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Critical leg ischemia

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https://www.readbyqxmd.com/read/29778609/emergency-department-utilization-after-lower-extremity-bypass-for-critical-limb-ischemia
#1
Vangelina Osteguin, Thomas W Cheng, Alik Farber, Mohammad H Eslami, Jeffrey A Kalish, Douglas W Jones, Denis Rybin, Stephen J Raulli, Jeffrey J Siracuse
OBJECTIVES: Patients with critical limb ischemia (CLI) utilize hospital resources at high rates. One major driver for resource utilization are Emergency Department (ED) visits. Our goal was to assess perioperative ED visits after lower extremity bypass (LEB) for CLI. METHODS: All patients undergoing LEB for CLI from 2008 to 2017 at our institution were analyzed. Emergency department visits and details of the visit within 30 and 90 days of discharge from index admission were recorded...
May 17, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29753232/traditional-and-nontraditional-glycemic-markers-and-risk-of-peripheral-artery-disease-the-atherosclerosis-risk-in-communities-aric-study
#2
Ning Ding, Lucia Kwak, Shoshana H Ballew, Bernard Jaar, Ron C Hoogeveen, Christie M Ballantyne, A Richey Sharrett, Aaron R Folsom, Gerardo Heiss, Maya Salameh, Josef Coresh, Alan T Hirsch, Elizabeth Selvin, Kunihiro Matsushita
BACKGROUND AND AIMS: Traditional glycemic markers, fasting glucose and hemoglobin A1c (HbA1c), predict incident peripheral artery disease (PAD). However, it is unknown whether nontraditional glycemic markers, fructosamine, glycated albumin, and 1,5-anhydroglucitol, are associated with PAD and whether these glycemic markers demonstrate particularly strong associations with severe PAD, critical limb ischemia (CLI). METHODS: We quantified the associations of these five glycemic markers with incident PAD (hospitalizations with PAD diagnosis or leg revascularization) in 11,634 ARIC participants using Cox regression models...
April 30, 2018: Atherosclerosis
https://www.readbyqxmd.com/read/29684991/postoperative-delirium-in-elderly-patients-with-critical-limb-ischemia-undergoing-major-leg-amputation-a-retrospective-study
#3
Young-Hee Shin, Jin Sun Yoon, Hee Jung Jeon, Youngbae B Kim, Young Soo Kim, Ju Young Park
Background: Critical limb ischemia has been identified as a risk factor for the incidence of postoperative delirium in elderly patients. Limb amputation is the last option in critical limb ischemia treatments. We investigated the incidence and predisposing factors of postoperative delirium in patients undergoing major leg amputation. Methods: From January 2012 to December 2016, 121 patients aged over 60 years who had undergone major leg amputation were enrolled in this study...
April 24, 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29682105/when-are-endovascular-and-open-bypass-treatments-preferred-for-femoropopliteal-occlusive-disease
#4
REVIEW
Ali F AbuRahma
Several meta-analyses and multicenter trials have shown that chronic limb ischemia did not occur for up to 5 years in 50%-70% of patients who underwent saphenous vein grafts, with limb salvage and perioperative mortality rates of >80% and 3%, respectively. However, open surgical bypass can have limitations, including postoperative morbidity/wound complications of 10%-20% and prolonged length of hospital stay and outpatient care. Several studies have analyzed clinical outcomes for patients with critical limb ischemia treated with endovascular therapies, but they have been mainly retrospective with significant heterogeneity or were single center...
March 25, 2018: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29525414/outcomes-of-reintervention-for-recurrent-symptomatic-disease-after-tibial-endovascular-intervention
#5
Hallie E Baer-Bositis, Taylor D Hicks, Georges M Haidar, Matthew J Sideman, Lori L Pounds, Mark G Davies
OBJECTIVE: Tibial interventions for critical limb ischemia are now commonplace. Restenosis and occlusion remain barriers to durability after intervention. The aim of this study was to examine the patient-centered outcomes of open and endovascular reintervention for symptomatic recurrent disease after a primary isolated tibial endovascular intervention. METHODS: A database of patients undergoing isolated primary lower extremity tibial endovascular interventions between 2006 and 2016 was retrospectively queried...
March 8, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29522872/external-validation-and-evaluation-of-reliability-of-the-farp-2-score-to-predict-early-graft-failure-after-infrainguinal-bypass
#6
Mazlum Sahin, Helin El
BACKGROUND: To evaluate the accuracy of the FARP2 (female gender [F], bypass after a previous angioplasty [A], Redo bypass [R], and Pedal bypass [P2 ]) scoring system in predicting early graft failure (EGF) after infrainguinal bypass surgery (IBS). METHODS: Charts of patients who underwent IBS between January 2014 and January 2017 in 2 tertiary academic centers were evaluated retrospectively. In follow-ups, 1 week after operation, detailed physical examination was done, Doppler ultrasonography was performed 1 month after operation, and integrity of the graft was evaluated...
March 6, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29504528/trends-of-the-treatment-of-critical-limb-ischemia-during-the-last-two-decades
#7
Romeo Martini
In this review 14 studies were identified reporting the treatment strategy in 4891 patients with Critical Limb Ischemia (CLI) with the aim to investigate if the strategy of treatment of the first episode of CLI has changed during the last 15-20 years. A computer research has been performed on PubMed and Scopus databases on November 2016. The used terms for the investigation about studies evaluating the strategy of treatment of CLI at the first-time presentation, have been "critical leg ischemia", "critical limb ischemia", "critical lower limb ischemia" along with the terms "placebo", "medical treatment" and/or "conservative" revascularisation, surgical revascularisation, endovascular revascularisation, hybrid revascularisation and primary amputation...
March 1, 2018: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/29487654/successful-carotid-thrombus-aspiration-middle-cerebral-mechanical-thrombectomy-and-axillary-artery-clot-disruption-attempt-in-a-patient-with-acute-ischemic-stroke-and-critical-upper-limb-ischemia
#8
Anton A Khilchuk, Sergey V Vlasenko, Sergey G Scherbak, Andrey M Sarana, Vitaliy V Popov
Acute thrombotic occlusions of the large vessels, such as internal carotid artery, arms and legs arteries, and intracranial vessels, frequently require multiple techniques such as selective thrombolysis, manual aspiration, and stent retrievers for mechanical thrombectomy with combination of the mentioned techniques. Because of the massive thrombotic burden associated with these conditions, the response to systemic intravenous thrombolysis is poor. We present a case of a successful massive thrombi aspiration in a single attempt using an 8Fr guide catheter with aspiration syringe, subsequent ipsilateral middle cerebral artery mechanical thrombectomy, and axillary artery clot disruption attempt in a patient with acute ischemic stroke, right arm critical ischemia, and persistent atrial fibrillation...
February 2018: Radiology Case Reports
https://www.readbyqxmd.com/read/29463493/effect-of-impulsive-compression-treatment-on-postoperative-complications-after-open-peripheral-vascular-revascularization-in-situ-protocol-for-a-randomized-control-trial
#9
Tenna Klit, Marie Dahl, Kim Christian Houlind, Hans Ravn
BACKGROUND: In patients with critical leg ischemia (CLI), the standard operative choice is an in situ bypass to the lower extremity to improve the patients´ prognosis and quality of life. Postoperative complications after surgery occur in 18 % of the patients, prolonging hospitalization and convalescence. The main operative complication is edema. This can be prevented by early mobilization or stimulation of the natural venous pump in the leg. OBJECTIVE: To investigate whether compression therapy with foot pump reduces postoperative edema, facilitates wound healing of the operation wounds, promotes healing of ischemic ulcers, and shortens hospitalization, increasing and improving the patient's subjective quality of life faster...
February 20, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29449960/physician-initiated-clinical-study-of-limb-ulcers-treated-with-a-functional-peptide-sr-0379-from-discovery-to-a-randomized-double-blind-placebo-controlled-trial
#10
Hironori Nakagami, Ken Sugimoto, Takahiro Ishikawa, Taku Fujimoto, Toshifumi Yamaoka, Misa Hayashi, Eiji Kiyohara, Hiroshi Ando, Yuta Terabe, Yoichi Takami, Koichi Yamamoto, Yasushi Takeya, Minoru Takemoto, Masaya Koshizaka, Tamotsu Ebihara, Ayumi Nakamura, Mitsunori Nishikawa, Xiang Jing Yao, Hideki Hanaoka, Ichiro Katayama, Koutaro Yokote, Hiromi Rakugi
SR-0379 is a functional peptide that has wound healing effect with anti-microbial action, making it an ideal drug to prevent infection. To evaluate the safety, efficacy, and pharmacokinetics of SR-0379 for the treatment of leg ulcers, a physician-initiated, phase I/IIa, first-in-patient clinical study was designed. A multi-center, double-blind, randomized clinical study was conducted from October 2015 to September 2016. The inclusion criteria for leg ulcers were (1) diabetes or critical limb ischemia and (2) wound size <6 cm in diameter...
2018: NPJ Aging and Mechanisms of Disease
https://www.readbyqxmd.com/read/29387895/-the-conspicuous-leg
#11
REVIEW
S M Schellong
Symptoms of the leg or of both legs, may indicate a need for evaluation and/or treatment, which must be clarified urgently or even as an emergency situation. Among the diseases which must be considered from a vascular viewpoint are critical limb ischemia, suspicion of deep leg vein thrombosis and special forms of venous insufficiency. With respect to infections erysipelas and the syndrome of infected diabetic foot must be considered as well as peripheral and central leg paresis as orthopedic and neurological disorders, respectively...
March 2018: Der Internist
https://www.readbyqxmd.com/read/29248242/plasma-microbiome-modulated-indole-and-phenyl-derived-metabolites-associate-with-advanced-atherosclerosis-and-postoperative-outcomes
#12
Cori A Cason, Kyle T Dolan, Gaurav Sharma, Ming Tao, Rohan Kulkarni, Irene B Helenowski, Brendan M Doane, Michael J Avram, Mary M McDermott, Eugene B Chang, C Keith Ozaki, Karen J Ho
OBJECTIVE: Multiple studies have shown that gut microbes contribute to atherosclerosis, and there is mounting evidence that microbial metabolism of dietary nutrients influences pathophysiology. We hypothesized that indole- and phenyl-derived metabolites that originate solely or in part from bacterial sources would differ between patients with advanced atherosclerosis and age- and sex-matched controls without clinically apparent atherosclerosis. METHODS: Plasma from the advanced atherosclerosis cohort (n = 100) was from patients who underwent carotid endarterectomy, open infrainguinal leg revascularization, or major leg amputation for critical limb ischemia...
December 13, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29200838/mortality-after-major-amputation-in-elderly-patients-with-critical-limb-ischemia
#13
Sanne Klaphake, Kevin de Leur, Paul Gh Mulder, Gwan H Ho, Hans G de Groot, Eelco J Veen, Hence Jm Verhagen, Lijckle van der Laan
Background: Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown. For this reason, this study evaluated mortality rates and patient-related factors associated with mortality after a major amputation in elderly patients with CLI. Methods: From 2006 to 2013, we included patients aged >70 years who were treated for chronic CLI by primary or secondary major amputation within or after 3 months of initial therapy (revascularization or conservative management)...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29193492/perfusion-measures-for-symptom-severity-and-differential-outcome-of-revascularization-in-limb-ischemia-preliminary-results-with-arterial-spin-labeling-reactive-hyperemia
#14
Hou-Jen Chen, Trisha L Roy, Graham A Wright
BACKGROUND: Previously, a theoretical model based on microvascular physiology was established to facilitate the interpretation of calf perfusion dynamics recorded by arterial spin labeling (ASL). PURPOSE: To investigate the clinical relevance of novel perfusion indices by comparing them to the symptoms, response to revascularization, and short-term functional outcome in patients with peripheral arterial disease (PAD). STUDY TYPE: Prospective cohort study...
November 28, 2017: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/28965800/short-and-long-term-readmission-rates-after-infrainguinal-bypass-in-a-safety-net-hospital-are-higher-than-expected
#15
Brianna M Krafcik, Sevan Komshian, Kimberly Lu, Lauren Roberts, Alik Farber, Jeffrey A Kalish, Denis Rybin, Jeffrey J Siracuse
OBJECTIVE: Readmission rates are expected to have an increasing effect on both the hospital bottom line and physician reimbursements. Safety net hospitals may be most vulnerable. We examined readmissions at 30 days, 90 days, and 1 year in a large safety net hospital to determine the magnitude and effect of short- and long-term readmission rates after lower extremity infrainguinal bypass in this setting. METHODS: All nonemergent extremity infrainguinal bypass performed at a large safety net hospital between 2008 and 2016 were identified...
December 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28883255/critical-leg-ischemia-following-abdominal-aortic-aneurysm-occlusion
#16
Shun-Ichi Kawarai, Keisuke Kanda, Masaharu Hatakeyama, Koichi Nagaya
No abstract text is available yet for this article.
October 1, 2017: Internal Medicine
https://www.readbyqxmd.com/read/28819879/lower-extremity-bypass-using-bovine-carotid-artery-graft-artegraft-an-analysis-of-124-cases-with-long-term-results
#17
Philip Lindsey, Angela Echeverria, Mathew Cheung, Elias Kfoury, Carlos F Bechara, Peter H Lin
INTRODUCTION: Although biological grafts have been utilized as a vascular conduit in leg bypass for many years, reports of a bovine carotid artery graft (BCAG) in lower extremity revascularization have been scarce. This study analyzed the outcome of lower leg bypass using BCAG. METHODS: A retrospective review of a prospectively collected database of all patients undergoing lower extremity bypass using BCAG from 2002 to 2017 was performed. Clinical outcomes including graft patency and limb salvage were evaluated...
January 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/28767168/the-possibility-of-free-tissue-transfer-as-a-nutrient-flap-for-critical-ischemic-foot-a-case-report
#18
Kentaro Tanaka, Kimihiro Igari, Mitsuhiro Kishino, Satoshi Usami, Tsutomu Homma, Takahiro Toyofuku, Yoshinori Inoue, Mutsumi Okazaki
Microsurgical procedure of free tissue transfer in critical limb ischemia patients with large ulceration has already been established. The nutrient flap concept was that transferred tissue functioned not only to cover the skin defect but also as a supplementary blood supply to the ischemic lower leg. This report showed the justification for this concept, which was rarely discussed. A 58-year-old male patient with progressive forefoot gangrene caused by arteriosclerosis obliterans was presented. The distal bypass procedure was performed as revascularization surgery, and a latissimus dorsi (LD) myocutaneous flap was transplanted to cover ulceration...
August 2, 2017: Microsurgery
https://www.readbyqxmd.com/read/28741197/axillobifemoral-bypasses-reappraisal-of-an-extra-anatomic-bypass-by-analysis-of-results-and-prognostic-factors
#19
D Dickas, F Verrel, J Kalff, A Koscielny
BACKGROUND: Axillobifemoral bypass (AFB) is method of second choice. It is reserved for patients at high operative risk or to bypass infected vessels or grafts. In this study, we analyzed prognostic factors for AFB patency and limb salvage rate to facilitate the choice of procedure. METHODS: Between Jan 2006 and Aug 2013, 45 patients underwent AFB surgery in our department, 24 for critical limb ischemia (CLI) and 23 for infection. Endpoints of study were graft occlusion, graft infection, amputation and patient's death...
January 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/28689942/life-expectancy-and-outcome-of-different-treatment-strategies-for-critical-limb-ischemia-in-the-elderly-patient
#20
S Klaphake, K de Leur, P G H Mulder, G H Ho, H G W Groot, E J Veen, L van der Laan
BACKGROUND: Treatment of critical limb ischemia (CLI) in the elderly patients is challenging because of the comorbidity and fragility of these patients. We analysed survival in relation to different treatment options, and estimated life expectancy of our study group by age and gender. METHODS: All patients aged ≥70 years, presenting with chronic CLI, between 2006 to 2013 were included. Treatment was conservative, endovascular, surgical or by primary major amputation...
July 6, 2017: Annals of Vascular Surgery
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