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chronic limb ischemia

Janaka Weragoda, Manuj C Weerasinghe, Rohini Seneviratne, S M Wijeyaratne
BACKGROUND: Peripheral arterial disease (PAD) is an emerging problem in Sri Lanka, particularly with the ageing population. A considerable number of patients are detected at a late stage with severe limb ischemia or chronic non-healing leg ulceration. Public awareness about PAD is important in developing preventive strategies. METHODS: A cross sectional study was conducted to assess awareness of PAD among adults aged 40-74 years in a district in Sri Lanka. In total, 2912 adults were selected for the study using a multistage probability proportionate to size sampling technique...
October 12, 2016: BMC Public Health
Shinsuke Mori, Keisuke Hirano, Yoshiaki Ito, Masahiro Yamawaki, Motoharu Araki, Norihiro Kobayashi, Hideyuki Takimura, Yasunari Sakamoto, Masakazu Tsutsumi, Takuro Takama, Yohsuke Honda, Takahiro Tokuda, Kenji Makino, Shigemitsu Shirai
AIM: To investigate the relationship between intravascular ultrasound (IVUS) findings and restenosis after stent implantation for long occlusive femoropopliteal (FP) lesions using the intraluminal approach. METHODS: This was a single-center retrospective study of 45 patients (49 lesions) with de novo long occlusive FP lesions treated with bare metal stents implanted using the intraluminal approach under IVUS guidance from April 2007 to December 2014. All patients were followed up at least 12 months...
October 1, 2016: Journal of Atherosclerosis and Thrombosis
Manuel Villanueva, Álvaro Iborra, Guillermo Rodríguez, Pablo Sanz-Ruiz
BACKGROUND: Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure...
October 3, 2016: BMC Musculoskeletal Disorders
Chandler A Long, Lucas H Timmins, Panagiotis Koutakis, Traci T Goodchild, David J Lefer, Iraklis I Pipinos, George P Casale, Luke P Brewster
OBJECTIVE: Peripheral arterial disease (PAD) is a significant age-related medical condition with limited pharmacologic options. Severe PAD, termed critical limb ischemia, can lead to amputation. Skeletal muscle is the end organ most affected by PAD, leading to ischemic myopathy and debility of the patient. Currently, there are not any therapeutics to treat ischemic myopathy, and proposed biologic agents have not been optimized owing to a lack of preclinical models of PAD. Because a large animal model of ischemic myopathy may be useful in defining the optimal dosing and delivery regimens, the objective was to create and to characterize a swine model of ischemic myopathy that mimics patients with severe PAD...
September 29, 2016: Journal of Vascular Surgery
Peter A Soden, Sara L Zettervall, Thomas Curran, Ageliki G Vouyouka, Philip P Goodney, Joseph L Mills, John W Hallett, Marc L Schermerhorn
OBJECTIVE: Prior studies on the cause and effect of surgical variation have been limited by utilization of administrative data. The Vascular Quality Initiative (VQI), a robust national clinical registry, provides anatomic and perioperative details allowing a more robust analysis of variation in surgical practice. METHODS: The VQI was used to identify all patients undergoing infrainguinal open bypass or endovascular intervention from 2009 to 2014. Asymptomatic patients were excluded...
September 27, 2016: Journal of Vascular Surgery
H W Wu, L Sun, D M Li, H Jing, B Xu, C T Wang, L Zhang
Objective: To summarize the short- and mid-term results on endovascular repair of primary retrograde Stanford type A aortic dissection with an entry tear in distal aortic arch or descending aorta. Methods: Between December 2009 and December 2014, 21 male patients of primary retrograde Stanford type A aortic dissection with a mean age of (52±9) years received endovascular repair in Department of Cardiothoracic Surgery, Jinling Hospital. Among the 21 cases, 17 patients were presented as ascending aortic intramural hematoma, 4 patients as active blood flow in false lumen and partial thrombosis, 8 patients as ulcer on descending aorta combined intramural hematoma in descending aorta, and 13 patients as typical dissection changes...
October 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Dominik André-Lévigne, Ali Modarressi, Rodrigue Pignel, Marie-Luce Bochaton-Piallat, Brigitte Pittet-Cuénod
The treatment of chronic wounds remains inconsistent and empirical. Hyperbaric oxygen therapy (HBOT) is a promising method to improve wound repair but there is still a lack of understanding of its mechanisms of action and its indications are not yet clearly defined. We studied the effects of HBOT in four different wound conditions by inflicting bilateral wounds on the dorsal aspect of the feet of nonischemic or ischemic limbs in normoglycemic or hyperglycemic rats. To create an ischemic condition, arterial resection was performed unilaterally...
September 29, 2016: Wound Repair and Regeneration
Trisha Roy, Garry Liu, Noor Shaikh, Andrew D Dueck, Graham A Wright
PURPOSE: To test and validate magnetic resonance imaging (MRI) sequences for peripheral artery lesion characterization and relate the MRI characteristics to the amount of force required for a guidewire to puncture peripheral chronic total occlusions (CTOs) as a surrogate for immediate failure of endovascular therapy. METHODS: Diseased superficial femoral, popliteal, and tibial artery segments containing 55 atherosclerotic lesions were excised from the amputated limbs of 7 patients with critical limb ischemia...
September 22, 2016: Journal of Endovascular Therapy
Konstantinos Spanos, George Kouvelos, Christos Karathanos, Sokol Xhepa, Giannoukas Athanasios, Miltiadis Matsagkas
Chronic total occlusions (CTOs) represent a technically demanding subset of lesions, which in most cases require special endovascular methods, advanced operator skills, and utilization of sophisticated assisting devices for successful treatment. CTO crossing devices offer an additional option to interventionists in the treatment of challenging lower extremity peripheral arterial occlusions. These devices may improve crossing rates, allowing delivery of therapeutic devices to the target lesion. Initial technical results seem quite promising, although adequate data on patient and device selection are lacking...
December 2016: Journal of Cardiovascular Surgery
Peter A Soden, Sara L Zettervall, Katie E Shean, Sarah E Deery, Jeffrey A Kalish, Christopher T Healey, Nikhil Kansal, Marc L Schermerhorn
BACKGROUND: Isolated common femoral endarterectomy was recently reported to have a 30-day mortality of 3.4%. The effect of adjunctive femoral endarterectomy at the time of lower extremity bypass is not well described, and therefore, the purpose of this study was to determine its associated perioperative and long-term risk. METHODS: Vascular Study Group of New England registry data were used to identify patients undergoing initial lower extremity bypass from 2003 to 2015...
September 12, 2016: Journal of Vascular Surgery
Jan P Skóra, Tomasz Płonek, Piotr Barć, Dagmara Baczyńska, Agata Radwańska, Artur Pupka, Krzysztof Korta, Marek Ussowicz, Łukasz Strożecki, Diana Kupczyńska-Markiewicz, Agnieszka Hałoń
BACKGROUND: Chronic limb ischemia is a serious clinical problem. Patients who do not qualify for standard treatment may benefit from novel gene therapies. OBJECTIVES: This study evaluated angiogenesis following intramuscular injections of angiogenic plasmid Ang-1 in Fisher rats. MATERIAL AND METHODS: Twenty rats had plasmids injected intramuscularly in their hind limbs. The study group consisted of 10 animals which received the Ang-1 plasmid, while the control group consisted of 10 rats that received an empty plasmid...
July 2016: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Juho Jalkanen, Mikael Maksimow, Maija Hollmén, Sirpa Jalkanen, Harri Hakovirta
Critical limb ischemia (CLI) is the advanced stage of peripheral artery disease (PAD) and associated with an extremely poor clinical outcome. In order to understand the possible role of circulating cytokines and poor outcome associated with CLI we compared the circulating cytokine profile of patients with CLI against patients with intermittent claudication (IC). The levels of 48 circulating cytokines were examined in 226 consecutive patients with peripheral artery disease (PAD) admitted for elective, non-urgent, invasive treatment of IC or CLI...
2016: PloS One
C Caradu, A S Battut, C Gonthier, D Midy, E Ducasse
One third of patients with critical limb ischemia (CLI) has below the knee lesions and requires a restoration of direct blood flow into the foot. However, many of these patients are ineligible for open surgery. The primary goals thus become pain relief and limb salvage over patency. The angiosome concept helps determine the target artery to treat in priority. The endovascular approach has decreased morbidity and mortality rates compared to distal bypass surgery; while subintimal retrograde, trans-collateral and loop techniques push the limits of open surgery by reopening the plantar arch, thereby improving run-off...
September 1, 2016: Journal des Maladies Vasculaires
C Goullet de Rugy, I Lazareth, C You, A Stansal, P Priollet
In vascular medicine, wound care requires pluridisciplinary expertise and nursing skill. Care must be perfectly adapted to each individual patient, the specificities of each particular wound, and the underlying vascular disease. The goal is to achieve wound healing. Inappropriate care can retard healing or even aggravate the wound. The skin should be cleaned with water a non-allergic detergent and should concern the entire limb in addition to the wound itself. Fibrin or necrosis detersion is an important step that can be painful...
September 2016: Journal des Maladies Vasculaires
Emanuela Viviani, Anna Maria Giribono, Donatella Narese, Doriana Ferrara, Giuseppe Servillo, Luca Del Guercio, Umberto Marcello Bracale
Compartment syndrome (CS) is a pathological increase of the interstitial pressure within the closed osseous fascial compartments. Trauma is the most common cause, followed by embolization, burns, and iatrogenic injuries; it usually involves the limbs. The major issue when dealing with CS is the possibility to do an early diagnosis in order to intervene precociously, through a fasciotomy, reducing the risk of tissue, vascular and nervous damage. Although it is an infrequent condition, it is potentially life threatening...
August 31, 2016: International Journal of Lower Extremity Wounds
Osamu Iida, Mitsuyoshi Takahara, Yoshimitsu Soga, Keisuke Hirano, Yasutaka Yamauchi, Kan Zen, Hiroyoshi Yokoi, Masaaki Uematsu
OBJECTIVE: Although clinical trials demonstrated the superiority of the Zilver (Cook Medical, Bloomington, Ind) paclitaxel-eluting stent (PTX), a recently developed drug-eluting stent (DES), to conventional therapy for femoropopliteal (FP) lesions, the incidence and risk factors of the repetition of reintervention after DES implantation in clinical practice remained unrevealed. METHODS: This was a subanalysis of the ZEPHYR (ZilvEr PTX for tHe Femoral ArterY and Proximal Popliteal ArteRy) study, enrolling FP lesions undergoing endovascular therapy (EVT) with DES implantation...
August 26, 2016: Journal of Vascular Surgery
Takashi Nakatsuji, Osami Kawarada, Teruo Noguchi, Hisao Ogawa, Satoshi Yasuda
The trans-collateral approach is a contemporary crossing technique for treating infrapopliteal chronic occlusion. However, in the setting of critical limb ischemia with multilevel disease, angiographically occult collateral vessels may be missed as a treatment opportunity. Herein, we report the potential of using occult collateral vessels for trans-collateral intervention in infrapopliteal chronic occlusion.
August 26, 2016: Annals of Vascular Surgery
Craig M Walker, Jihad Mustapha, Thomas Zeller, Andrej Schmidt, Miguel Montero-Baker, Aravinda Nanjundappa, Marco Manzi, Luis Mariano Palena, Nelson Bernardo, Yazan Khatib, Robert Beasley, Luis Leon, Fadi A Saab, Adam R Shields, George L Adams
PURPOSE: To report a prospective, multicenter, observational study ( identifier NCT01609621) of the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs). METHODS: Twelve sites around the world prospectively enrolled 197 patients (mean age 71±11 years, range 41-93; 129 men) from May 2012 to July 2013 who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary...
August 24, 2016: Journal of Endovascular Therapy
Kenneth Tran, Brant W Ullery, Marcus R Kret, Jason T Lee
BACKGROUND: The aim of this study was to evaluate the performance and predictors of stent failure of paclitaxel drug-eluting stents for the treatment of femoropopliteal disease. METHODS: A retrospective review of clinical and angiographic data was performed for patients treated for femoropopliteal disease with the Zilver PTX (Cook Medical, Bloomington, IN) stent by a single operator between 2012 and 2015 at a tertiary referral center. Clinical grading was determined by both Rutherford classification and the Society for Vascular Surgery's Wound, Ischemia, and Foot Infection (WIFi) scoring system, and lesions were classified anatomically by the TransAtlantic Intersociety Consensus (TASC) II criteria...
August 20, 2016: Annals of Vascular Surgery
Alik Farber, Robert T Eberhardt
Importance: Chronic critical limb ischemia, marked by intractable lower extremity ischemic rest pain and tissue loss, is a highly morbid condition that leads to the loss of ambulation and decreased quality of life. It is associated with a high risk of limb loss and mortality and presents a significant economic burden to society. Objective: To review the current state of epidemiology, pathophysiology, diagnosis, and treatment of critical limb ischemia. Evidence Review: An extensive literature search of the subject matter was conducted on material published in English between 1980 and 2016; both landmark and recently published articles were evaluated...
August 17, 2016: JAMA Surgery
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