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Critic limb ischemia

R N Berchiolli, M Marconi, D M Mocellin, D Adami, M Ferrari
OBJECTIVE: The aim of the study is to evaluate the safety and effectiveness of common femoral endarterectomy (CFE) in critical limb ischemia (CLI) associated with proximal and distal endovascular (EV) revascularization in diabetic (type 1 and type 2) and non-diabetic patients. PATIENTS AND METHODS: We analyzed patients from January 2008 to December 2011 who underwent one-staged hybrid procedures. Patients were divided into three groups: group 1 = EV reconstruction proximal to the CFE, group 2 = EV procedures distal to the CFE, group 3 = both proximal and distal EV procedures...
February 2019: European Review for Medical and Pharmacological Sciences
Yann Gouëffic, Jean-Pierre Favre, Eric Steinmetz, Aline Ordureau, Valéry-Pierre Riche, Béatrice Guyomarch, Eugenio Rosset
BACKGROUND: While autogenous venous graft is preferable in below the knee bypass surgery for patients in critical limb ischemia, some 20% of patients will have no suitable vein for grafting, compelling a resort to artificial graft materials. Retrospective sub-group analyses within published studies comparing heparin-bonded PTFE with crude PFTE graft in below the knee bypass suggest that heparin-bonded graft offers superior long-term patency rates, but this has not been prospectively verified in patients with critical limb ischemia...
February 12, 2019: Annals of Vascular Surgery
Jun Yuan, Joanne Tm Tan, Kushwin Rajamani, Emma L Solly, Emily J King, Laura Lecce, Philippa Jl Simpson, Yuen Ting Lam, Alicia J Jenkins, Christina A Bursill, Anthony C Keech, Martin Kc Ng
Fenofibrate, a peroxisome proliferator-activated receptor alpha (PPARα) agonist, reduces lower limb amputations in patients with type 2 diabetes mellitus. The mechanism is, however, unknown. Here we demonstrate that fenofibrate markedly attenuates diabetes-related impairment of ischemia-mediated angiogenesis. In a murine model of hindlimb ischemia, daily oral fenofibrate treatment restored diabetes-impaired blood flow recovery, foot movement, hindlimb capillary density, vessel diameter, and vascular endothelial growth factor (VEGF) signaling to non-diabetic levels in both wildtype and PPARα-knockout mice, indicating that these fenofibrate effects are largely PPARα-independent...
February 14, 2019: Diabetes
August Ysa, Marta Lobato, Ederi Mikelarena, Amaia Arruabarrena, Roberto Gómez, Ana Apodaka, Matthew Metcalfe, Juan L Fonseca
PURPOSE: To describe a maneuver to facilitate percutaneous arteriovenous fistula creation during venous arterialization procedures in patients with no-option critical limb ischemia. TECHNIQUE: Following a failed arterial recanalization attempt, a balloon catheter is passed up to the tip of the guidewire. Venous access is gained distally, a 4-F sheath is antegradely passed, and a 4-mm GooseNeck snare is advanced through it. A fluoroscopic view that overlaps the snare and the inflated balloon is obtained...
February 15, 2019: Journal of Endovascular Therapy
Tomasz Nowakowski, Krzysztof Piotr Malinowski, Rafał Niżankowski, Teresa Iwaniec, Anetta Undas
INTRODUCTION: Hypolysible fibrin clots composed of tightly packed fibers characterize patients with peripheral artery disease (PAD) especially those with critical limb ischemia (CLI). Little is known about the impact of a prothrombotic clot phenotype on restenosis following endovascular revascularization in CLI. The goal of this study was to compare fibrin clot properties and their determinants in CLI patients with restenosis after endovascular treatment (ET) and those free of this complication...
February 14, 2019: Journal of Thrombosis and Thrombolysis
Eugenio Stabile, Donato Gerardi, Fabio Magliulo, Drago Zhelev, Vassil Chervenkoff, Kim Taeymans, Doncho Kotasov, Peter Goverde, Giuseppe Giugliano, Bruno Trimarco, Giovanni Esposito
PURPOSE: To report the 1-year outcomes of the prospective Legflow drug-coated balloon (DCB) registry, which evaluated the safety and 12-month efficacy of the Legflow balloon in the treatment of femoropopliteal disease. METHODS: The Legflow is a new generation of DCB that has a homogenous, stable surface coating incorporating 0.1-µm paclitaxel particles. From January 2014 to June 2016, 139 patients (mean age 67.1±10.8 years; 109 men) were enrolled at 4 European institutions...
February 2019: Journal of Endovascular Therapy
Eric A Secemsky, Harun Kundi, Ido Weinberg, Michael R Jaff, Anna Krawisz, Sahil A Parikh, Joshua A Beckman, Jihad Mustapha, Kenneth Rosenfield, Robert W Yeh
Importance: In a recent meta-analysis of randomized clinical trials, femoropopliteal artery revascularization with paclitaxel drug-coated devices was associated with increased long-term all-cause mortality compared with non-drug-coated devices. However, to our knowledge, these findings have not been replicated in other data sources and may be subject to confounding from missing data associated with patient withdrawal and loss to follow-up. Objective: To evaluate differences in all-cause mortality between patients who were treated with drug-coated devices vs non-drug-coated devices for femoropopliteal artery revascularization...
February 12, 2019: JAMA Cardiology
Răzvan A Ciocan, Cristina-Sorina Cătană, Cristina Drugan, D Gherman Claudia, Andra Ciocan, Tudor C Drugan, Sorana D Bolboacă
AIM: To evaluate if smoking, quantified by the serum cotinine levels, is related to the evolution of patients with critical limb ischemia (CLI). METHOD: A pilot study was conducted on CLI patients who addressed at the Second Surgery Clinic of the Emergency County Hospital, Cluj-Napoca, Romania between November 2015 and December 2016. The sample of patients was split into two groups using the threshold of 15 ng/mL for the serum level of cotinine (low cotinine level - LCL vs...
February 11, 2019: Acta Clinica Belgica
Costantino Del Giudice, Roberto Gandini
PURPOSE: To evaluate the safety and efficacy of low-frequency, high-intensity ultrasound energy delivered via a new dedicated ultrasound catheter followed by conventional balloon angioplasty to treat calcified infrapopliteal lesions. MATERIALS AND METHODS: A prospective, nonrandomized, single-center pilot study enrolled 12 patients (mean age 72.2±5.3 years; 8 men) with critical limb ischemia (9 Rutherford category 5 and 3 category 6) between January and November 2017...
February 11, 2019: Journal of Endovascular Therapy
Tim Kaufeld, Eric Beckmann, Fabio Ius, Nurbol Koigeldiev, Wiebke Sommer, Bakr Mashaqi, Felix N Fleissner, Thierry Siemeni, Jacob Ono Puntigam, Jessica Kaufeld, Axel Haverich, Christian Kuehn
BACKGROUND: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique...
February 8, 2019: Perfusion
Jihad Mustapha, William Gray, Brad J Martinsen, Ryan W Bolduan, George L Adams, Gary Ansel, Michael R Jaff
PURPOSE: To report the 1-year results of a multicenter study of peripheral artery disease (PAD) treatment with a variety of endovascular treatment strategies employed in routine practice. MATERIALS AND METHODS: The LIBERTY trial ( identifier NCT01855412) is a prospective, observational, core laboratory-assessed, multicenter study of endovascular device intervention in 1204 subjects (mean age 69.8±10.7 years; 770 men) stratified by Rutherford category (RC): claudicants (RC2,3; n=501) and critical limb ischemia (CLI) with no/minimal tissue loss (RC4,5; n=603) or significant tissue loss (RC6; n=100)...
February 6, 2019: Journal of Endovascular Therapy
Ehrin J Armstrong, Syed Alam, Steve Henao, Arthur C Lee, Brian G DeRubertis, Miguel Montero-Baker, Carlos Mena, Bennett Cua, Luis Mariano Palena, Richard Kovach, Venita Chandra, Amjad AlMahameed, Craig M Walker
Critical limb ischemia (CLI), defined as ischemic rest pain or nonhealing ulceration due to arterial insufficiency, represents the most severe and limb-threatening manifestation of peripheral artery disease. A major challenge in the optimal treatment of CLI is that multiple specialties participate in the care of this complex patient population. As a result, the care of patients with CLI is often fragmented, and multidisciplinary societal guidelines have not focused specifically on the care of patients with CLI...
February 1, 2019: Journal of Endovascular Therapy
Konstantinos Aznaouridis, Maria Bonou, Konstantina Masoura, Sophia Vaina, Charalambos Vlachopoulos, Dimitris Tousoulis
A 66-year-old man with refractory angina was admitted for percutaneous coronary intervention (PCI) through a tortuous saphenous vein graft sequentially anastomosed with a diagonal and a first marginal branch. Our target was a critical stenosis at the retrograde limb of the first marginal proximal to saphenous vein graft anastomosis. Stent delivery to our target lesion mandated tracking through sequential angulations. In this case, we enhanced the support of the guide catheter and delivered a stent on the retrograde limb of the first marginal branch with very deep intubation of the guide catheter into the saphenous vein graft and use of a buddy wire, which is a cheaper and relatively safer maneuver than complex techniques such as the double guide-catheter extension technique...
February 2019: Journal of Invasive Cardiology
Fadi Saab, Brad J Martinsen, Dylan Wrede, Ann Behrens, George L Adams, Jihad A Mustapha
The Orbital Atherectomy System is a novel form of atherectomy that uses orbital sanding and pulsatile forces, an effective method of treatment for peripheral atherosclerotic lesions with varying levels of occlusion. Although the devices only has a general indication from the FDA to treat atherosclerotic lesions, they are effective in treating all kinds of lesions, and can therefore mitigate effects of all severities of peripheral artery disease. This approach to endovascular therapy involves the use of differential sanding to preferentially ablate fibrous, fibrofatty and calcified lesions, while deflecting healthy intima away from the crown...
January 28, 2019: Journal of Cardiovascular Surgery
Miroslav Špaček, Pavel Měřička, Libor Janoušek, Petr Štádler, Miloš Adamec, Robert Vlachovský, Igor Guňka, Pavel Navrátil, Filip Thieme, Rudolf Špunda, Jan Burkert, Robert Staffa, Petr Němec, Jaroslav Lindner
BACKGROUND: Vascular allotransplantations are performed worldwide in selected patients suffering from vascular prosthesis infection or critical limb ischemia. Either fresh or cryopreserved vascular allograft may be used. OBJECTIVES: In various points, we address several aspects (allograft procurement, cryopreservation and transplantation technique) of the program of vascular allotransplantations in the Czech Republic. MATERIAL AND METHODS: Vascular grafts retrieval has been done within multiorgan harvests using no-touch technique...
January 23, 2019: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Alik Farber, Kenneth Rosenfield, F Sandra Siami, Michael Strong, Matthew Menard
There is significant variability and equipoise in the management of critical limb ischemia (CLI). The Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial, funded by the National Heart, Lung, and Blood Institute, is a prospective, open label, multicenter, multispecialty randomized controlled trial designed to compare treatment efficacy, functional outcomes, cost-effectiveness, and quality of life for 2100 patients suffering from CLI. BEST-CLI is enrolling those patients who are determined to be candidates for open surgical or endovascular revascularization and is designed to be comprehensive, pragmatic, and balanced...
February 2019: Journal of Vascular Surgery
Fragiska Sigala, George Galyfos, Kyriakos Stavridis, Konstantinos Tigkiropoulos, Ioannis Lazaridis, Dimitrios Karamanos, Vangelis Mpontinis, Nikolaos Melas, Ioulia Zournatzi, Konstantinos Filis, Nikolaos Saratzis
Purpose: Aim of this study is to report real-life experience on the treatment of peripheral artery disease (PAD) with a specific drug-coated balloon (DCB), and to evaluate potential prognostic factors for outcomes. Materials and Methods: This is a retrospective study reporting outcomes in patients with PAD who were treated with the Lutonix DCB during a four-year period. Major outcomes included: all-cause mortality, amputation, clinical improvement, wound healing and target lesion revascularization (TLR)...
December 2018: Vascular Specialist International
Nicole Allen, Tessa J Barrett, Yu Guo, Michael Nardi, Bhama Ramkhelawon, Caron B Rockman, Judith S Hochman, Jeffrey S Berger
BACKGROUND AND AIMS: Platelets are a major culprit in the pathogenesis of cardiovascular disease (CVD). Circulating monocyte-platelet aggregates (MPA) represent the crossroads between atherothrombosis and inflammation. However, there is little understanding of the platelets and monocytes that comprise MPA and the prevalence of MPA in different CVD phenotypes. We aimed to establish (1) the reproducibility of MPA over time in circulating blood samples from healthy controls, (2) the effect of aspirin, (3) the relationship between MPA and platelet activity and monocyte subtype, and (4) the association between MPA and CVD phenotype (coronary artery disease, peripheral artery disease [PAD], abdominal aortic aneurysm, and carotid artery stenosis)...
January 2, 2019: Atherosclerosis
Munir Patel, John C Lantis
At least 15% of patients with critical limb ischemia are not candidates for standard revascularization. In this day and age, with new techniques-including retrograde access to the foot-and numerous angioplasty and atherectomy techniques available, the critical limb ischemia patient can still be faced without options. Distal bypass surgery may still remain the gold standard, and likely permits the patient to have the best options for healing, but carries significant comorbidities after undergoing the procedure...
January 18, 2019: Surgical Technology International
Ki Hong Choi, Taek Kyu Park, Jihoon Kim, Young-Guk Ko, Cheol Woong Yu, Chang-Hwan Yoon, Jae-Hwan Lee, Pil-Ki Min, Yoon Seok Koh, In-Ho Chae, Donghoon Choi, Seung-Hyuk Choi
Background With advances in peripheral artery disease ( PAD ) treatments such as endovascular treatment ( EVT ), personalized patient assessment is important. Data on sex differences in clinical outcome for PAD patients undergoing EVT have been limited, and studies have produced conflicting results. This study sought to compare midterm clinical outcomes between women and men in a large population of patients with PAD undergoing EVT . Methods and Results The K- VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease) registry is a nationwide, multicenter, observational study that includes 3073 PAD patients undergoing EVT ...
January 22, 2019: Journal of the American Heart Association
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