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chronic limb ischemia

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https://www.readbyqxmd.com/read/29459014/regional-variation-in-racial-disparities-among-patients-with-peripheral-artery-disease
#1
Thomas F X O'Donnell, Chloe Powell, Sarah E Deery, Jeremy D Darling, Kakra Hughes, Kristina A Giles, Grace J Wang, Marc L Schermerhorn
OBJECTIVE: Prior studies identified significant racial disparities as well as regional variation in outcomes of patients with peripheral artery disease (PAD). We aimed to determine whether regional variation contributes to these racial disparities. METHODS: We identified all white or black patients who underwent infrainguinal revascularization or amputation in 15 deidentified regions of the Vascular Quality Initiative between 2003 and 2017. We excluded three regions with <100 procedures...
February 16, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29456512/local-injections-of-superoxide-dismutase-attenuate-the-exercise-pressor-reflex-in-rats-with-femoral-artery-occlusion
#2
Jihong Xing, Jian Lu, Jiahao Liu, Jianhua Li
The exercise pressor reflex is amplified in patients with peripheral artery disease (PAD) and in an experimental PAD model of rats induced by femoral artery occlusion. Heightened blood pressure worsens the restricted blood flow directed to the limbs in this disease. The purpose of this study was to determine the role played by muscle oxidative stress in regulating the augmented pressor response to static exercise in PAD. We hypothesized that limb ischemia impairs muscle superoxide dismutase (SOD) thereby leading to abnormal autonomic responsiveness observed in PAD animals, and a chronic compensation of SOD for anti-oxidation improves the exaggerated exercise pressor reflex...
2018: Frontiers in Physiology
https://www.readbyqxmd.com/read/29454751/strain-dependent-variation-in-acute-ischemic-muscle-injury
#3
Cameron A Schmidt, Adam J Amorese, Terence E Ryan, Emma J Goldberg, Michael D Tarpey, Thomas D Green, Reema R Karnekar, Dean J Yamaguchi, Espen E Spangenburg, Joseph M McClung
Limited efficacy of clinical interventions for peripheral arterial disease (PAD) necessitates a better understanding of the environmental and genetic determinants of tissue pathology. Existing research has largely ignored the early skeletal muscle injury response during hindlimb ischemia (HLI). We compared the hindlimb muscle response, following six hours of ischemia, in two mouse strains that differ dramatically in their post-ischemic extended recovery: C57BL/6J and BALB/cJ. Perfusion, measured by laser Doppler and normalized to the control limb, differed only slightly between strains following HLI (<12% across all measures)...
February 15, 2018: American Journal of Pathology
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
#4
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/29449058/-epidemiology-of-lower-extremity-artery-disease
#5
Victor Aboyans, Marie-Antoinette Sevestre, Ileana Désormais, Philippe Lacroix, Gerry Fowkes, Michael H Criqui
It is estimated that more than 200 million individuals are affected by lower extremity artery disease (LEAD) worldwide. This prevalence has increased between 2000 and 2010 by 25%, especially in low/middle income countries. In France, about one million people are affected by this condition. Almost two-thirds of patients with LEAD are asymptomatic. This explains the interest of the measurement of the ankle-brachial index (ABI), an objective and harmless diagnostic tool. An ABI≤0.90 is considered as diagnostic for LEAD...
February 12, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29439850/distal-vein-patch-use-and-limb-events-after-infragenicular-prosthetic-bypasses
#6
Bernardino C Branco, Panos Kougias, Jonathan D Braun, Joseph L Mills, Neal R Barshes
OBJECTIVE: In the absence of suitable autologous vein, the use of prosthetic grafts for infragenicular bypasses in peripheral arterial disease has become standard practice. The purpose of this study was to investigate whether creating a vein patch at the distal anastomosis would further improve patency and freedom from major adverse limb events (MALEs). Furthermore, we sought to investigate whether the use of a distal vein patch (DVP) was associated with lower rates of acute limb ischemia (ALI) for those presenting with occluded prosthetic bypass graft...
February 10, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29421428/cryopreserved-homografts-in-infected-infrainguinal-fields-are-associated-with-frequent-reinterventions-and-poor-amputation-free-survival
#7
S Keisin Wang, Ashley R Gutwein, Natalie A Drucker, Michael P Murphy, Andres Fajardo, Michael C Dalsing, Raghu L Motaganahalli, Gary W Lemmon
OBJECTIVE: Single-length saphenous vein continues to be the conduit of choice in infected-field critical limb ischemia (CLI). However, half of these individuals have inadequate vein secondary to previous use or chronic venous disease. We reviewed our outcomes of infected-field infrainguinal bypasses performed with cryopreserved homografts (CH), a widely-accepted alternative to autogenous vein in this setting. METHODS: This is a retrospective, institutional descriptive analysis of infected-field infrainguinal revascularizations between 2012-2015...
February 5, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29404750/acute-limb-ischemia-secondary-to-native-artery-occlusion-results-of-a-contemporary-case-series
#8
Nuria Seguí, Carlos Ruiz-Carmona, Alina Velescu, Eduardo Mateos, Roberto Elosua, Albert Clará
BACKGROUND: The treatment of acute limb ischemia (ALI) has barely changed over the last years. However, the progressive implementation of anticoagulants, antiplatelet agents or statins within the population might have modified the profile and prognosis of patients suffering an ALI. The aim of this study was to evaluate the current results of the management of ALI secondary to a native artery occlusion. METHODS: Retrospective study of 220 consecutive patients (mean age 78 years; 49% male) was conducted between 2007 and 2015...
February 5, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29395284/safety-and-efficacy-of-intravenous-lidocaine-for-pain-management-in-the-emergency-department-a-systematic-review
#9
REVIEW
Lucas Oliveira J E Silva, Kristin Scherber, Daniel Cabrera, Sergey Motov, Patricia J Erwin, Colin P West, M Hassan Murad, M Fernanda Bellolio
STUDY OBJECTIVE: We evaluate the safety and efficacy of intravenous lidocaine in adult patients with acute and chronic pain who are undergoing pain management in the emergency department (ED). METHODS: We searched Ovid CENTRAL, Ovid EMBASE, and Ovid MEDLINE databases for randomized controlled trials and observational studies from inception to January 2017. Efficacy outcomes included reduction in pain scores from baseline to postintervention and need for rescue analgesia...
January 29, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29390867/the-incidence-risk-factors-and-outcomes-of-contrast-induced-nephropathy-in-patients-with-critical-limb-ischemia-following-lower-limb-angiography
#10
Marcus Vinícius Martins Cury, Marcelo Fernando Matielo, Francisco Cardoso Brochado Neto, Rafael de Athayde Soares, Vinícius Lopes Adami, Jalíese Dantas Fernandes Morais, Aline Yoshimi Futigami, Roberto Sacilotto
Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves...
January 1, 2018: Angiology
https://www.readbyqxmd.com/read/29373539/acute-limb-ischemia-much-more-than-just-a-lack-of-oxygen
#11
REVIEW
Florian Simon, Alexander Oberhuber, Nikolaos Floros, Albert Busch, Markus Udo Wagenhäuser, Hubert Schelzig, Mansur Duran
Acute ischemia of an extremity occurs in several stages, a lack of oxygen being the primary contributor of the event. Although underlying patho-mechanisms are similar, it is important to determine whether it is an acute or chronic event. Healthy tissue does not contain enlarged collaterals, which are formed in chronically malperfused tissue and can maintain a minimum supply despite occlusion. The underlying processes for enhanced collateral blood flow are sprouting vessels from pre-existing vessels (via angiogenesis) and a lumen extension of arterioles (via arteriogenesis)...
January 26, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29363382/precise-retrograde-supera-stenting-of-the-ostium-presto-of-the-superficial-femoral-artery-for-complex-femoropopliteal-occlusions-the-presto-technique
#12
Luis M Palena, Larry J Diaz-Sandoval, Laiq M Raja, Luis Morelli, Marco Manzi
PURPOSE: To describe a novel technique designed to safely and precisely deploy the Supera stent accurately at the ostium of the proximal superficial femoral artery (SFA) without compromising the profunda and common femoral arteries. TECHNIQUE: After antegrade crossing of the chronic total occlusion (CTO) at the SFA ostium and accurate predilation of the entire SFA lesion, a retrograde arterial access is obtained. The Supera stent is navigated in retrograde fashion to position the first crown to be released just at the SFA ostium...
January 1, 2018: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/29349437/staged-endovascular-repair-of-an-abdominal-aortic-aneurysm-adjacent-to-a-chronic-high-flow-iliocaval-traumatic-arteriovenous-fistula
#13
S Keisin Wang, Ashley R Gutwein, Tom Casciani, Michael P Murphy, Gary W Lemmon
Large-vessel chronic traumatic arteriovenous fistulas are a rare complication after trauma. Delayed presentation can consist of one or more features of high-output cardiac failure, pulsatile abdominal mass, bruit, limb ischemia, and venous congestion. We describe a patient with a complex iliocaval fistula secondary to a remote gunshot wound associated with a large 8.5-cm aortic aneurysm. Informed consent of the patient was obtained for publication of the case.
December 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349433/popliteal-artery-entrapment-syndrome-presenting-as-acute-limb-ischemia-in-pregnancy
#14
William Sellers, Melissa Obmann, Shivprasad Nikam, Boyoung Song, David Mariner
Popliteal artery entrapment syndrome typically causes calf claudication in young active adults. Acute limb ischemia from popliteal artery thrombosis, embolization, or aneurysmal degeneration is less common. Chronic compression, histologic changes, and predisposing factors, such as vigorous exercise or hypercoagulability, play a role in these cases. We present the case of a 32-year-old pregnant woman with acute limb ischemia found to have popliteal artery thrombosis as a result of popliteal artery entrapment syndrome...
December 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29336387/dexmedetomidine-for-prevention-of-skeletal-muscle-ischaemia-reperfusion-injury-in-patients-with-chronic-limb-ischaemia-undergoing-aortobifemoral-bypass-surgery-a-prospective-double-blind-randomized-controlled-study
#15
Tanveer Singh Kundra, Ashwini Thimmarayappa, Manasa Dhananjaya, N Manjunatha
BACKGROUND: Dexmedetomidine is a selective α-2 agonist used for sedation. It has also been shown to have myocardial protective effect and prevent ischemia-reperfusion injury in off-pump coronary artery bypass patients. The aim of our study was to assess the effect of dexmedetomidine for prevention of skeletal muscle ischemia-reperfusion injury in patients undergoing aortobifemoral bypass surgery. METHODOLOGY: Sixty adult patients (Group dexmedetomidine n = 30, Group normal saline n = 30) undergoing aortobifemoral bypass surgery were recruited over 3 months...
January 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29276913/-change-in-the-nature-of-the-course-of-arterial-hypertension-in-patients-with-chronic-arterial-insufficiency-of-the-extremities-in-acute-thrombotic-occlusion
#16
N N Levchuk, N V Teplova, E M Evsikov, D A Majtesyan, R A Sharipov, M H Zhapueva, V V Kashirin, G A Chervyakova, E G Kurumlidu, S A Abduragimov
The article is devoted to the investigation of the mechanisms of the development of arterial hypertension (AH) in patients with atherosclerosis of the abdominal aorta and the formation of chronic lower limb ischemia (Lerish syndrome). With the development of thrombotic occlusion of arteries of the lower extremities, the nature of the course of hypertension worsens. The operational recovery of the main blood flow in the limbs positively influences the course of hypertension in the majority of patients.
November 2017: Kardiologiia
https://www.readbyqxmd.com/read/29248242/plasma-microbiome-modulated-indole-and-phenyl-derived-metabolites-associate-with-advanced-atherosclerosis-and-postoperative-outcomes
#17
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/29242066/external-polytetrafluoroethylene-reinforcement-of-varicose-autologous-vein-grafts-in-peripheral-bypass-surgery-produces-durable-bypass-function
#18
Achim Neufang, Christine Espinola-Klein, Savvas Savvidis, Walther Schmiedt, Alicia Poplawski, Christian Friedrich Vahl, Bernhard Dorweiler
OBJECTIVE: Use of autologous veins as peripheral bypass graft may become critical in the presence of significant varicose degeneration of the harvested vein. External support of such dilated veins with standard polytetrafluoroethylene (PTFE) prostheses was recommended as an option to use these veins for peripheral bypass. A single-center experience with this technique regarding long-term graft function, secondary reinterventions, and potential graft degeneration is presented. METHODS: Between January 1995 and January 2006, there were 54 patients with varicose veins who underwent 57 consecutive infrainguinal vein bypass operations with PTFE reinforcement in 57 limbs...
December 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29240587/reclaiming-autologous-amputated-tissue-for-limb-salvage-of-a-diabetic-foot-burn-with-underlying-critical-limb-ischemia
#19
Catherine N Tchanque-Fossuo, Andrew M Wishy, Kaitlyn I M West, David L Dawson, Sara E Dahle, John G Carson
BACKGROUND: Diabetes mellitus is a worldwide pandemic that impacts more than 387 million people, with 29 million individuals affected in the United States alone. Diabetic patients have a 25% lifetime risk of developing a diabetic foot ulcer (DFU). Having a DFU is associated with a risk of recurrence approaching 70%. In addition, 1 in 6 patients with DFU will have a lower-limb amputation, with an associated increase in mortality ranging from 47% to 70%. Therefore, limb salvage is critical in patients with DFU...
January 2018: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/29226477/cell-therapy-for-critical-limb-ischemia-an-integrated-review-of-pre-clinical-and-clinical-studies
#20
REVIEW
Mohammad Qadura, Daniella C Terenzi, Subodh Verma, Mohammed Al-Omran, David A Hess
Critical limb ischemia (CLI), the most severe form of peripheral artery disease, is characterized by pain at rest and non-healing ulcers in the lower extremities. For patients with CLI, where the extent of atherosclerotic artery occlusion is too severe for surgical bypass or percutaneous interventions, limb amputation remains the only treatment option. Thus, cell-based therapy to restore perfusion and promote wound healing in patients with CLI is under intense investigation. Despite promising preclinical studies in animal models, transplantation of bone marrow (BM) derived cell populations in patients with CLI has shown limited benefit preventing limb amputation...
December 11, 2017: Stem Cells
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