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Rozhledy V Chirurgii : Mesicnik... 2023Surgical treatment is associated with an unwanted response of the organism to the so-called surgical trauma. This response is called surgical stress....
INTRODUCTION
Surgical treatment is associated with an unwanted response of the organism to the so-called surgical trauma. This response is called surgical stress. Ischaemia-reperfusion injury is one of essential causes of tissue damage. It comprises functional and structural changes in tissue that occur after the restoration of circulation, after an episode of ischaemia. Necrosis of irreversibly changed cells and endothelial and mitochondrial-induced tissue swelling occur.
METHODS
Physiology, pathophysiology of endothelial glycocalyx: Endothelial glycocalyx is a 0.2 to 5 micrometres thin heteropolysaccharide layer that covers the endothelium on its intraluminal side. Backbone molecules of the glycocalyx include proteoglycans, glycoproteins, and glycosaminoglycans. Damage of the endothelial glycocalyx was described in trauma patients, in patients with septic shock, in ischemia and reperfusion injury, and during extensive surgical procedures. Approaches to prevent endothelial glycocalyx damage: Remote ischemic preconditioning was tested as a method of ischemia and reperfusion injury prevention during and after surgery. Nevertheless, the expected effect was not confirmed in performed meta-analyses. Endothelial glycocalyx damage can be prevented pharmacologically with a broad spectrum of substances, such as antithrombin III, doxycycline, hydrocortisone, etanercept, or nitric oxide donors. Hydrogen inhalation or albumin affects glycocalyx positively. Sulodexide provides a positive effect on the protection and reparation of endothelial glycocalyx. This proteoglycan with antithrombotic, fibrinolytic, hypofibrinogenemic, and lipolytic function is used for the treatment of venous diseases, ischaemic heart disease, and peripheral arterial disease. A positive effect of sulodexide on renal dysfunction was documented in a model of ischaemia and reperfusion injury. Equally, a positive effect of sulodexide was described on endothelium repair after its mechanical damage.
CONCLUSION
Further research needs to be performed to evaluate the effect of endothelium-protectives on glycocalyx damage prevention and repair in ischaemia and reperfusion models involving large laboratory animals or in clinical trials in patients undergoing surgical revascularisation procedures.
Topics: Animals; Humans; Glycocalyx; Reperfusion Injury; Ischemia; Endothelium, Vascular
PubMed: 38378459
DOI: 10.33699/PIS.2023.102.12.453-458 -
Clinical Therapeutics Nov 2023This narrative review summarizes recent research examining treatment targets for peripheral artery disease (PAD)-related limb ischemia. (Review)
Review
PURPOSE
This narrative review summarizes recent research examining treatment targets for peripheral artery disease (PAD)-related limb ischemia.
METHODS
Targeted searches of the PubMed and clinical trial registry databases were performed to identify recent findings from animal models of limb ischemia and clinical studies examining PAD progression and treatment. Ongoing clinical trials testing new treatments for PAD were also reviewed. Relevant full-text articles were retrieved and critically reviewed. Where indicated, data were tabulated and summarized in the text.
FINDINGS
Most people with PAD need treatment to improve their walking and function and limit leg pain. Currently, the available treatments of cilostazol, exercise therapy, and revascularization have several deficiencies, including limited access, poor uptake, limited efficacy, and risk of complications. Severe PAD threatens limb viability and is treated by endovascular or open surgical revascularization but is not always successful in achieving limb salvage. Research is ongoing to develop and test new therapies, including new exercise programs, drugs, stem cell treatments and RNA therapeutics, so that new and adjunctive PAD treatments can be offered. Results from multiple clinical trials are expected within the next 5 years.
IMPLICATIONS
It is envisaged that a range of new therapies for PAD will be available in the future.
Topics: Animals; Humans; Peripheral Arterial Disease; Ischemia; Limb Salvage; Walking; Treatment Outcome; Risk Factors
PubMed: 37770310
DOI: 10.1016/j.clinthera.2023.09.005 -
Vascular Medicine (London, England) Apr 2021
Topics: Amputation, Surgical; Chronic Limb-Threatening Ischemia; Humans; Ischemia; Limb Salvage; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 33587691
DOI: 10.1177/1358863X20987611 -
The New England Journal of Medicine Jul 2018
Review
Topics: Aged; Algorithms; Amputation, Surgical; Chronic Disease; Endovascular Procedures; Foot; Gangrene; Humans; Ischemia; Male; Peripheral Vascular Diseases; Toes; Vascular Surgical Procedures
PubMed: 29996085
DOI: 10.1056/NEJMcp1709326 -
Seminars in Vascular Surgery Jun 2022Chronic limb-threatening ischemia (CLTI) is on the rise due to the increasing prevalence of diabetes, which is a significant cause of morbidity and mortality worldwide.... (Review)
Review
Chronic limb-threatening ischemia (CLTI) is on the rise due to the increasing prevalence of diabetes, which is a significant cause of morbidity and mortality worldwide. Due to diabetes, many patients with CLTI present with a predominance of tibial and pedal artery disease. Despite best care, limb amputation cannot always be prevented. Surgical bypass has always been the mainstay in distal revascularization and limb salvage; however, many patients with CLTI have comorbidities, insufficient vein, and anatomic abnormalities that prevent them from undergoing surgery. As a result, endovascular therapies have increased over the last 2 decades and are providing revascularization options in these patients. Although most of the current endovascular literature has focused on above-ankle arterial interventions, recent studies have highlighted the feasibility, safety, and clinical importance of pedal artery interventions. These endovascular techniques hold promise in relieving ischemic pain, healing foot ulcers, reducing rates and extent of amputation, and improving patient functionality and quality of life. This review aims to comprehensively detail pedal artery interventions in terms of anatomy, technique, intraprocedural imaging, and outcomes. In addition, suggestions of when to perform pedal artery interventions and post-intervention surveillance options will be discussed.
Topics: Amputation, Surgical; Arteries; Endovascular Procedures; Humans; Ischemia; Limb Salvage; Peripheral Arterial Disease; Quality of Life; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35672110
DOI: 10.1053/j.semvascsurg.2022.04.007 -
Catheterization and Cardiovascular... May 2021
Topics: Hemorrhage; Humans; Ischemia; Peripheral Vascular Diseases; Treatment Outcome
PubMed: 33974740
DOI: 10.1002/ccd.29726 -
Vascular Medicine (London, England) Apr 2021
Topics: Amputation, Surgical; Chronic Limb-Threatening Ischemia; Endovascular Procedures; Humans; Ischemia; Limb Salvage; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 33825578
DOI: 10.1177/1358863X21998436 -
Techniques in Vascular and... Jun 2016With a rise in the aging popluation, the prevalence of peripheral arterial disease (PAD) is markedly increasing. The overall disease prevalence of PAD is in the range of... (Review)
Review
With a rise in the aging popluation, the prevalence of peripheral arterial disease (PAD) is markedly increasing. The overall disease prevalence of PAD is in the range of 3%-10%, which increases to 15%-20% in persons older than 70 years of age. Given this upward trend in disease prevalence, the economic and societal burden of PAD would be considerable. The subgroup of patients who develop critical limb ischemia (CLI) represents the most challenging population to manage medically, surgically, and endovascularly. Patients with symptomatic PAD and CLI have an increased risk for death and cardiovascular events, especially in those with CLI who carry with them a substantial risk of limb loss. Advances in medical, surgical, and endovascular techniques have shown excellent outcomes in the treatment of these patients, however the optimal management paradigm has not been elucidated. This article reviews the classification and epidemiology, risk factors, natural history, and health care costs associated with PAD and CLI.
Topics: Adult; Age Distribution; Aged; Amputation, Surgical; Asymptomatic Diseases; Critical Illness; Endovascular Procedures; Female; Health Care Costs; Humans; Incidence; Ischemia; Limb Salvage; Lower Extremity; Male; Middle Aged; Peripheral Arterial Disease; Prevalence; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 27423989
DOI: 10.1053/j.tvir.2016.04.001 -
The Journal of Cardiovascular Surgery Aug 2022
Topics: Arterial Occlusive Diseases; COVID-19; Humans; Ischemia; Limb Salvage; Peripheral Vascular Diseases; Treatment Outcome
PubMed: 35848872
DOI: 10.23736/S0021-9509.22.12314-1 -
European Journal of Vascular and... Feb 2020
Topics: Acute Disease; Angiography; Anticoagulants; Europe; Heparin; Humans; Ischemia; Peripheral Arterial Disease; Preoperative Care; Societies, Medical; Specialties, Surgical; Vascular Surgical Procedures; Vasodilator Agents
PubMed: 31899099
DOI: 10.1016/j.ejvs.2019.09.006