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Diabetes And Chronic Limb Ischaemia And Revascularization

Lewis Meecham, Matthew Popplewell, Gareth Bate, Smitaa Patel, Andrew W Bradbury
BACKGROUND: Bypass surgery (BS) remains the gold standard revascularization strategy in patients with chronic limb-threatening ischemia (CLTI) owing to infrainguinal disease. The Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-1 trial showed that, in patients with CLTI who survived for 2 years or more, BS resulted in better clinical outcomes. Despite this finding, there has been an increasing trend toward an endovascular-first approach to infrainguinal CLTI. Our aim was to investigate whether changes in practice have impacted the clinical outcomes of BS in our unit 10 years after BASIL-1...
March 6, 2019: Journal of Vascular Surgery
Anand Dayama, Nikolaos Tsilimparis, Stephen Kolakowski, Nathaniel M Matolo, Misty D Humphries
BACKGROUND: Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease...
January 2019: Journal of Vascular Surgery
Sílvia da Silva, João Vasconcelos, Miguel Maia, José Carlos Vidoedo, M Jesus Dantas, André Cruz, João Almeida Pinto
OBJECTIVES: We aimed to assess the outcome of endovascular revascularization in Diabetic patients with Fontaine stage IV chronic ischaemia, at our Diabetic Foot Clinic. Primary outcomes were ulcer healing, major amputation and limb salvage. METHODS: Retrospective single center analysis of patients treated between January 2009 and May 2015. Time-dependent event rates were estimated by the Kaplan-Meier method. The differences between groups were evaluated with the chi-square test...
January 2016: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Mesut Mutluoglu, Gunalp Uzun, Michael Bennett, Peter Germonpré, David Smart, Daniel Mathieu
Diabetic foot ulcers (DFUs) are one of the most common indications for hyperbaric oxygen treatment (HBOT). The role of HBOT in DFUs is often debated. Recent evidence based guidelines, while recommending its use, urge further studies to identify the patient subgroups most likely to benefit from HBOT. A recent study in Diabetes Care aimed to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with chronic DFUs. In this study, patients with Wagner grade 2-4 diabetic foot lesions were randomly assigned to have HBOT (30 sessions/90 min/244 kPa) or sham treatment (30 sessions/90 min/air/125 kPa)...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
J A Brizuela Sanz, J A González Fajardo, J H Taylor, L Río Solá, M F Muñoz Moreno, C Vaquero Puerta
OBJECTIVES: It is difficult to establish which patients suffering from critical lower limb ischaemia will benefit from revascularization. Risk scores can provide objectivity in decision making. The aim was to design a new risk score (ERICVA) and compare its predictive power with the PREVENT III and Finnvasc scores. METHODS: An observational retrospective study of patients who underwent revascularization (open or endovascular) in Valladolid's University Hospital between 2005 and 2010 was designed...
January 2016: European Journal of Vascular and Endovascular Surgery
Joseph L Mills
The confluence of several chronic conditions--in particular ageing, peripheral artery disease, diabetes, and chronic kidney disease--has created a global wave of lower limbs at risk for major amputation. While frequently asymptomatic or not lifestyle limiting, at least 1% of the population has peripheral artery disease of sufficient severity to be limb threatening. To avoid the critical error of failing to diagnose ischaemia, all patients with diabetic foot ulcers and gangrene should routinely undergo physiologic evaluation of foot perfusion...
January 2016: Diabetes/metabolism Research and Reviews
Holger Reinecke, Michael Unrath, Eva Freisinger, Holger Bunzemeier, Matthias Meyborg, Florian Lüders, Katrin Gebauer, Norbert Roeder, Klaus Berger, Nasser M Malyar
AIMS: Only few and historic studies reported a bad prognosis of peripheral arterial disease (PAD) and critical limb ischaemia (CLI). The contemporary state of treatment and outcomes should be assessed. METHODS AND RESULTS: From the largest public health insurance in Germany, all in- and outpatient diagnosis and procedural data were retrospectively obtained from a cohort of 41 882 patients hospitalized due to PAD during 2009-2011, including a follow-up until 2013...
April 14, 2015: European Heart Journal
M Iu Kaputin, S A Platonov, D V Ovcharenko, A A Voronkov, M A Kiselev
The study was aimed at assessing remote results of endovascular treatment of patients presenting with lower limb critical ischaemia (LLCI) and kept on chronic haemodialysis. We retrospectively analysed the results of endovascular interventions in a total of 16 patients with ischaemic defects of the foot being on chronic haemodialysis, performed from 2001 to 2012 at the Department of Roentgenosurgical Methods of Diagnosis and Treatment of the St. Petersburg Scientific Research Institute for Emergency Ambulance Care named after I...
2014: Angiology and Vascular Surgery
Stavros Spiliopoulos, George Pastromas, Athanasios Diamantopoulos, Konstantinos Katsanos
INTRODUCTION: Long-term antiplatelet therapy with clopidogrel has been recommended in patients undergoing peripheral arterial procedures. Poor antiplatelet effect of clopidogrel or high on-clopidogrel platelet reactivity (HCPR) has been recently identified in patients with peripheral arterial disease (PAD). AREAS COVERED: This review focuses on the use of clopidogrel and the phenomenon of HCPR in PAD patients treated for intermittent claudication or critical limb ischaemia (CLI)...
October 2014: Expert Opinion on Pharmacotherapy
I G Uchkin, Z Kh Shugushev, T A Vikhert, A M Zudin, A K Gonsales, A A Tarkovskiĭ
Currently, there is a tendency towards an increase in the incidence rate of cardiovascular disease. According to the data of the World Health Organization the incidence rate of obliterating diseases of peripheral arteries varies from 5 to 10%. Diseases of peripheral arteries manifest themselves by such a severe condition as lower-limb critical ischaemia. Most often lower-limb chronic critical ischaemia develops in patients with multi-level lesions of the arterial bed. Treatment of such patients constitutes a serious problem since it requires large-scope revascularization...
2013: Angiology and Vascular Surgery
A V Maksimov, K A Koreĭba, R M Nuretdinov, M A Usmanov, V V Glinkin
Analysed herein are the results of the joint work of the Pyoseptic Surgery Department of the Centre "Diabetic Foot" with the Vascular Surgery Department based in various clinics over 2 periods - 2010 and 2011. During the first period, a total of 126 patients with critical ischaemia were treated without using revascularizing methods, during the second period, a total of 205 patients with critical ischaemia were examined by vascular surgeons deciding upon the problem concerning possibility of revascularization...
2013: Angiology and Vascular Surgery
Krzysztof Bojakowski, Rafał Góra, Grzegorz Jodkowski, Piotr Andziak
UNLABELLED: Limb ischaemia caused by formation of dialysis fistula is rare but serious complication. The severity of symptoms may vary but rest pains and necrotic lesions are observed in most advance cases. In these patients different invasive procedures for treatment are performed - from simplest dialysis fistula ligation to complicated vascular reconstructions. The aim of the study was to evaluate treatment results of upper limb ischaemia triggered by dialysis fistula. MATERIAL AND METHODS: We have analysed methods and results of treatment of 14 patients with symptomatic upper limb ischaemia caused by dialysis fistula treated in our department between 1st January, 2006 and 30th June, 2013...
November 2013: Polski Przeglad Chirurgiczny
I I Dedov, S A Terekhin, V Iu Kalashnikov, V A Mitish, L P Doronina, A Iu Tokmakova, G R Galstian, K V Melkozerov, E V Peretokina
Presented in the article is a clinical example of surgical treatment of a patient with a severe course of type 2 diabetes mellitus, multiple lesions of coronary arteries, lower-limb arteries with the development of lower-limb ischaemia, bilateral lesions of renal arteries and chronic renal insufficiency, the presence of an aneurysm of the infrarenal portion of the aorta. The unique nature of the case report consists in joint work of endocrinologists, cardiologists, specialists in purulent surgery and reoentgenovascular surgeons, also in carrying out simultaneous endovascular reconstructive operation on various vascular basins: stenting of the right renal artery, balloon angioplasty and stenting of the left leg arteries and endovascular prosthetic repair of the abdominal aortic aneurysm...
2012: Angiology and Vascular Surgery
M Lepäntalo
Despite numerous attempts, chronic critical limb ischaemia (CLI) has not been unequivocally defined as yet. Its epidemiology is poorly investigated and its prevalence probably higher than anticipated. It is accompanied by high mortality and morbidity irrespective of the way it is treated. Its management is very expensive. Additionally, the prevailing diabetes epidemic is increasing the need for revascularizations although there is a clear lack of evidence as to when to revascularize an ulcerated diabetic foot...
2012: Scandinavian Journal of Surgery: SJS
D Aerden, P Haentjens, K von Kemp, B Van den Bossche, I Staelens, E Debing, B Keymeulen, P Van den Brande
BACKGROUND: To investigate whether the indication for the first revascularization (diabetic foot, acute ischaemia, aneurysmal disease, chronic occlusive disease) determines the surgical history and survival time in amputated limbs. METHODS: The surgical history of lower extremities amputated between 2002 and 2009 was reviewed for the number of (endo)vascular procedures, minor amputations, wound debridements, complications requiring surgery (acute ischaemia, bleeding, graft infection) and limb survival time (LST)...
November 2011: Acta Chirurgica Belgica
Mauri Lepäntalo, Leslie Fiengo, Fausto Biancari
Peripheral arterial disease is common among diabetic patients with renal insufficiency, and most of the diabetic patients with end-stage renal disease (ESRD) have peripheral arterial disease. Ischaemia is probably overrepresented as an etiological factor for a diabetic foot ulcer in this group of patients compared with other diabetic patients. ESRD is a strong risk factor for both ulceration and amputation in diabetic patients. It increases the risk of nonhealing of ulcers and major amputation with an OR of 2...
February 2012: Diabetes/metabolism Research and Reviews
I N Ignatovich, G G Kondratenko, G A Sergeev, S N Kornievich, D A Taganovich, I M Khrapov, N M Mikhaĭlova
The article deals with diabetic foot syndrome defined as a multidisciplinary problem. A reconstructive vascular operation in critical ischaemia on the background of diabetic foot syndrome is herein shown to be an efficient and justified intervention. Revascularization makes it possible to carry out sparing resections on the foot, to appropriately cope with the events of lower-limb critical ischaemia, and to reliably decrease the rate of high amputations.
2010: Angiology and Vascular Surgery
A Nordström, C Hansson, L Karlström
Larval therapy (LT) is known to be a gentle and effective method for removing necrotic tissue and bacteria and reducing the accompanying unpleasant odour. Ischaemia has been considered a relative contraindication for LT. We report a patient with ischaemia treated with LT. Inguinal revascularization was performed on a 69-year-old man with critical limb ischaemia, diabetes mellitus, heart failure and end-stage renal disease. Areas of dry black malodorous gangrene remained on the distal areas of the feet after surgery and the patient's poor health did not allow any additional surgery...
December 2009: Clinical and Experimental Dermatology
E Minar
Critical limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that describes patients with chronic ischaemic rest pain, or patients with ischaemic skin lesions, either ulcers or gangrene. The clinical diagnosis of CLI should be confirmed by haemodynamic parameters such as the ankle- or toe systolic pressure. The estimated annual incidence of CLI ranges between 500 and 1 000 new cases per 1 million, with diabetes being the most important risk factor. CLI is also a marker for mostly generalized and severe atherosclerosis, and therefore the prognosis of patients is poor concerning overall survival...
January 2009: Hämostaseologie
Pramook Mutirangura, Chanean Ruangsetakit, Chumpol Wongwanit, Nuttawut Sermsathanasawadi, Khamin Chinsakchai
BACKGROUND: Major limbs loss and high mortality rate were observed in the management of Thai patients with atherosclerosis obliterans (ASO) of the lower extremities. These were the results of delayed diagnosis and treatment together with the associated morbidities. There is a lack of information of this disease resulting in a lack of knowledge and awareness of this problem among general practitioners in Thailand. OBJECTIVES: The purposes of this study were (1) to identify the prevalence of this disease in a tertiary care hospital, (2) to enumerate the risk factors and comorbidities, (3) to identify clinical characteristics of the disease and (4) to evaluate the outcomes of treatment...
October 2006: Journal of the Medical Association of Thailand
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