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chronic limb ischemia

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https://www.readbyqxmd.com/read/29221961/prevalence-of-high-on-treatment-aspirin-and-clopidogrel-platelet-reactivity-in-patients-with-critical-limb-ischemia
#1
Leonardo C Clavijo, Noor Al-Asady, Ashwat Dhillon, Ray V Matthews, Jorge Caro, Han Tun, Vincent Rowe, David M Shavelle
OBJECTIVES: The goal of this study is to establish the prevalence of high on-treatment platelet reactivity to aspirin (HPRA) and clopidogrel (HPRC) in patients with critical limb ischemia (CLI). BACKGROUND: CLI is associated with an increased risk of death and cardiovascular events. Unlike other patient populations with atherosclerotic cardiovascular disease, previous studies failed to demonstrate a benefit of antiplatelet therapy in patients with CLI. METHODS: From June 2014 to November 2016, we performed platelet reactivity studies for P2Y12 and thromboxane A2 (TXA2) inhibition in 100 CLI patients receiving daily treatment with aspirin and clopidogrel...
October 28, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29221836/efficacy-versus-complications-in-arterial-thrombolysis
#2
H P Ebben, M V van Burink, V Jongkind, D E Mouwen, J Udding, W Wisselink, J K Kievit, A M Wiersema, K K Yeung
BACKGROUND: Acute peripheral arterial occlusions threaten life and limb. Thrombolysis is an established, minimally invasive alternative treatment for surgical thromboembolectomy. Yet, there is no consensus regarding an optimal thrombolysis protocol and current knowledge is largely based on studies from the 1990's. This study reviews a contemporary cohort of patients treated with thrombolysis and aims to evaluate the treatment results and to identify possible predictors for outcome and (bleeding) complications...
December 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29218290/critical-upper-limb-ischemia-due-to-brachial-tourniquet-in-misdiagnosed-thoracic-outlet-syndrome-after-carpal-tunnel-decompression-a-case-report
#3
Cesare Tiengo, Andrea Monticelli, Stefano Bonvini, Valentina Wassermann, Erica Dalla Venezia, Franco Bassetto
We present the case of a 68-year-old woman, referred to our department for critical upper limb ischemia, which had occurred a few days after homolateral surgical ligamentotomy for carpal tunnel syndrome, diagnosed and confirmed by electromyography, and performed with a brachial tourniquet. The patient was later admitted for subsequent progressive necrosis of the first three fingers of the left hand, accompanied by signs of upper limb ischemia. An accessory cervical rib was identified, completely obliterating the subclavian artery distally at the origin of the suprascapular artery...
September 2017: World Journal of Plastic Surgery
https://www.readbyqxmd.com/read/29217449/role-of-brachial-artery-ligation-bal-in-management-of-prosthetic-arterio-venous-graft-infections
#4
A R Chandrashekar, Chetan R Hoskatti, Sanjay C Desai, Rajendra B Prasad
CONTEXT: Arterio-Venous Graft (AVG) infections can present as major life-threatening hemorrhage or sepsis in a chronic kidney disease patient. Frequently all these patients present in critical condition which need prompt and expeditious management. Various procedures are described for management of infected grafts and its bleeding complications. However these procedures are associated with postop-operative bleeding and persistent infection. AIM: To study brachial artery ligation near the elbow joint in the management of an infected AV graft...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29214670/recanalization-of-native-superficial-femoral-artery-chronic-total-occlusion-after-failed-femoropopliteal-bypass-in-patients-with-critical-limb-ischemia
#5
Zhenjiang Li, Rui Feng, Feng Qin, Zhiqing Zhao, Liangxi Yuan, Yiming Li, Junjun Liu, Jiaxuan Feng, Jian Zhou, Junmin Bao, Zaiping Jing
OBJECTIVES: This study aimed to examine the outcomes of endovascular recanalization for native superficial femoral artery (SFA) chronic total occlusion (CTO) in patients with critical limb ischemia (CLI) after femoropopliteal bypass failure with limited surgical revascularization options. BACKGROUND: Endovascular recanalization of native artery occlusions has been recently used as a new alternative for threatened limbs after bypass graft occlusion. The feasibility and efficacy has not been widely reported...
December 6, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/29207364/transpedal-access-for-the-management-of-complex-peripheral-artery-disease
#6
Konstantinos Marmagkiolis, Partha Sardar, Jihad A Mustapha, Miguel Montero-Baker, Konstantinos Charitakis, Cezar Iliescu, Dmitriy N Feldman
OBJECTIVES: To evaluate the safety and efficacy of transpedal access for the management of complex peripheral artery disease (PAD). INTRODUCTION: Critical limb ischemia is associated with high risk of limb loss, as well as cardiovascular and all-cause mortality. Transpedal access is a novel, increasingly utilized technique for the management of complex PAD. METHODS: We performed a literature search using PubMed from January 2003 to December 2016...
December 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/29200838/mortality-after-major-amputation-in-elderly-patients-with-critical-limb-ischemia
#7
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/29196241/scleroderma-skin-ulcers-definition-classification-and-treatment-strategies-our-experience-and-review-of-the-literature
#8
REVIEW
Dilia Giuggioli, Andreina Manfredi, Lumetti Federica, Colaci Michele, Clodoveo Ferri
BACKGROUND: Skin ulcers (SU) are one of the most frequent manifestations of systemic sclerosis (SSc). SSc-SU are very painful, often persistent and recurrent; they may lead to marked impairment of patient's activities and quality of life. Despite their severe impact on the whole SSc patient's management, the proposed definition, classification criteria, and therapeutic strategies of SSc-SU are still controversial. OBJECTIVE: The present study aimed to elaborate a comprehensive proposal of definition, classification, and therapeutic strategy of SSc-SU on the basis of our long-term single center experience along with a careful revision of the world literature on the same topic...
November 28, 2017: Autoimmunity Reviews
https://www.readbyqxmd.com/read/29169546/telehealth-electronic-monitoring-to-reduce-postdischarge-complications-and-surgical-site-infections-after-arterial-revascularization-with-groin-incision
#9
Albeir Y Mousa, Mike Broce, Elaine Davis, Barbara McKee, Michael Yacoub
It is intuitive that postdischarge surgical complications are associated with increased patient dissatisfaction, and are directly associated with an increase in medical expenditures. It is also easy to make the connection that many post-hospital discharge surgical complications, including surgical site infections (SSIs), could be influenced or exacerbated by patient comorbidities. The authors of a recent study reported that female gender, obesity, diabetes, smoking, hypertension, coronary artery disease, critical limb ischemia, chronic obstructive pulmonary disease, dyspnea, and neurologic disease were significant predictors of SSIs after vascular reconstruction was performed...
December 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29169498/heterogeneity-of-ankle-brachial-indices-in%C3%A2-patients-undergoing-revascularization-for%C3%A2-critical%C3%A2-limb-ischemia
#10
Devraj Sukul, Scott F Grey, Peter K Henke, Hitinder S Gurm, P Michael Grossman
OBJECTIVES: This study sought to describe the distribution of pre-intervention treated-limb ankle-brachial indices (ABIs) among patients with critical limb ischemia (CLI) undergoing percutaneous vascular intervention (PVI) or surgical revascularization (SR). BACKGROUND: CLI is diagnosed by the presence of rest pain, tissue ulceration, or gangrene due to chronic arterial insufficiency. It is unclear what fraction of patients with suspected CLI have severe peripheral artery disease (PAD) on noninvasive functional testing...
November 27, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29162367/arterial-reconstructions-for-chronic-lower-extremity-ischemia-in-preadolescent-and-adolescent-children
#11
Jonathan L Eliason, Dawn M Coleman, Adam Gumushian, James C Stanley
OBJECTIVE: Chronic lower extremity ischemia in pediatric patients is uncommon. The intent of this study was to better define the arterial reconstructive options and their long-term durability in preadolescent and adolescent children having clinically relevant arterial occlusions affecting the lower extremity. METHODS: The medical records of 33 consecutive pediatric patients who underwent lower extremity revascularization for chronic ischemia at the University of Michigan from 1974 to 2016 were reviewed...
November 18, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29143147/-esc-guidelines-2017-on-peripheral-arterial-diseases-summary-of-the-most-important-recommendations-and-innovations
#12
C Espinola-Klein
The current European Society of Cardiology (ESC) guidelines on peripheral arterial diseases include recommendations on diagnostics and treatment of atherosclerotic manifestations in peripheral arteries. Because of the high coincidence of atherosclerosis in different arterial territories, screening for other atherosclerotic lesions is necessary in patients with clinical symptoms in one vascular bed. Consistent treatment of cardiovascular risk factors is important in all patients with peripheral atherosclerosis...
November 15, 2017: Herz
https://www.readbyqxmd.com/read/29124029/femoro-supragenicular-popliteal-bypass-with-a-bridging-stent-graft-in-a-diffusely-diseased-distal-target-popliteal-artery-alternative-to-below-knee-popliteal-polytetrafluoroethylene-bypass
#13
Joung Hun Byun, Tae Gyu Kim, Yun Gyu Song
Background: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. Methods: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral-above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft...
October 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29079519/n-acetylcysteine-effects-on-a-murine-model-of-chronic-critical-limb-ischemia
#14
Wallace Aguiar de Medeiros, Leandro Almeida da Silva, Dhébora Mozena Dall'Igna, Monique Michels, Andressa Manfredini, Juliano Dos Santos Cardoso, Larissa Constantino, Giselli Scaini, Francieli Vuolo, Emílio L Streck, Cristiane Ritter, Felipe Dal-Pizzol
During chronic limb ischemia, oxidative damage and inflammation are described. Besides oxidative damage, the decrease of tissue oxygen levels is followed by several adaptive responses. The purpose of this study was to determine whether supplementation with N-acetylcysteine (NAC) is effective in an animal model of chronic limb ischemia. Chronic limb ischemia was induced and animals were treated once a day for 30 consecutive days with NAC (30mg/kg). After this time clinical scores were recorded and soleus muscle was isolated and lactate levels, oxidative damage and inflammatory parameters were determined...
October 24, 2017: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/29079009/long-term-mortality-benefit-of-renin-angiotensin-system-inhibitors-in-patients-with-chronic-limb-threatening-ischemia-undergoing-vascular-intervention
#15
Thomas C F Bodewes, Jeremy D Darling, Thomas F X O'Donnell, Sarah E Deery, Katie E Shean, Murray A Mittleman, Frans L Moll, Marc L Schermerhorn
OBJECTIVE: The beneficial effect of renin-angiotensin system (RAS) inhibitors has been well-established in patients with cardiovascular disease; however, their effectiveness in patients with chronic limb-threatening ischemia (CLTI), a selected disease-burdened population, is largely unknown. The purpose of this study was to evaluate long-term outcomes of RAS inhibitor use in patients with CLTI undergoing a vascular intervention. METHODS: For this study, all patients with CLTI undergoing a first-time revascularization (bypass or endovascular) were analyzed at our institution between 2005 and 2014...
October 24, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29074815/hyperbaric-oxygen-therapy-in-the-treatment-of-ischemic-lower-extremity-ulcers-in-patients-with-diabetes-results-of-the-damo2cles-multicenter-randomized-clinical-trial
#16
Katrien T B Santema, Robert M Stoekenbroek, Mark J W Koelemay, Jim A Reekers, Laura M C van Dortmont, Arno Oomen, Luuk Smeets, Jan J Wever, Dink A Legemate, Dirk T Ubbink
OBJECTIVE: Conflicting evidence exists on the effects of hyperbaric oxygen therapy (HBOT) in the treatment of chronic ischemic leg ulcers. The aim of this trial was to investigate whether additional HBOT would benefit patients with diabetes and ischemic leg ulcers. RESEARCH DESIGN AND METHODS: Patients with diabetes with an ischemic wound (n = 120) were randomized to standard care (SC) without or with HBOT (SC+HBOT). Primary outcomes were limb salvage and wound healing after 12 months, as well as time to wound healing...
October 26, 2017: Diabetes Care
https://www.readbyqxmd.com/read/29074110/evaluation-of-a-new-model-of-hind-limb-ischemia-in-rabbit
#17
Costantino Del Giudice, Gabriel Ifergan, Guillaume Goudot, Valerie Bellamy, Emmanuel Messas, Olivier Clement, Patrick Bruneval, Philippe Menasche, Marc Sapoval
OBJECTIVE: Various animal models of critical limb ischemia have been developed in the past. However, there is no animal model that can undergo endovascular treatment, while providing reproducible true critical limb ischemia with arterial ulcers and rest pain. We evaluated the efficacy of a new model of rabbit hindlimb ischemia created through a percutaneous approach using embolization with calibrated particles. METHODS: Through a percutaneous transauricular artery approach and selective catheterization of the superficial femoral artery, embolization of distal limb vessels was performed using a mixture of 300- to 500-μm calibrated microparticles (Embosphere, Merit Medical, Salt Lake City, Utah), saline solution, and iodine contrast...
October 23, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29038476/pro-angiogenic-effect-of-rantes-loaded-polysaccharide-based-microparticles-for-a-mouse-ischemia-therapy
#18
N Suffee, C Le Visage, H Hlawaty, R Aid-Launais, V Vanneaux, J Larghero, O Haddad, O Oudar, N Charnaux, A Sutton
Peripheral arterial disease results from the chronic obstruction of arteries leading to critical hindlimb ischemia. The aim was to develop a new therapeutic strategy of revascularization by using biodegradable and biocompatible polysaccharides-based microparticles (MP) to treat the mouse hindlimb ischemia. For this purpose, we deliver the pro-angiogenic chemokine Regulated upon Activation, Normal T-cell Expressed and Secreted (RANTES)/CCL5 in the mouse ischemic hindlimb, in solution or incorporated into polysaccharide-based microparticles...
October 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29036797/effects-of-venotonic-drugs-on-the%C3%A2-microcirculation-comparison-between-ruscus-extract-and-micronized-diosmine1
#19
Fatima Zely Garcia de Almeida Cyrino, Daniela Signorelli Balthazar, Fernando Lencastre Sicuro, Eliete Bouskela
BACKGROUND: Chronic venous disease of the lower limbs is a common public health problem worldwide with negative impact on quality of life and results with drugs used to treat it are sparse, probably due to lack of good experimental models. OBJECTIVE: In this investigation we have tested the effects of two commonly used venotonic substances, Ruscus extract and micronized diosmine, on the microcirculation in vivo. METHODS: These substances were given orally, by gavage, during two weeks, twice daily and observations were made using the hamster cheek pouch preparation...
October 7, 2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/29034032/current-perspective-on-hemodialysis-patients-with-peripheral-artery-disease
#20
REVIEW
Shin Okamoto, Osamu Iida, Toshiaki Mano
The prevalence of peripheral artery disease is substantially higher in patients on chronic hemodialysis than in the general population. The presence of calcified lesions characteristic of hemodialysis patients has an adverse influence on the initial success and long-term outcomes of both surgical bypass and endovascular therapy. Although the selection of revascularization strategy depends on whether an autologous vein is available and if the patient has a life expectancy of at least two years, it is difficult to predict the life expectancy in a real-world clinical situation...
June 25, 2017: Annals of Vascular Diseases
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