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Limb ischemia

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https://www.readbyqxmd.com/read/27921418/-diabetic-foot-syndrome-from-the-perspective-of-internist-educated-in-podiatry
#1
Alexandra Jirkovská
Podiatry is the science dealing with the diagnostics and treatment of the foot and ankle and associated tissues and structures by all appropriate methods and also with the local manifestation of the overall processes in this area. Diabetic foot disease is defined as infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in the lower extremity of people with diabetes according to the latest edition of the International Consensus. Successful treatment and prevention of diabetic foot syndrome depends on a holistic approach, in which it is seen as part of the multiple organ involvement...
2016: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/27921154/peripheral-stent-thrombosis-leading-to-acute-limb-ischemia-and-major-amputation-incidence-and-risk-factors-in-the-aortoiliac-and-femoropopliteal-arteries
#2
Konstantinos Katsanos, Said A M Al-Lamki, Aneeta Parthipun, Stavros Spiliopoulos, Sanjay Dhanji Patel, Ioannis Paraskevopoulos, Hany Zayed, Athanasios Diamantopoulos
PURPOSE: To report the real-world incidence and risk factors of stent thrombosis in the aortoiliac and femoropopliteal arteries in case of bare nitinol stent (BNS) or covered nitinol stent (CNS) placement from a single-centre retrospective audit. MATERIALS AND METHODS: Medical records of consecutive patients treated with peripheral stent placement for claudication or critical limb ischemia were audited for definite stent thrombosis defined as imaging confirmed stent thrombosis that presented as acute limb-threatening ischemia...
December 5, 2016: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27916029/-evaluation-between-bypass-surgery-and-endovascular-therapy-to-peripheral-arterial-disease-patients-with-critical-limb-ischemia
#3
S K Shen, D M Wu, C G Wang, L K Zhang, Q W Gang
Bypass surgery(BSX) and endovascular therapy(EVT) are the most important therapeutic method to critical limb ischemia.EVT has potential advantages in reducing surgical trauma and early postoperative complications, shortening hospital stay and so on. Concerning long-term results, BSX is better in reducing long-term mortality and improving long-term patency than EVT group. Therefore, control indications reasonably and select individualized methods, avoid the abuse of EVT are more meaningful for patients.
December 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/27914820/cell-therapy-in-critical-limb-ischemia-a-comprehensive-analysis-of-two-cell-therapy-products
#4
Claire Tournois, Bernard Pignon, Marie-Antoinette Sevestre, Rida Al-Rifai, Valerie Creuza, Gaël Poitevin, Caroline François, Philippe Nguyen
BACKGROUND: Cell therapy has been proposed as a salvage limb procedure in critical limb ischemia (CLI). In spite of the fact that clinical trials found some efficacy, the mechanism of action remains elusive. The objective of this study was to characterize two autologous cell therapy products (CTPs) obtained from patients with advanced peripheral arterial disease. METHODS: Bone marrow (BM-CTPs) (n = 20) and CTPs obtained by non-mobilized cytapheresis (peripheral blood [PB]-CTPs) (n = 20) were compared...
November 30, 2016: Cytotherapy
https://www.readbyqxmd.com/read/27910185/drug-eluting-balloon-angioplasty-for-below-the-knee-lesions-in-end-stage-renal-disease-patients-with-critical-limb-ischemia-midterm-results
#5
Burak Teymen, Süleyman Aktürk
BACKGROUND: The 1-year restenosis rate after standard balloon angioplasty (BA) of long lesions in below-the-knee arteries may be as high as 70%. Our aim was to investigate the efficacy and safety of paclitaxel drug-eluting balloon (DEB) for treatment of below the knee lesions in end stage renal disease patients (ESRD) with critical limb ischemia (CLI). METHODS: Our study is a retrospective, single-center study. Inclusion criteria were ESRD, critical limb ischemia (Rutherford class 4 or higher) and significant stenosis or occlusion of at least 1 below-the-knee vessel...
December 2, 2016: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/27909643/source-control-and-graft-preservation-using-negative-pressure-wound-therapy-with-antibiotic-instillation-a-case-report
#6
Victoria Gilbert, Timothy Kelly, Robert Grossi
Negative pressure wound therapy (NPWT) is widely used to treat many types of complex wounds, and the advent of the instillation and dwell time (NPWTi-d) technique has enhanced this system with the addition of automated treatment with topical solutions. In the field of vascular surgery, NPWT is utilized to help close wounds over underlying grafts; however keeping these wounds free of infection and avoiding large reoperation when infection occurs remains a challenge. In this case report we present a patient who required acute intervention for limb ischemia, with a large wound created in the groin for anastomosis of a prosthetic graft bypass...
October 31, 2016: Curēus
https://www.readbyqxmd.com/read/27909265/prevention-of-the-collapse-of-pial-collaterals-by-remote-ischemic-perconditioning-during-acute-ischemic-stroke
#7
Junqiang Ma, Yonglie Ma, Bin Dong, Mischa V Bandet, Ashfaq Shuaib, Ian R Winship
Collateral circulation is a key variable determining prognosis and response to recanalization therapy during acute ischemic stroke. Remote ischemic perconditioning (RIPerC) involves inducing peripheral ischemia (typically in the limbs) during stroke and may reduce perfusion deficits and brain damage due to cerebral ischemia. In this study, we directly investigated pial collateral flow augmentation due to RIPerC during distal middle cerebral artery occlusion (MCAo) in rats. Blood flow through pial collaterals between the anterior cerebral artery (ACA) and the MCA was assessed in male Sprague Dawley rats using in vivo laser speckle contrast imaging (LSCI) and two photon laser scanning microscopy (TPLSM) during distal MCAo...
December 1, 2016: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/27908824/arteriographic-patterns-of-atherosclerosis-and-the-association-between-diabetes-mellitus-and-ethnicity-in-chronic-critical-limb-ischemia
#8
Jayer Chung, J Gregory Modrall, Martyn Knowles, Qun Xiang, Lawrence A Lavery, Carlos H Timaran, R James Valentine
BACKGROUND: Disparate outcomes in critical limb ischemia (CLI) persist between ethnicities. The contribution of modifiable factors versus intrinsic biologic differences remains unclear. Hence, we aimed to quantify the associations between ethnicity and anatomic patterns of arterial occlusive disease in CLI, adjusting for known atherosclerotic risk factors. METHODS: We performed a retrospective, single-center review of consecutive patients presenting to the vascular surgery service with CLI...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27905554/increased-plasma-vegf-levels-following-ischemic-preconditioning-are-associated-with-downregulation-of-mirna-762-and-mir-3072-5p
#9
Koji Ueno, Makoto Samura, Tamami Nakamura, Yuya Tanaka, Yuriko Takeuchi, Daichi Kawamura, Masaya Takahashi, Tohru Hosoyama, Noriyasu Morikage, Kimikazu Hamano
Ischemic preconditioning (IPC) has protective effects against ischemia-perfusion injury of organs. In the present study, we investigated the associated mechanisms after performing remote IPC (rIPC) of lower limbs by clamping abdominal aorta in mice. Subsequent experiments showed decreased damage and paralysis of lower limbs following spinal cord injury (SCI). Concomitantly, plasma vascular endothelial growth factor (VEGF) levels were increased 24 h after rIPC compared with those in sham-operated animals. In subsequent microRNA analyses, thirteen microRNAs were downregulated in exosomes 24 h after rIPC...
December 1, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27903480/long-term-outcomes-of-common-femoral-artery-stenting
#10
Bahaa Nasr, Adrien Kaladji, Pierre-Alexandre Vent, Philippe Chaillou, Alain Costargent, Thibault Quillard, Yann Gouëffic
OBJECTIVES: The purpose of this study was to report the 5-years outcome relative to endovascular repair of the common femoral artery for occlusive disease. MATERIALS/METHODS: 36 consecutive patients (40 limbs) underwent stenting for common femoral artery lesions. Patients were followed up systematically within a prospectively maintained database over 5 years. Follow-up included clinical examination, duplex scan and biplane x-ray at 1, 6, 12 months and yearly thereafter...
November 26, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27903473/treatment-of-type-ii-endoleak-and-aneurysm-expansion-after-evar
#11
Konstantinos G Moulakakis, Christos Klonaris, John Kakisis, Constantine N Antonopoulos, Andreas Lazaris, George S Sfyroeras, George Mantas, Spyridon N Vasdekis, Elias N Brountzos, George Geroulakos
AIM: The management of type II endoleak causing sac enlargement continues to be a topic of debate. The purpose of this study was to examine and compare the outcomes between open surgical technique with sacotomy and suturing of the feeding vessels to interventional embolization in patients with aneurysm sac expansion after EVAR. MATERIAL-METHODS: Inclusion criteria for intervention in patients with prior EVAR and type II endoleak were: asymptomatic expanding aneurysm sac > 5mm between two consecutive follow-up CTA scans, symptomatic aneurysm sac expansion...
November 26, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27901322/risk-factors-analysis-of-thromboembolectomy-for-acute-thromboembolic-lower-extremity-ischemia-in-native-arteries
#12
Gabriele Piffaretti, Alessandro Angrisano, Marco Franchin, Massimo Ferrario, Nicola Rivolta, Alessandro Bacuzzi, Patrizio Castelli, Matteo Tozzi
BACKGROUND: Aim of this study is to report the results of thromboembolectomy (ThEmb) for acute thromboembolic lower limb ischemia (ATLI) in native arteries and to create a predictive score for amputation-free survival (AFS) at 30 days. METHODS: It is a single center, retrospective analysis of a four years period. All patients had ThEmb: adjunctive procedures included femoral and/or popliteal endarterectomy in 30 (18.3%) cases, PTA- stent in 24 (14.6%), and femoral endarterectomy plus PTA-stent in 12 (7...
November 30, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27898007/limb-remote-ischemic-postconditioning-reduces-ischemia-reperfusion-injury-by-inhibiting-nadph-oxidase-activation-and-myd88-traf6-p38map-kinase-pathway-of-neutrophils
#13
Gangling Chen, Xinyi Ye, Jiangwei Zhang, Tingli Tang, Lin Li, Peirong Lu, Qi Wu, Boyang Yu, Junping Kou
Limb remote ischemic postconditioning (LRIP) has been confirmed to reduce the ischemia-reperfusion injury but its mechanisms are still not clear. This study clarified the mechanism of LRIP based on the nicotinamide-adenine dinucleotide phosphate (NADPH) oxidase and Myeloid differentiation factor 88 (MyD88)-Tumor necrosis factor (TNF) receptor-associated factor 6 (TRAF6)-P38 pathway of neutrophils. Rat middle cerebral artery occlusion (MCAO) model was used in this study. Ischemia-reperfusion injury was carried out by MCAO 1...
November 25, 2016: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/27896629/remote-limb-ischemic-preconditioning-protects-rats-against-cerebral-ischemia-via-hif-1%C3%AE-ampk-hsp70-pathway
#14
Ming Xia, Qian Ding, Zhidan Zhang, Qinggen Feng
Remote limb ischemic preconditioning (RIPC) is a clinically feasible strategy to protect against ischemia/reperfusion injury, but the knowledge concerning the mechanism underlying RIPC is scarce. This study was performed to examine the effect of RIPC on brain tissue suffering from ischemia challenge and explore its underlying mechanism in a rat model. The animals were divided into four groups: Sham, middle cerebral artery occlusion (MCAO), RIPC, and MCAO+RIPC. We found that previous exposure to RIPC significantly attenuated neurological dysfunction and lessened brain edema in MCAO+RIPC group...
November 28, 2016: Cellular and Molecular Neurobiology
https://www.readbyqxmd.com/read/27896226/use-of-the-directional-atherectomy-for-the-treatment-of-femoro-popliteal-lesions-in-patients-with-critical-lower-limb-ischemia
#15
Umberto Marcello Bracale, Gaetano Vitale, Guido Bajardi, Donatella Narese, Ettore Dinoto, Anna Maria Giribono, Doriana Ferrara, Luca Del Guercio, Massimo Midiri, Felice Pecoraro
: Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia...
November 2016: Translational Medicine @ UniSa
https://www.readbyqxmd.com/read/27896186/use-of-a-temporary-shunt-as-a-salvage-technique-for-distal-extremity-amputations-requiring-repair-by-vessel-grafting-during-critical-ischemia
#16
Bilsev Ince, Mehmet Dadaci, Zeynep Altuntas
BACKGROUND: Although the use of temporary shunts in proximal extremity amputations has been reported, no study has described the use of temporary shunts in distal extremity amputations that require vein grafting. Moreover, the total volume of blood loss when temporary shunts are used has not been reported. The aim of this study was to investigate the applicability of a temporary shunt for distal extremity amputations requiring repair by vessel grafting with an ischemia time of >6 hours...
November 2016: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/27890841/development-of-a-scoring-system-for-the-prediction-of-early-graft-failure-after-peripheral-arterial-bypass-surgery
#17
Andreas M Lazaris, Sotiria Mastoraki, Evangelos Kontopantelis, Konstantinos Seretis, Maria Karouki, Konstantinos Moulakakis, Miltiadis Matsagkas, Spyros N Vasdekis
OBJECTIVES: An occluded lower limb arterial bypass is associated with poor prognosis for the limb. Currently, no risk assessment method to estimate the risk of early graft failure exists. Aim of this study was to investigate the effect of various potential factors on early graft failure of infrainguinal bypass surgery and to develop a risk-scoring model to predict it. DESIGN AND METHODS: A prospective observational clinical study was performed. One hundred infrainguinal bypass procedures (60 autologous and 40 synthetic grafts), throughout a 3-year period were included...
November 24, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27890836/microcirculation-evaluated-by-intraoperative-fluorescence-angiography-after-tibial-bypass-surgery
#18
Ulrich Rother, Werner Lang, Raymund E Horch, Ingo Ludolph, Alexander Meyer, Susanne Regus
OBJECTIVE: Intact microperfusion of the foot in the critical ischemic limb remains a crucial condition for ulcer healing. Aim of this clinical study was to evaluate the immediate effect of tibial bypass surgery on the microcirculation by usage of fluorescence angiography. METHODS: Prospective analysis of 33 patients presenting with critical limb ischemia (Rutherford 4 to 6) undergoing tibial bypass surgery was performed. Macroperfusion was investigated by measurement of ankle-brachial index...
November 24, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27888751/remote-ischemic-preconditioning-attenuates-egr-1-expression-following-myocardial-ischemia-reperfusion-injury-through-activation-of-the-jak-stat-pathway
#19
H Mudaliar, B Rayner, M Billah, N Kapoor, W Lay, A Dona, R Bhindi
BACKGROUND/OBJECTIVES: Remote ischemic preconditioning (RIPC) protects the myocardium from ischemia/reperfusion (I/R) injury however the molecular pathways involved in cardioprotection are yet to be fully delineated. Transcription factor Early growth response-1 (Egr-1) is a key upstream activator in a variety of cardiovascular diseases. In this study, we elucidated the role of RIPC in modulating the regulation of Egr-1. METHODS: This study subjected rats to transient blockade of the left anterior descending (LAD) coronary artery with or without prior RIPC of the hind-limb muscle and thereafter excised the heart 24h following surgical intervention...
November 10, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27884944/ruptured-abdominal-aortic-aneurysm-after-endovascular-aortic-aneurysm-repair-thrombosis
#20
Jesse Victory, Syed Ali Rizvi, Enrico Ascher, Anil Hingorani
BACKGROUND: Complete thrombosis of an aortic endograft after an endovascular aortic aneurysm repair is a rare complication. The majority of thrombotic events occur in the iliac limbs. CASE PRESENTATION: We present the case of a patient who presented with acute limb ischemia as the result of a thrombosed infra-renal aortic endograft. After restoration of blood flow to the lower extremities with an axillary to bi-femoral artery bypass, the patient was lost to follow-up...
November 24, 2016: Vascular
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