vascular Surgery
H Naouli, B Benfor, H Jiber, A Bouarhroum
Axillary artery injury from humeral neck fracture is an uncommon event. Vascular damage due to these injuries may threaten limb loss. In some cases, the signs of ischemia may not be evident just after the injury and may only appear later on. Therefore, a high index of suspicion is essential. It is important to bear this association in mind, so as to make an early diagnosis and avoid serious complications. We are describing the case of a young patient involved in a motor vehicle crash with an axillary artery trauma due to the surgical neck of humerus fracture...
October 13, 2016: Journal des Maladies Vasculaires
J-S Doly, E Lorian, I Desormais, J Constans, A Bura Rivière, P Lacroix
OBJECTIVES: To assess the prevalence and the association between aspirin resistance in critical limb ischemia patients using the VerifyNow(®) bed-side platelet test, and occurrence of cardiovascular morbidity and/or death at one year. MATERIALS AND METHODS: National multicenter prospective observational study related to COPART II centers. From 2010 through 2014, 64 subjects hospitalized for critical limb ischemia and already treated by aspirin before the VerifyNow(®) test were included...
October 13, 2016: Journal des Maladies Vasculaires
Yi Wang, HongBin Liu, Peng Li, Wei Wang
A 40-year-old male who had a severe tremor, bradykinesia, and rigidity for 6 years underwent bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) at our hospital. The patient did not have any prior ischemia events or any risk factors in his medical history. Six and 9 months post-operation, this patient was admitted to the hospital twice for lower left limb involuntary twitching. Two magnetic resonance imaging (MRI) scans showed cerebral ischemia surrounding the implanted electrode. To our knowledge, this is the first case of recurrent cerebral ischemia associated with DBS...
October 15, 2016: Acta Neurochirurgica
Filippo Benedetto, Domenico Spinelli, Narayana Pipitò, Giambattista Gagliardo, Alberto Noto, Simona Villari, Antonio David, Francesco Spinelli
OBJECTIVE: The purpose of this study was to examine the outcomes of a vascular hybrid polytetrafluoroethylene (PTFE) graft, provided with a nitinol-reinforced section (NRS) on one end, in hemodialysis vascular access placement. METHODS: A retrospective study was conducted including all the consecutive patients who underwent Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) implantation for hemodialysis access placement between October 2013 and November 2015...
October 12, 2016: Journal of Vascular Surgery
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