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Critical leg ischemia

N S Abyshov, A G Abdullaev, E D Zakirdzhaev, R A Guliev, M B Akhmedov, G T Tagizade, G M Zeinalova, L D Mamedova
AIM: to evaluate the results of combined treatment of thromboangiitis obliterans with severe lower limb ischemia using prolonged epidural anaesthesia and autohemotherapy with ozone. MATERIAL AND METHODS: It was analyzed treatment of 125 patients with thromboangiitis obliterans and severe lower limb ischemia. Patients were divided into 2 groups. Control group consisted of 60 patients who underwent conventional perioperative therapy with anticoagulants, antiplatelet agents, dextrans, metabolic drugs, glucocorticoids, angioprotectors, narcotic and non-narcotic analgesics...
2016: Khirurgiia
Mehdi H Shishehbor, Christopher J White, Bruce H Gray, Matthew T Menard, Robert Lookstein, Kenneth Rosenfield, Michael R Jaff
Critical limb ischemia (CLI), the most advanced form of peripheral artery disease, is associated with significant morbidity, mortality, and health care resource utilization. It is also associated with physical, as well as psychosocial, consequences such as amputation and depression. Importantly, after a major amputation, patients are at heightened risk of amputation on the contralateral leg. However, despite the technological advances to manage CLI with minimally invasive technologies, this condition often remains untreated, with significant disparities in revascularization and amputation rates according to race, socioeconomic status, and geographic region...
September 22, 2016: Journal of the American College of Cardiology
Agnieszka Jazwa, Urszula Florczyk, Anna Grochot-Przeczek, Bart Krist, Agnieszka Loboda, Alicja Jozkowicz, Jozef Dulak
Vascular endothelial growth factor (VEGF), as an endothelial cell-specific mitogen, is crucial for new blood vessels formation. Atherosclerosis affecting the cardiovascular system causes ischemia and functio laesa in tissues supplied by the occluded vessels. When such a situation occurs in the lower extremities, it causes critical limb ischemia (CLI) often requiring leg amputation. Low oxygen tension leads to upregulation of hypoxia-regulated genes (i.e. VEGF), that should help to restore the impaired blood flow...
September 9, 2016: Vascular Pharmacology
C Goullet de Rugy, I Lazareth, C You, A Stansal, P Priollet
In vascular medicine, wound care requires pluridisciplinary expertise and nursing skill. Care must be perfectly adapted to each individual patient, the specificities of each particular wound, and the underlying vascular disease. The goal is to achieve wound healing. Inappropriate care can retard healing or even aggravate the wound. The skin should be cleaned with water a non-allergic detergent and should concern the entire limb in addition to the wound itself. Fibrin or necrosis detersion is an important step that can be painful...
September 2016: Journal des Maladies Vasculaires
Mikolaj Walensi, Christian Berg, Michael Piotrowski, Franz-Eduard Brock, Johannes N Hoffmann
The adductor canal compression syndrome is one of the several rare nontraumatic causes of arterial occlusions, which may lead to critical ischemia of the lower limb. We report the case of a 46-year-old athletic woman, who suffered from activity-related paresthesia and sharp pain in the left upper and lower leg for 2 years. Imaging and neurological investigations of the spine remained without pathological findings that would explain the patient's complaints. Actually, the patient presented with symptoms of critical lower limb ischemia...
August 20, 2016: Annals of Vascular Surgery
M Venermo, N Settembre, A Albäck, P Vikatmaa, P-S Aho, M Lepäntalo, Y Inoue, H Terasaki
BACKGROUND: Ankle brachial index (ABI), toe pressures (TP), and transcutaneous oxygen pressure (TcPO2) are traditionally used in the assessment of critical limb ischemia (CLI). Indocyanine green (ICG) fluorescence imaging can be used to evaluate local circulation in the foot and to evaluate the severity of ischemia. This prospective study analyzed the suitability of a fluorescence imaging system (photodynamic eye [PDE]) in CLI. MATERIAL AND METHODS: Forty-one patients with CLI were included...
October 2016: European Journal of Vascular and Endovascular Surgery
Marie Pavé, Laurent Benadiba, Ludovic Berger, Djeloul Gouicem, Maxime Hendricks, Didier Plissonnier
PURPOSE: To evaluate the long-term clinical results of Below-the-Knee Percutaneous Transluminal Angioplasty (BTK-PTA) with or without stenting, in patients with Critical Limb Ischemia (CLI), and to determine factors affecting clinical results including the role of the angiosome concept. METHODS: All patients undergoing primary BTK-PTA from January 2007 to December 2011 were included. Primary patency, assisted patency, limb salvage, survival and wound healing were assessed using the Kaplan-Meier method...
July 14, 2016: Annals of Vascular Surgery
Mohammad Ali Husainy, Balla Suresh, Cheng Fang, Thoraya Ammar, Rajesh Botchu, V Thava
PURPOSE: The OUTBACK(®) catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA) and the superficial femoral artery (SFA) using the OUTBACK(®) catheter in cases where other techniques were unsuccessful...
April 2016: Indian Journal of Radiology & Imaging
Mustafa A Altaha, Jeffrey D Jaskolka, Kongteng Tan, Manuela Rick, Peter Schmitt, Ravi J Menezes, Bernd J Wintersperger
PURPOSE: The aim of this study was to evaluate diagnostic performance of non-contrast-enhanced 2D quiescent-interval single-shot (QISS) and 3D turbo spin-echo (TSE)-based subtraction magnetic resonance angiography (MRA) in the assessment of peripheral arteries in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: Nineteen consecutive patients (74 % male, 72.8 ± 9.9 years) with CLI underwent 2D QISS and 3D TSE-based subtraction MRA at 1.5 T...
June 28, 2016: European Radiology
Alexander Meyer, Katharina Schinz, Werner Lang, Axel Schmid, Susanne Regus, Ulrich Rother
BACKGROUND: Management of dialysis patients with critical limb ischemia (CLI) still represents a challenge to vascular medicine, whereas the effects of the pedal arch quality in these patients with predominant affection of the infrapopliteal vessels have rarely been evaluated. Therefore, our aim was to analyze the outcomes of infrapopliteal angioplasty in the setting of chronic renal failure (end-stage renal disease) and evaluate the influence of the pedal arch involvement on clinical success...
August 2016: Annals of Vascular Surgery
David S Kauvar, Candice L Osborne
Femoropopliteal bypass (FPB) remains a widely accepted treatment option for symptomatic leg ischemia, even in patients without features of critical limb ischemia (CLI). These patients are revascularized to improve symptoms of exertional limb pain and the goal of such treatment is to increase their ability to ambulate within the community. Therefore, the anticipated initial discharge disposition for a patient without CLI undergoing FPB is back to their home. This study examined the disposition at initial discharge of such patients...
May 2016: American Surgeon
Michael Allon
Once hemodialysis patients have exhausted all option for a permanent vascular access in both upper extremities, they are often relegated at many dialysis centers to permanent catheter dependence with all its attendant complications, including infections, frequent dysfunction, and central vein stenosis. This commentary makes the case that thigh grafts are a far superior alternative to dialysis catheters in many of these patients. Technical graft failure may occur in some patients due to severe femoral artery calcification, but screening for calcification by ultrasound or computerized tomography can reduce the likelihood of a technical failure...
July 2016: Seminars in Dialysis
Dae Han Choi, Myeong Jin Kim, Chan Jong Yoo, Cheol Wan Park
Lower extremity ischemia following deployment of a vascular closure device for access site closure after a transfemoral endovascular procedure rarely occurs. A 68-year-old woman diagnosed with subarachnoid hemorrhage due to a ruptured anterior communicating aneurysm was treated by endovascular coil embolization. The StarClose SE device was deployed for right femoral arteriotomy closure. After 2 days, critical ischemia occurred on her right lower leg due to total occlusion of the popliteo-tibial artery. Emergent surgical embolectomy was performed and the nitinol clip of the StarClose device was captured in the lumen of the tibioperoneal trunk...
April 5, 2016: Journal of Neurointerventional Surgery
Dae Han Choi, Myeong Jin Kim, Chan Jong Yoo, Cheol Wan Park
Lower extremity ischemia following deployment of a vascular closure device for access site closure after a transfemoral endovascular procedure rarely occurs. A 68-year-old woman diagnosed with subarachnoid hemorrhage due to a ruptured anterior communicating aneurysm was treated by endovascular coil embolization. The StarClose SE device was deployed for right femoral arteriotomy closure. After 2 days, critical ischemia occurred on her right lower leg due to total occlusion of the popliteo-tibial artery. Emergent surgical embolectomy was performed and the nitinol clip of the StarClose device was captured in the lumen of the tibioperoneal trunk...
2016: BMJ Case Reports
Miljenko Kovacević, Marin Boroe, Igor Medved, Slavica Kovacić, Davor Primc, Jadranko Sokolić
We report a successful treatment of unusual case of a 48 year old male patient with acute aortic dissection type Stanford A that expanded into left common and external iliac artery diagnosed by MSCT angiography, presenting as a single leg paresis, without symptoms of a chest or back pain. Patient was operated with conventional ascending aortic replacement. Patient had no known prior medical condition. He has been treated for acute thrombosis of the left popliteal artery developing one day after ascending aortic replacement surgery, embolectomy was performed...
December 2015: Collegium Antropologicum
A J Fischer, P Lebiedz, M Wiaderek, M Lichtenberg, D Böse, S Martens, F Breuckmann
If myocardial infarction remains silent, only clinical signs of complications may unveil its presence. Life-threatening complications include myocardial rupture, thrombus formation, or arterial embolization. In the presented case, a 76-year-old patient was admitted with left-sided hemiparesis. In duplex sonography, a critical stenosis of the right internal carotid artery was identified and initially but retrospectively incorrectly judged as the potential cause for ischemia. During operative thromboendarterectomy, arterial embolism of the right leg occurred coincidentally, more likely pointing towards a cardioembolic origin...
2016: Case Reports in Emergency Medicine
Scott T Robinson, Alison M Douglas, Tatiana Chadid, Katie Kuo, Ajai Rajabalan, Haiyan Li, Ian B Copland, Thomas H Barker, Jacques Galipeau, Luke P Brewster
UNLABELLED: Mesenchymal stem cells (MSC) hold promise in promoting vascular regeneration of ischemic tissue in conditions like critical limb ischemia of the leg. However, this approach has been limited in part by poor cell retention and survival after delivery. New biomaterials offer an opportunity to localize cells to the desired tissue after delivery, but also to improve cell survival after delivery. Here we characterize the mechanical and microstructural properties of a novel hydrogel composed of pooled human platelet lysate (PL) and test its ability to promote MSC angiogenic activity using clinically relevant in vitro and in vivo models...
May 2016: Acta Biomaterialia
I K Tesdal, C K Krzemien, C Weiss
AIM: Clinical and statistical study analysing factors with influence on success rates, procedure-related complications, and long-term results for patients who underwent angioplasty of the crural arteries. MATERIAL AND METHODS: Retrospectively we evaluated all patients who underwent angioplasty of the crural arteries due to critical chronic limb ischemia or severe claudication in the time period from 1/2002 to 12/2005. These patients were contacted in the time period from 1/2009 to 12/2010, and a follow-up examination including angiography was performed or telephone interviews were conducted with patients, relatives and referring physicians for follow-up...
March 2016: Der Radiologe
B Sigvant, F Lundin, E Wahlberg
OBJECTIVE: Peripheral arterial disease (PAD) afflicts up to 20% of older people and is associated with a high risk of cardiovascular (CV) morbidity, but a rather low risk of progression of leg symptoms. These risk estimations are largely taken from cohort studies performed 20 years ago. To test the validity of this, available data were systematically reviewed and attempts were made to perform meta-analyses of CV risk and disease progression. METHODS: A database literature search was conducted of the period 1990-2015 using related subject headings...
March 2016: European Journal of Vascular and Endovascular Surgery
Jessica P Simons, Philip P Goodney, Julie Flahive, Andrew W Hoel, John W Hallett, Larry W Kraiss, Andres Schanzer
BACKGROUND: Providing patients and payers with publicly reported risk-adjusted quality metrics for the purpose of benchmarking physicians and institutions has become a national priority. Several prediction models have been developed to estimate outcomes after lower extremity revascularization for critical limb ischemia, but the optimal model to use in contemporary practice has not been defined. We sought to identify the highest-performing risk-adjustment model for amputation-free survival (AFS) at 1 year after lower extremity bypass (LEB)...
April 2016: Journal of Vascular Surgery
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