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Critical limb ischaemia

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https://www.readbyqxmd.com/read/29786412/the-use-of-scoring-balloons-in-the-superficial-femoral-artery
#1
Simon Bays
Percutaneous transluminal angioplasty and stenting is becoming increasingly the first line treatment for patients with both claudication and critical limb ischaemia instead of surgery, with the aim of returning the patient's quality of life in the former and preventing amputation. Drug eluting technologies have seen a large surge in popularity in recent years, and significant patient benefits have been seen with the use of drug eluting stents and balloons over the use of plain balloon angioplasty. Unfortunately in many patients with arterial disease there is significant vessel wall calcification - this can theoretically be a barrier to drug delivery, and can also be a contributing factor to flow limiting dissection and the subsequent need for bail out stenting...
May 22, 2018: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29776002/the-chaos-of-hospitalisation-for-patients-with-critical-limb-ischaemia-approaching-major-amputation
#2
Susan Monaro, Sandra West, Jana Pinkova, Janice Gullick
AIMS AND OBJECTIVES: To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). BACKGROUND: CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29704386/autologous-mononuclear-cells-from-different-sources-are-seen-to-improve-wound-healing-in-patients-with-haematological-malignancies
#3
W F Wan Jamaludin, F Mohamad Yusoff, N A Ismail, M R Mohd Idris, S Palaniappan, C K K Ng, N Abdullah, S Z A Zaider, S F S Abdul Wahid
INTRODUCTION: Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival. BACKGROUND: Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding...
April 2018: Malaysian Journal of Pathology
https://www.readbyqxmd.com/read/29701412/functional-popliteal-artery-entrapment-syndrome
#4
Luis Gamas, João Rocha Neves, Luís Machado, Ricardo Ferreira, Pedro Paz Dias, José Teixeira
INTRODUCTION: Popliteal artery entrapment is an uncommon syndrome, caused by extrinsic compression of the popliteal artery by muscular or tendinous structures. It occurs mainly in young individuals, with no atherosclerostic risk factors, and a mean age of presentation of 20 to 40 years, and has higher prevalence in males (83% of patients). Clinical presentation depends on the degree of arterial lesion, the most common being intermittent claudication, with critical ischemia being frequent...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29688209/-hybrid-intervention-for-an-atherosclerotic-lesion-of-arteries-of-the-iliofemoral-segment
#5
K A Kireev, A A Fokin, D V Rodnianskiĭ
The article describes a clinical case report regarding a successfully performed hybrid intervention in a patient presenting with critical ischaemia of a lower limb and an atherosclerotic lesion of arteries of the iliofemoral segment. Endovascular reconstruction in an isolated manner turned out to be impossible for both technical and anatomical reasons, whereas open reconstruction required two surgical accesses, an extended scope of the operation, and the use of a synthetic graft. Using a hybrid approach favourably contributed to adequate restoration of blood flow in the ischaemized limb, a decrease in the traumatic nature of the intervention, and also ensured angiographic control over the state of the operated arterial segment...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/29688198/-hybrid-surgical-treatment-of-a-multilevel-lesion-of-lower-limb-arteries
#6
P D Puzdriak, V V Shlomin, E A Shloĭdo, M A Ivanov, Iu P Didenko, I V Kas'ianov, P B Bondarenko, N Iu Grebenkina, T B Rakhmatillaev
The study was aimed at assessing immediate postoperative and remote results of hybrid surgical treatment of patients with a multilevel lesion of lower-limb arteries. Described herein is the authors' experience with simultaneous hybrid surgical management of 48 patients, including 43 subjects with a multilevel lesion of arteries of the lower extremities. There were 40 men and 8 women, with the average age amounting to 65.8±7.9 years. Of these, 30 patients suffered from stage II-b chronic arterial insufficiency (CAI), 11 had stage III CAI and 7 had stage IV CAI according to A...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/29658630/lumbar-sympathectomy-versus-prostanoids-for-critical-limb-ischaemia-due-to-non-reconstructable-peripheral-arterial-disease
#7
REVIEW
Indrani Sen, Sunil Agarwal, Prathap Tharyan, Rachel Forster
BACKGROUND: Peripheral arterial disease (PAD) is a common circulatory problem that can lead to reduced blood flow to the limbs, which may result in critical limb ischaemia (CLI), a painful manifestation that occurs when a person is at rest. The mainstay of treatment for CLI is surgical or endovascular repair. However, when these means of treatment are not suitable, due to anatomical reasons or comorbidities, treatment for pain is limited. Lumbar sympathectomy and prostanoids have both been shown to reduce pain from CLI in people who suffer from non-reconstructable PAD, but there is currently insufficient evidence to determine if one treatment is superior...
April 16, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29579246/high-sensitivity-cardiac-troponin-and-natriuretic-peptide-with-risk-of-lower-extremity-peripheral-artery-disease-the-atherosclerosis-risk-in-communities-aric-study
#8
Kunihiro Matsushita, Lucia Kwak, Chao Yang, Yuanjie Pang, Shoshana H Ballew, Yingying Sang, Ron C Hoogeveen, Bernard G Jaar, Elizabeth Selvin, Christie M Ballantyne, A Richey Sharrett, Aaron R Folsom, Gerardo Heiss, Josef Coresh, Alan T Hirsch
Aims: Cardiac troponin T (cTnT) is suggested as a predictor of amputation in patients with peripheral artery disease (PAD). However, cTnT-PAD association has not been systematically studied in a large study. This study evaluated the association of high-sensitivity cTnT (hs-cTnT) with PAD incidence and also explored whether natriuretic peptide (NT-proBNP), another representative cardiac marker, predicts PAD risk. Methods and results: Among 12 288 middle-aged adults, the associations of hs-cTnT and NT-proBNP with incident PAD (hospitalizations with PAD diagnosis or leg revascularization [cases with rest pain or tissue loss considered as critical limb ischaemia (CLI)]) were quantified with multivariable Cox regression models...
March 22, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29557735/microarray-analysis-for-delineating-the-gene-expression-in-biopsies-of-gastrocnemius-muscle-of-patients-with-chronic-critical-limb-ischaemia-compared-with-non-ischaemic-controls
#9
Daniel Freund, Silke Brilloff, Tamer Ghazy, Stephan Kirschner, Gabor Gäbel, Irene Hinterseher, Norbert Weiss, Adrian Mahlmann
BACKGROUND: Microarray analysis has been carried out in this pilot study to compare delineated gene expression profiles in the biopsies of skeletal muscle taken from patients with chronic critical limb ischaemia (CLI) and non-ischaemic control subjects. PATIENTS AND METHODS: Biopsy of gastrocnemius muscle was obtained from six patients with unreconstructed CLI referred for surgical major amputation. As control, biopsies of six patients undergoing elective knee arthroplasty without evidence of peripheral arterial occlusive disease were taken...
March 20, 2018: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/29532760/efficacy-and-safety-of-autologous-cell-based-therapy-in-patients-with-no-option-critical-limb-ischaemia-a-meta-analysis
#10
Fadilah S Abdul Wahid, Nor Azimah Ismail, Wan Fariza Wan Jamaludin, Nor Asiah Muhamad, Mohamad Azim Mohamad Idris, Nai Ming Lai
BACKGROUND: Revascularisation therapy is the current gold standard of care for critical limb ischemia (CLI), although a significant proportion of patients with CLI either are not fit for or do not respond well to this procedure. Recently, novel angiogenic therapies such as the use of autologous cellbased therapy (CBT) have been examined, but the results of individual trials were inconsistent. OBJECTIVE: To pool all published studies that compared the safety and efficacy of autologous CBT derived from different sources and phenotypes with non cell-based therapy (NCT) in CLI patients...
2018: Current Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/29516399/lumbar-sympathectomy-can-improve-symptoms-associated-with-ischaemia-vasculitis-diabetic-neuropathy-and-hyperhidrosis-affecting-the-lower-extremities-a-single-centre-experience
#11
Sean C Maguire, Christina A Fleming, Gavin O'Brien, Gerald McGreal
BACKGROUND: Lumbar sympthectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularisation for that indication. However, it retains a role in the management of critical limb ischaemia and other conditions causing lower limb pain with or without ischaemia. We report the role of LS in modern surgical practice when revascularisation and pain management options have been exhausted. METHODS: A medical chart review was performed on all patients who underwent LS in our unit from 2005 to 2016 (inclusive)...
March 7, 2018: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29490953/budget-impact-analysis-of-heparin-bonded-polytetrafluoroethylene-grafts-propaten-against-standard-polytetrafluoroethylene-grafts-for-below-the-knee-bypass-in-patients-with-critical-limb-ischaemia-in-france
#12
Simon Vergnaud, Valéry-Pierre Riche, Philippe Tessier, Nicolas Mauduit, Adrien Kaladji, Yann Gouëffic
OBJECTIVES: To evaluate the budget impact of progressive replacement of standard polytetrafluoroethylene (PTFE) grafts by heparin-bound PTFE (Propaten) for below-the-knee (BTK) bypass in patients with critical limb ischaemia (CLI). DESIGN: From a review of the scientific literature, we calculated a theoretical BTK primary patency for Propaten grafts. Using the French hospital expenditure database (PMSI), we retrospectively estimated a rehospitalisation rate for standard PTFE grafts...
February 28, 2018: BMJ Open
https://www.readbyqxmd.com/read/29473538/-a-woman-with-swelling-and-blue-red-discolouration-of-the-leg
#13
E Benthem, V Brown
A 61-year-old woman presented with a sudden marked swelling and blue-red discolouration of her entire left leg. The diagnosis phlegmasia cerulea dolens was made. This is an extreme case of lower-extremity deep venous thrombosis that can cause critical limb ischaemia and possible limb loss.
2018: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/29428535/diabetic-foot-limb-salvage-a-series-of-809-attempts-and-predictors-for-endovascular-limb-salvage-failure
#14
Zhiwen Joseph Lo, Zhimin Lin, Uei Pua, Lawrence Han Hwee Quek, Bien Ping Tan, Sundeep Punamiya, Glenn Wei Leong Tan, Sriram Narayanan, Sadhana Chandrasekar
BACKGROUND: To review patient characteristics and outcomes of in-patient diabetic foot limb salvage and identify risk factors predicting for endovascular limb salvage failure. METHODS: Retrospective study of limb salvage attempts in 809 patients between August 2013 and July 2015. RESULTS: Sixty-eight percent of our study population were male with mean age at 65 years and 73% presented with Rutherford grade 6 critical limb ischemia, with the remaining 27% Rutherford grade 5...
February 9, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29419359/minimising-failure-in-critical-lower-limb-ischaemia-intervention-adjuvant-capillary-bed-recruitment-is-the-missed-opportunity
#15
Sherif Sultan, Edel Patricia Kavanagh, Niamh Hynes
Critical limb ischaemia is the end stage of peripheral arterial disease before limb loss. Contemporary interventions to restore blood flow have high morbidity and mortality and fail to provide sustained restoration of peripheral circulation. Cell-based therapies designed to promote neovascularisation or angiogenesis have been shown in trials to be safe but clinically ineffective. Notwithstanding endless research in the area, no headway has been made in identifying a successful therapy designed specifically to target muscle disease in critical lower limb ischaemia...
January 1, 2018: Vascular
https://www.readbyqxmd.com/read/29402670/infrapopliteal-angioplasty-of-one-or-more-than-one-artery-for-critical-limb-ischaemia-a-randomised-clinical-trial
#16
Rodrigo B Biagioni, Luisa C Biagioni, Felipe Nasser, Marcelo C Burihan, José C Ingrund, Adnan Neser, Fausto Miranda
OBJECTIVE: The aim was to analyse the effect of the treatment of more than one infrapopliteal artery with respect to wound healing and limb salvage. METHODS: Seventy-eight patients were enrolled prospectively for 80 procedures (80 limbs) that were randomly divided into two groups: 40 in the single vessel (SV) group and 40 in the multiple vessel group (MV). All patients had tissue loss. The choice of the first artery to treat was based on an analysis of two factors: the ease of the required endovascular technique and the presence of adequate distal outflow...
April 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29373203/editor-s-choice-a-prospective-study-to-evaluate-complete-wound-healing-and-limb-salvage-rates-after-angiosome-targeted-infrapopliteal-balloon-angioplasty-in-patients-with-critical-limb-ischaemia
#17
Ahmed Elbadawy, Haitham Ali, Mahmoud Saleh, Ayman Hasaballah
OBJECTIVE/BACKGROUND: To evaluate complete wound healing and limb salvage rates in patients with critical limb ischaemia (CLI) with concurrent foot ulceration/gangrene who underwent angiosome targeted infrapopliteal balloon angioplasty. METHODS: This was a prospective observational study. In total, 212 patients who underwent successful infrapopliteal balloon angioplasty to assist wound healing and achieve limb salvage were included from June 2014 to March 2016. Propensity score matching was developed to compare complete wound healing, 1 year amputation free survival (AFS), and limb salvage rates between the two study groups (direct revascularisation [DR] and indirect revascularisation [IR])...
March 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29366686/commentary-on-a-prospective-study-to-evaluate-complete-wound-healing-and-limb-salvage-rates-after-angiosome-targeted-infrapopliteal-balloon-angioplasty-in-critical-limb-ischaemia-patients
#18
Anne Lejay, Nabil Chakfé
No abstract text is available yet for this article.
March 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29318581/prostanoids-for-critical-limb-ischaemia
#19
REVIEW
Valeria Vietto, Juan Va Franco, Victoria Saenz, Denise Cytryn, Jose Chas, Agustín Ciapponi
BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity and mortality due to cardiovascular disease in the general population. Although numerous treatments have been adopted for patients at different disease stages, no option other than amputation is available for patients presenting with critical limb ischaemia (CLI) unsuitable for rescue or reconstructive intervention. In this regard, prostanoids have been proposed as a therapeutic alternative, with the aim of increasing blood supply to the limb with occluded arteries through their vasodilatory, antithrombotic, and anti-inflammatory effects...
January 10, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29314703/a-retrospective-cost-analysis-of-angioplasty-compared-to-bypass-surgery-for-lower-limb-arterial-disease-in-an-australian-tertiary-health-service
#20
Natalie Ly Ngu, James Lisik, Dinesh Varma, Gerard S Goh
INTRODUCTION: Percutaneous transluminal angioplasty (PTA) and surgical bypass (BYP) are treatment options for symptomatic peripheral arterial disease (PAD). PTA and BYP have different clinical outcomes and cost implications. This paper aims to compare hospital-related costs of PTA and BYP for PAD of the lower limbs in an Australian health service. METHODS: A retrospective cost analysis using clinical and financial data from an urban, tertiary hospital was performed...
January 5, 2018: Journal of Medical Imaging and Radiation Oncology
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