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Critical limb ischaemia

Lampros Liasis, George Malietzis, George Galyfos, Thanos Athanasiou, Harry T Papaconstantinou, Fragiska Sigala, Georgios Zografos, Konstantinos Filis
INTRODUCTION: Lower limb ischaemia in diabetic patients is a result of macro- and microcirculation dysfunction. Diabetic patients undergoing limb amputation carry high mortality and morbidity rates, and decision making concerning the level of amputation is critical. Aim of this study is to evaluate a novel microdialysis technique in order to monitor tissue microcirculation preoperatively and predict the success of limb amputation in such patients. MATERIALS AND METHODS: Overall, 165 patients with type II diabetes mellitus undergoing lower limb amputation were enrolled...
October 12, 2016: Wound Repair and Regeneration
Benedetta Mazzanti, Serena Urbani, Simone Dal Pozzo, Paola Bufano, Lara Ballerini, Alessia Gelli, Irene Sodi, Irene Donnini, Massimo Di Gioia, Stefano Guidi, Julien Camisani, Riccardo Saccardi
BACKGROUND: Clinical grade processing of harvested bone marrow is required in various clinical situations, particularly in the management of ABO mismatching in allogeneic haematopoietic stem cell transplantation (HSCT) and in regenerative medicine. MATERIAL AND METHODS: We report a single-centre experience using a fully automated, clinical grade, closed system (Sepax, Biosafe, Switzerland). From 2003 to 2015, 125 procedures were performed in our laboratory, including buffy-coat production for HSCT (n=58), regenerative medicine in an orthopaedic setting (n=54) and density-gradient separation in a trial for treatment of critical limb ischaemia (n=13)...
September 27, 2016: Blood Transfusion, Trasfusione del Sangue
E Saarinen, P Kauhanen, M Söderström, A Albäck, M Venermo
INTRODUCTION: As the population ages and the incidence of diabetes increases, the expected number of patients with critical limb ischaemia (CLI) requiring distal revascularization will remain high or even increase. The aim of this study was to investigate the long-term results of inframalleolar bypass. MATERIAL AND METHODS: A total of 352 inframalleolar bypasses for CLI performed between 2002 and 2013 were included. Risk factors were evaluated and patency (both clinical and imaging based), leg salvage, survival, and amputation free survival (AFS) assessed...
October 2, 2016: European Journal of Vascular and Endovascular Surgery
Po-Yuan Hsu, Edward Hsi, Tzu-Ming Wang, Ruey-Tay Lin, Yi-Chu Liao, Suh-Hang H Juo
Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and conveys a significant health burden globally. Critical limb ischaemia encompasses the most severe consequence of PAD. Our previous studies indicate that microRNA let-7g prevents atherosclerosis and improves endothelial functions. This study aimed to investigate whether and how let-7g therapy may improve blood flow to ischaemic limbs. The present study shows that let-7g has multiple pro-angiogenic effects on mouse ischaemic limb model and could be a potential therapeutic agent for PAD...
October 3, 2016: Journal of Cellular and Molecular Medicine
Gaurav Gulsin, Solange Serna, Clare Morris, Abutariq Taher, Ian Loke
Takotsubo cardiomyopathy (TC) is a rare condition, characterized by acute left ventricular (LV) dysfunction in the absence of flow-limiting coronary artery disease, usually provoked by a physical or emotional stressor. The condition is far more common in women. The commonest presenting symptoms in patients with TC are chest pain and shortness of breath, often mimicking an acute coronary syndrome. A number of complications of TC are recognized, and very rarely patients experience cardioembolic phenomena secondary to LV thrombus formation in TC...
August 2016: Oxford Medical Case Reports
S D Patel, L Biasi, I Paraskevopoulos, J Silickas, T Lea, A Diamantopoulos, K Katsanos, H Zayed
BACKGROUND: Both infrapopliteal (IP) bypass surgery and percutaneous transluminal angioplasty have been shown to be effective in patients with critical limb ischaemia (CLI). The most appropriate method of revascularization has yet to be established, as no randomized trials have been reported. The aim of this study was to compare the outcomes of patients with similar characteristics treated using either revascularization method. METHODS: Consecutive patients undergoing IP bypass and IP angioplasty for CLI (Rutherford 4-6) at a single institution were compared following propensity score matching...
September 21, 2016: British Journal of Surgery
K J Williams, A Babber, R Ravikumar, A H Davies
BACKGROUND: Peripheral arterial disease (PAD) is common and symptoms can be debilitating and lethal. Risk management, exercise, radiological and surgical intervention are all valuable therapies, but morbidity and mortality rates from this disease are increasing. Circulatory enhancement can be achieved using simple medical electronic devices, with claims of minimal adverse side effects. The evidence for these is variable, prompting a review of the available literature. METHODS: Embase and Medline were interrogated for full text articles in humans and written in English...
September 17, 2016: Advances in Experimental Medicine and Biology
G Roditi, A Christie, S Chandramohan
AIM: To prospectively compare the performance of extracellular space contrast agents (ECSCAs) versus a blood-pool contrast agent (BPCA) for a comprehensive lower-limb magnetic resonance angiography (MRA) protocol in patients with either claudication or critical ischaemia. MATERIALS AND METHODS: Thirty patients with claudication underwent lower-limb magnetic resonance angiography (MRA) (dynamic crural, three-station bolus chase, and infra-inguinal high resolution) using a triphasic injection method with both a ECSCA and BPCA to allow intra-individual comparison, and 30 patients with critical ischaemia were scanned with either a ECSCA or BPCA...
September 11, 2016: Clinical Radiology
Iu I Kazakov, I B Lukin, N Iu Sokolova, M A Strakhov
Analysed herein are both immediate and remote results of surgical treatment of 93 patients presenting with chronic atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. The patients were subjected to autovenous femoropopliteal bypass grafting to the isolated arterial segment or balloon angioplasty with stenting of the superficial femoral artery. While choosing the method of arterial reconstruction we assessed concomitant diseases, primarily lesions of the coronary and cerebral circulation...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Fay Crawford, Karen Welch, Alina Andras, Francesca M Chappell
BACKGROUND: Peripheral arterial disease (PAD) of the lower limb is common, with prevalence of both symptomatic and asymptomatic disease estimated at 13% in the over 50 age group. Symptomatic PAD affects about 5% of individuals in Western populations between the ages of 55 and 74 years. The most common initial symptom of PAD is muscle pain on exercise that is relieved by rest and is attributed to reduced lower limb blood flow due to atherosclerotic disease (intermittent claudication). The ankle brachial index (ABI) is widely used by a variety of healthcare professionals, including specialist nurses, physicians, surgeons and podiatrists working in primary and secondary care settings, to assess signs and symptoms of PAD...
September 14, 2016: Cochrane Database of Systematic Reviews
Nele Warmke, Kathryn J Griffin, Richard M Cubbon
Pericytes are mural cells that support and stabilise the microvasculature, and are present in all vascular beds. Pericyte-endothelial cell crosstalk is essential in both remodelling and quiescent vasculature, and this complex interaction is often disrupted in disease states. Pericyte loss is believed to be an early hallmark of diabetes-associated microvascular disease, including retinopathy and nephropathy. Here we review the current literature defining pericyte biology in the context of diabetes-associated vascular disease, with a particular focus on whether pericytes contribute actively to disease progression...
November 2016: Journal of Diabetes and its Complications
Sevdalina N Lambova
Micro- and macrovascular pathology is a frequent finding in a number of common rheumatic diseases. Secondary Raynaud's phenomenon (RP) is among the most common symptoms in systemic sclerosis and several other systemic autoimmune diseases including a broad differential diagnosis. It should be also differential from other peripheral vascular syndromes such as embolism, thrombosis, etc., some of which lead to clinical manifestation of the blue toe syndrome. The current review discusses the instrumental methods for vascular assessments...
April 2016: Folia Medica
Sara Roos, Ing-Marie Fyhr, Katharina S Sunnerhagen, Ali-Reza Moslemi, Anders Oldfors, Michael Ullman
Muscle biopsy is an essential part in the diagnostic workup in patients with suspected neuromuscular disorders. It is therefore important to be aware of morphological alterations that can be caused by systemic factors or natural ageing. Chronic limb ischaemia is frequent in elderly individuals. This study was performed to examine histopathological and mitochondrial changes in muscle in patients with chronic critical limb ischaemia. Muscle biopsy of skeletal muscle of the lower limb of patients with chronic ischaemia leading to amputation was performed and compared with muscle biopsies of healthy, age-matched controls...
November 2016: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
Pasha Normahani, Nigel J Standfield, Usman Jaffer
BACKGROUND: Acute limb ischemia (ALI) continues to pose a significant challenge to clinicians and is associated with an unacceptably high rate of morbidity and mortality. Despite its time critical nature, little is known regarding the delays encountered during the patient pathway. The aim of this study was to identify sources of delay in the patient pathway at our institution. METHODS: 67 cases of ALI of the lower extremities from 66 patients, who had presented to our center between May 2003 to April 2014, were identified for retrospective analysis...
August 12, 2016: Annals of Vascular Surgery
Barnaby C Reeves, Katie Pike, Chris A Rogers, Rachel Cm Brierley, Elizabeth A Stokes, Sarah Wordsworth, Rachel L Nash, Alice Miles, Andrew D Mumford, Alan Cohen, Gianni D Angelini, Gavin J Murphy
BACKGROUND: Uncertainty about optimal red blood cell transfusion thresholds in cardiac surgery is reflected in widely varying transfusion rates between surgeons and cardiac centres. OBJECTIVE: To test the hypothesis that a restrictive compared with a liberal threshold for red blood cell transfusion after cardiac surgery reduces post-operative morbidity and health-care costs. DESIGN: Multicentre, parallel randomised controlled trial and within-trial cost-utility analysis from a UK NHS and Personal Social Services perspective...
August 2016: Health Technology Assessment: HTA
J S Lindholt, K Houlind, B Gottschalksen, C N Pedersen, H Ravn, B Viddal, G Pedersen, M Rasmussen, C Wedel, M B Bramsen
BACKGROUND: Cohort studies suggest superior long-term patency of luminal heparin-bonded polytetrafluoroethylene (Hb-PTFE) bypass grafts compared with standard PTFE grafts. The aim of this study was to compare the outcomes of Hb-PTFE grafts with those of standard PTFE grafts 5 years after a randomized trial. METHODS: Patients with intermittent claudication or critical limb ischaemia requiring femorofemoral or femoropopliteal bypass grafting were randomized in a clinical trial of Hb-PTFE versus standard PTFE in 11 Scandinavian centres between 2005 and 2009...
September 2016: British Journal of Surgery
Beatriz Gavier, Fernando Vazquez, Esteban Gandara
BACKGROUND: Despite being an important risk factor for venous thromboembolism and ischaemic stroke, the role of antiphospholipid antibodies in patients with peripheral arterial disease remains a matter of debate. The aim of this study was to evaluate the association of persistently elevated antiphospholipid antibodies and lower extremity peripheral arterial disease. METHODS: We conducted a systematic review of electronic databases including MEDLINE, EUROPUBMED and EMBASE to assess the prevalence of antiphospholipid antibodies in patients with lower extremity peripheral arterial disease...
2016: VASA. Zeitschrift Für Gefässkrankheiten
Marcus Vinícius Martins Cury, Francisco Cardoso Brochado-Neto, Marcelo Fernando Matielo, Rafael de Athayde Soares, Anna Karina Paiva Sarpe, Roberto Sacilotto
BACKGROUND: The aim of this study was to determine the outcomes of primary bypass graft surgery (BGS) compared to BGS after failed angioplasty (PTA). PATIENTS AND METHODS: Between January 2007 and January 2014, we performed 136 BGSs exclusively for the treatment of critical limb ischaemia. Two cohorts were identified: 1) primary BGS (n = 102; group I), and 2) BGS after prior PTA (n = 34; group II). Data were analysed retrospectively and the primary endpoints were the rates of secondary patency, amputation-free survival, freedom from major adverse outcomes (graft occlusion, amputation, or death), and overall survival, which were assessed with the Kaplan-Meier method...
2016: VASA. Zeitschrift Für Gefässkrankheiten
Silvia Bleda, Joaquin de Haro, Ignacio Lopez de Maturana, Cesar Varela, Antonio Ferruelo, Francisco Acin
OBJECTIVES: Inflammatory stress stimuli in the plasma of patients with peripheral artery disease (PAD) are able to trigger the expression of NLRP1 inflammasome in human aortic endothelial cells (HAECs). Our objective was to elucidate the effect of simvastatin treatment on NLRP1 inflammasome expression in endothelial cells exposed to the plasma of PAD patients. MATERIAL AND METHODS: The study included 81 patients with PAD, 24 of them treated with simvastatin (20mg/day) and 57 without statin therapy...
July 13, 2016: Annals of Vascular Surgery
Francis G Fowkes, Rachel Forster, Carol E Levin, Nadraj G Naidoo, Ambuj Roy, Chang Shu, John Spertus, Kun Fang, Luis Bechara-Zamudio, Mariella Catalano, Adriana Visona, Sigrid Nikol, John P Fletcher, Michael R Jaff, William R Hiatt, Lars Norgren
Lower extremity peripheral artery disease (PAD) is increasing in prevalence in low- and middle-income countries creating a large health care burden. Clinical management may require substantial resources but little consideration has been given to which treatments are appropriate for less advantaged countries. The aim of this review was to systematically appraise published data on the costs and effectiveness of PAD treatments used commonly in high-income countries, and for an international consensus panel to review that information and propose a hierarchy of treatments relevant to low- and middle-income countries...
July 7, 2016: International Angiology: a Journal of the International Union of Angiology
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