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Critical limb ischaemia

Fadilah S Abdul Wahid, Nor Azimah Ismail, Wan Fariza Wan Jamaluddin, Nor Asiah Muhamad, Mohamad Mohamad Azim Mohamad Idris, Nai Ming Lai
BACKGROUND: Revascularisation therapy is the curent gold standard of care for critical limb ischaemia (CLI), although a significant proportion of patients with CLI either are not fit for or do not respond well to this procedure. Recently, novel angiogeneic therapies such as the use of autologous cell-based 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...
March 13, 2018: Current Stem Cell Research & Therapy
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
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
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
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 inpatient diabetic foot limb salvage and identify risk factors predicting for endovascular limb salvage failure. METHODOLOGY: Retrospective study of limb salvage attempts in 809 patients between August 2013 and July 2015. RESULTS: 68% of our study population were male with mean age at 65 years-old and 73% presented with Rutherford grade 6 critical limb ischaemia, with the remaining 27% Rutherford grade 5...
February 8, 2018: Annals of Vascular Surgery
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
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...
February 2, 2018: European Journal of Vascular and Endovascular Surgery
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])...
January 16, 2018: European Journal of Vascular and Endovascular Surgery
Anne Lejay, Nabil Chakfé
No abstract text is available yet for this article.
January 20, 2018: European Journal of Vascular and Endovascular Surgery
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
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
Pradeep Kumar Mada, Folusakin Ayoade, Ailing Li, John Todd
A 59-year-old man with a history of peripheral vascular disease status post femoral popliteal bypass presented with critical limb ischaemia of the left leg. An arterial Doppler ultrasound showed an occluded graft requiring an above knee amputation. Five days after surgery, the patient developed fever, leucocytosis, significant stump swelling and pain, and serosanguinous discharge from his wound. Wound swab cultures from the stump grew Trichosporon asahii A venous Doppler ultrasound revealed extensive thrombosis of the left lower extremity...
January 6, 2018: BMJ Case Reports
Ulrich Rother, Werner Lang, Raymund E Horch, Ingo Ludolph, Alexander Meyer, Olaf Gefeller, Susanne Regus
OBJECTIVES: The "angiosome" concept as a model for decision making in revascularisation of patients with critical limb ischaemia (CLI) has been subject to lively discussion in recent years. The aim of this prospective pilot study was to use intra-operative fluorescence angiography to provide further data on the angiosome concept on the level of microcirculation after tibial bypass surgery. DESIGN, MATERIALS, AND METHODS: This was a prospective analysis of 40 patients presenting with CLI Rutherford stage IV to VI before and after tibial bypass surgery...
February 2018: European Journal of Vascular and Endovascular Surgery
Lars Norgren, Manesh R Patel, William R Hiatt, Daniel M Wojdyla, F Gerry R Fowkes, Iris Baumgartner, Kenneth W Mahaffey, Jeffrey S Berger, W Schuyler Jones, Brian G Katona, Peter Held, Juuso I Blomster, Frank W Rockhold, Martin Björck
OBJECTIVES: Critical limb ischaemia (CLI) implies an increased risk of cardiovascular morbidity and mortality, and the optimal antithrombotic treatment is not established. DESIGN, MATERIALS, METHODS: The EUCLID trial investigated the effect of monotherapy with ticagrelor versus clopidogrel in 13,885 patients with peripheral artery disease (PAD); the primary endpoint was cardiovascular death, myocardial infarction, or ischaemic stroke. Patients planned for revascularisation or amputation within 3 months, were excluded...
December 19, 2017: European Journal of Vascular and Endovascular Surgery
Iléana Desormais, Victor Aboyans, Francis Pesteil, Philipe Lacroix
Medical management of peripheral arterial disease (PAD) patients is aimed at limb symptom relief and reducing systemic major adverse events risk. For the first purpose: exercise therapy is recommended in case of claudication; multidisciplinary evaluation for surgical options is mandatory in case of critical limb ischaemia. Reducing cardiac and stroke risk can be achieved through: statin prescription in most of the cases; antiplatelet agents in symptomatic PAD patients; cardio-vascular risk factors control.
December 19, 2017: La Presse Médicale
A V Gavrilenko, A A Kravchenko, D V Shatalova
Primary endovascular interventions carried out according to the indications determined by the TASC II guidelines have proved successful in treatment of patients presenting with critical lower limb ischaemia. However, performing secondary and complicated reconstructions requires an individual approach with the assessment of all possible risks involved. Presented herein is a clinical case report regarding repeat reconstruction in a woman with critical lower limb ischaemia after a previously performed endovascular intervention...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Gabriele Pagliariccio, Luciano Carbonari
No abstract text is available yet for this article.
January 2018: European Journal of Vascular and Endovascular Surgery
S T W van Haelst, C Koopman, H M den Ruijter, F L Moll, F L Visseren, I Vaartjes, G J de Borst
BACKGROUND: The aim of this study was to evaluate absolute mortality risks and to determine whether changes in mortality risk occurred in patients with intermittent claudication (IC) or critical limb ischaemia (CLI) in the Netherlands between 1998 and 2010. METHODS: Data for patients treated between 1998 and 2010 were obtained from Dutch nationwide registers: the Hospital Discharge Register, Population Register and Cause of Death Register. The registers were used to obtain information regarding IC and CLI hospitalizations, co-morbidities, demographic factors, and date and cause of death...
November 8, 2017: British Journal of Surgery
Chathuranga Lakmal Fonseka, Sampath Rukshani Galappaththi, Dayakshi Abeyaratne, Nirmali Tissera, Lalith Wijayaratne
Background: Polyarteritis nodosa (PAN) is a medium vessel vasculitis which causes significant morbidity and mortality. Usually, it presents with constitutional symptoms with angiographic evidence of aneurysms or segmental stenosis of arteries of mesenteric or renal vasculature. It is exceedingly uncommon for PAN to present with symptomatic progressive intermittent claudication. Case Presentation: We describe a 60-year-old male who presented with rapidly progressive intermittent claudication of his right leg...
2017: Case Reports in Medicine
Takuya Tsujimura, Osamu Iida, Takayuki Ishihara, Masashi Fujita, Masaharu Masuda, Shin Okamoto, Kiyonori Nanto, Takashi Kanda, Akihiro Sunaga, Mitsuyoshi Takahara, Masaaki Uematsu
The impact of the severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) has not been systematically studied. We retrospectively analysed 622 patients with PAD (intermittent claudication (IC): n = 446; critical limb ischaemia (CLI): n = 176). The association of SYNTAX score and LVEF with mortality was analysed using the Cox proportional hazard model. In patients with IC, a high SYNTAX score was significantly associated with mortality, whereas reduced LVEF was significantly associated with mortality in patients with CLI...
November 2017: Internal Medicine Journal
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