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limb salvaging

Hiroshi Chadani, Soichiro Usui, Oto Inoue, Takashi Kusayama, Shin-Ichiro Takashima, Takeshi Kato, Hisayoshi Murai, Hiroshi Furusho, Ayano Nomura, Hirofumi Misu, Toshinari Takamura, Shuichi Kaneko, Masayuki Takamura
Selenoprotein P (SeP), a liver-derived secretory protein, functions as a selenium supply protein in the body. SeP has been reported to be associated with insulin resistance in humans through serial analysis of gene expression. Recently, SeP has been found to inhibit vascular endothelial growth factor-stimulated cell proliferation in human umbilical vein endothelial cells, and impair angiogenesis in a mouse hind limb model. In this study, the role of SeP in ischemia/reperfusion (I/R) injury has been investigated...
March 16, 2018: International Journal of Molecular Sciences
Christina Enciso Holm, Christian Bardram, Anja Falk Riecke, Peter Horstmann, Michael Mørk Petersen
PURPOSE: Previous studies reported variable outcome and failure rates after mega-prosthetic reconstructions in the lower extremities. The purpose of this study was to make a long-term single-center evaluation of patients treated with limb-sparing surgery and reconstruction with mega-prostheses in the lower extremities. METHODS: We identified 50 patients (osteosarcoma (n = 30), chondrosarcoma (n = 9), osteoclastoma (n = 6), Ewing sarcoma (n = 4), angiosarcoma (n = 1)), who underwent limb-sparing reconstruction of the lower extremities (proximal femur (n = 9), distal femur (n = 29), proximal tibia (n = 9), and the entire femur (n = 3)) between 1985 and 2005...
March 12, 2018: International Orthopaedics
Andrew J Jacobs, Carol D Morris, Adam S Levin
BACKGROUND: Reported rates of the incidence of lymph node metastasis in soft tissue sarcoma vary considerably. Many are based on single-institution series and small patient populations. Certain sarcoma subtypes, including synovial sarcoma, have been associated with a higher risk of lymph node involvement. Most single centers have insufficient numbers of patients to assess lymph node metastasis accurately, but larger national databases may allow a more accurate estimation. QUESTIONS/PURPOSES: We queried a large national database and asked the following questions: (1) What proportion of patients with soft tissue sarcoma have lymph node metastasis and distant metastasis? (2) What histologic subtypes are associated with increased risk of nodal metastasis? (3) What is the impact of lymph node metastases and histologic subtype on survival? (4) Does lymph node excision improve survival of patients with soft tissue sarcoma? METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program is a national database that covers a geographic cross-section representing approximately 28% of the US population across demographic groups...
March 2018: Clinical Orthopaedics and related Research
Matthew J Thompson, John C Shapton, Stephanie E Punt, Christopher N Johnson, Ernest U Conrad
BACKGROUND: The quantitative accuracy of MRI in predicting the intraosseous extent of primary sarcoma of bone has not been definitively confirmed, although MRI is widely accepted as an accurate tool to plan limb salvage resections. Because inaccuracies in MRI determination of tumor extent could affect the ability of a tumor surgeon to achieve negative margins and avoid local recurrence, we thought it important to assess the accuracy of MR-determined tumor extent to the actual extent observed pathologically from resected specimens in pediatric patients treated for primary sarcomas of bone...
March 2018: Clinical Orthopaedics and related Research
Hong Kuan Kok, Shirish G Prabhudesai, Irfan Ahmed, Narayan Karunanithy, Said Abisi, Konstantinos Katsanos, Athanasios Diamantopoulos
PURPOSE: Endovascular treatment of infrapopliteal peripheral arterial disease (PAD) is an established and effective treatment strategy for patients with symptomatic PAD. Increasingly, complex infrapopliteal lesions are treated with an endovascular first approach, especially in the setting of critical limb ischemia for limb salvage, avoiding major amputations which impact on mobility and quality of life. However, many complex infrapopliteal lesions involving the bifurcation of the tibial arteries remain challenging to treat due to recoil or acute dissection following angioplasty and may require stenting using specialized techniques...
March 5, 2018: Annals of Vascular Surgery
Christos D Karkos, Georgios Koudounas, Ioakeim T Giagtzidis, Maria-Aphroditi Mitka, Ioannis Pliatsios, Konstantinos O Papazoglou
Popliteal artery injury is a potentially-limb threatening complication of traumatic knee dislocation. We describe two such cases that had been treated in our unit over the last decade. The first one was a 23-year-old woman who injured her right knee during a long jump competition and the second was a 27-year-old man who had a motorbike accident. Both suffered traumatic knee dislocation along with significant ligament and neurovascular injuries. In the first patient, the popliteal artery was found thrombosed due to intimal rupture and required thrombectomy and vein patch repair, whereas, in the second patient, the artery was completely transected and required end-to-end anastomosis...
March 5, 2018: Annals of Vascular Surgery
António Gaspar, André P Lourenço, Miguel Álvares Pereira, Pedro Azevedo, Roberto Roncon-Albuquerque, Jorge Marques, Adelino F Leite-Moreira
To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1:1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical From 258 patients randomized to RIC or SOC, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively...
March 7, 2018: Basic Research in Cardiology
Matteo Bossi, Matteo Tozzi, Marco Franchin, Stefania Ferraro, Nicola Rivolta, Massimo Ferrario, Chiara Guttadauro, Patrizio Castelli, Gabriele Piffaretti
Background : This study aimed to present cases with cryopreserved human allografts (CHAs) for vascular reconstruction in both aortic and peripheral infected prosthetic grafts. Materials and Methods : This is a single center, observational descriptive study with retrospective analysis. In all cases, the infected prosthetic graft material was completely removed. At discharge, patients were administered anticoagulants. Follow-up examinations included clinical visits, echo-color-Doppler ultrasounds, or computed tomography angiography within 30 days and at 3, 6, and 12 months after the treatment, and then twice per year...
December 25, 2017: Annals of Vascular Diseases
Sungho Lim, Michael J Javorski, Pegge M Halandras, Paul C Kuo, Bernadette Aulivola, Paul Crisostomo
OBJECTIVE: Acute limb ischemia (ALI) in a pediatric patient is a rare condition but may result in lifelong disability. A paucity of evidence exists to derive treatment guidelines; some surgeons advocate conservative management over invasive measures. The purpose of this study was to evaluate the role of surgical revascularization in the pediatric population and outcomes of conservative vs surgical management. METHODS: The Healthcare Cost and Utilization Project State Inpatient Database (California, Iowa, and New York) between 2007 and 2013 was queried using International Classification of Diseases, Ninth Revision codes...
March 1, 2018: Journal of Vascular Surgery
Miroslav Špaček, Pavel Měřička, Libor Janoušek, Petr Štádler, Miloš Adamec, Robert Vlachovský, Igor Guňka, Pavel Navrátil, Filip Thieme, Petr Mitáš, Rudolf Špunda, Jaroslav Špatenka, Robert Staffa, Petr Němec, Jaroslav Lindner
The transplantation of fresh or cryopreserved vascular allografts in patients with a prosthetic graft infection or critical limb ischemia is necessary for their limb salvage and, in many cases, represents a lifesaving procedure. While transplantation of fresh allografts has a long history in the Czech Republic, the standard use of cryopreserved vascular allografts was introduced into the clinical practice in 2011 as a result of the implementation of EU Directive 2004/23/EC into national legislation (Human Cell and Tissue Act No...
March 3, 2018: Cell and Tissue Banking
Nassiri N, Huntress LA
Endovascular salvage of failed surgical bypasses has been scantly reported for treatment of infrainguinal occlusive disease. While catheter-directed thrombolysis and/or mechanical thromboembolectomy have been the mainstay of endovascular salvage of previous bypass grafts, native vessel recanalization remains seldom attempted. Herein, we present a unique approach to native vessel recanalization of a chronically thrombosed popliteal artery aneurysm for non-healing distal ulceration.
March 1, 2018: Annals of Vascular Surgery
Benjamin Del Tatto, Anne Lejay, Vincent Meteyer, Mathieu Roussin, Yannick Georg, Fabien Thaveau, Bernard Geny, Nabil Chakfe
OBJECTIVE: The purpose of this study was to report mid-term outcomes of open repair (OR) or endovascular repair (ER) of popliteal artery aneurysms (PAA) and assess if outcomes of patients have changed in the endovascular era. METHODS: This monocentric and retrospective study included all consecutive patients treated for PAA between January 2004 and December 2016. Before 2010 all patients underwent OR, but ER was available since 2010 and the choice between OR or ER was made on the basis of clinical presentation and preoperative morphological assessment...
March 1, 2018: Annals of Vascular Surgery
Abhisekh Mohapatra, Jon C Henry, Efthimios D Avgerinos, Rabih A Chaer, Steven A Leers, Aureline Boitet, Michael J Singh, Eric S Hager
OBJECTIVE: Ischemic heel ulcerations are generally thought to carry a poor prognosis for limb salvage. We hypothesized that patients undergoing infrapopliteal revascularization for heel wounds, either bypass or endovascular intervention, would have lower wound healing rates and amputation-free survival than patients with forefoot wounds. METHODS: A retrospective chart review was performed of patients who presented between 2006 and 2013 to our institution with ischemic foot wounds and infrapopliteal arterial disease and underwent either pedal bypass or endovascular tibial artery intervention...
February 28, 2018: Annals of Vascular Surgery
Jesse A Columbo, Louise Davies, Ravinder Kang, J Aaron Barnes, Kathleen A Leinweber, Bjoern D Suckow, Philip P Goodney, David H Stone
OBJECTIVES: To date, studies of vascular amputees primarily examine quantitative outcomes following limb loss. Less is known about the patient's perspective after major lower limb amputation. Here, we define and describe the postamputation recovery period. METHODS: Qualitative study using purposive, maximum variation sampling on the variables of amputation level and times since surgery. We first conducted structured interviews with 20 participants (median age: 65 years, range: 45-88 years; 85% male; below knee amputation n = 14; above knee amputation n = 6; median time from amputation to interview = 16 months, range: 4-51 months)...
January 1, 2018: Vascular and Endovascular Surgery
Toshio Takayama, Jon S Matsumura
BACKGROUND: Complete revascularization, achieving inline flow to the foot through at least 1 patent tibioperoneal artery, is considered to be desirable for treating critical limb ischemia (CLI). Hybrid procedure, combined femoral endarterectomy and endovascular treatment, is commonly performed on patients with CLI because they often present with complicated lower extremity lesions involving the common femoral artery. This study aimed to investigate the efficacy of complete revascularization (CR) achieved by hybrid procedure on limb salvage in patients with CLI...
January 1, 2018: Vascular and Endovascular Surgery
Abhisekh Mohapatra, Mikayla N Lowenkamp, Jon C Henry, Aureline Boitet, Efthimios D Avgerinos, Rabih A Chaer, Michel S Makaroun, Steven A Leers, Eric S Hager
INTRODUCTION: Endovascular strategies are often preferred for revascularization of ischemic foot wounds secondary to infrapopliteal disease due to the less invasive technique and faster recovery. Bypass is typically reserved for failures or lesions not amenable to balloon angioplasty. However, the effects of an endovascular-first approach on subsequent bypass grafts is largely unknown. This study evaluates the effects of prior tibial interventions on successive bypasses to pedal targets...
February 23, 2018: Annals of Vascular Surgery
Li Lin, Shaoyong Deng, Futing Zhang, Yaoze Liang, Zhenhua Huang
BACKGROUND: Osteosarcoma is one of the most malignant primary bone cancers, while is rarely reported in China. Of note, very few data of prognosis has been documented in this region. Thus, we carried a retrospective study to identify prognostic factors and to analyze outcomes in patients of both classic and non-classic high-grade osteosarcomas. Classic osteosarcoma is defined as of high-grade histology, age below 40 years, with extremity localized primary tumor, and without detectable metastasis at primary diagnosis...
February 23, 2018: World Journal of Surgical Oncology
Po-Kuei Wu, Cheng-Fong Chen, Chao-Ming Chen, Yu-Chi Cheng, Shang-Wen Tsai, Tain-Hsiung Chen, Wei-Ming Chen
BACKGROUND: Immediately recycling the resected bone segment in a biologic limb salvage reconstruction is an option after wide resection of bone. Intraoperative extracorporeal irradiation and freezing are the two major tumor-killing techniques applied on the fresh tumor-bearing autografts. However, graft-derived tumor recurrence and complications are concerns affecting graft survival. QUESTIONS/PURPOSES: We therefore asked: (1) Is there a difference in the proportion of patients achieving union by 18 months after surgery between the groups with extracorporeal-irradiated autografts and frozen-treated autografts? (2) Is there any difference in the frequency of graft-related complications for patients receiving either an extracorporeal-irradiated or a frozen-treated autograft? (3) Is there a difference between the techniques in terms of graft-derived recurrence? (4) Are there differences in failure-free grafts, and limb and overall survivorship between autografts treated by extracorporeal irradiation or by freezing? METHODS: During the study period we treated a total of 333 patients with high-grade osteosarcoma...
February 21, 2018: Clinical Orthopaedics and related Research
Bin Li, Zhiping Deng, Xiaohui Niu
PURPOSE: Resection length should be designed before limb salvage surgery of bone tumours. The aim of this study was to evaluate the accuracy of free hand resections. METHODS: Two hundred forty-eight cases were enrolled, including 173 osteosarcomas, 24 giant cell tumours, 16 chondrosarcomas, seven spindle cell sarcomas, 14 bone metastases, three undifferentiated pleomorphic sarcomas, three Ewing sarcomas, two angiosarcomas, and six other bone and soft tissue tumours...
February 21, 2018: International Orthopaedics
Berkan Ozpak, Sahin Bozok, Mustafa Cagdas Cayir
Objectives To evaluate 36-month outcomes of drug-eluting balloons in infrapopliteal (=below-the-knee) arterial segments, we made a prospective registry enrolling patients (Rutherford class 2 to 5, ankle-brachial index 0.4-0.7) who were revascularized with drug-eluting balloon from August 2011 to December 2014. Methods Three hundred and seven infrapopliteal arteries were revascularized only with drug-eluting balloon. Endpoints included target lesion revascularization, primary patency rate, and changes in ankle-brachial index and Rutherford class...
January 1, 2018: Vascular
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