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Seminars in Vascular Surgery Jun 2022Patients with chronic limb-threatening ischemia (CLTI) are medically complex and continue to experience high rates of amputation, despite improved diagnosis and... (Review)
Review
Patients with chronic limb-threatening ischemia (CLTI) are medically complex and continue to experience high rates of amputation, despite improved diagnosis and treatment. Limb salvage programs and multidisciplinary teams provide comprehensive patient care and have been associated with reduced amputation rates. Recent societal guidelines suggest the adoption of limb salvage programs to improve care of patients with CLTI. In this article, we describe the critical components of a limb salvage program and outline the following steps to aid in their construction: community and institution assessment, formation of a multidisciplinary team, provision of patient care, and monitoring outcomes and processes refinement.
Topics: Amputation, Surgical; Chronic Disease; Chronic Limb-Threatening Ischemia; Humans; Ischemia; Limb Salvage; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35672113
DOI: 10.1053/j.semvascsurg.2022.04.011 -
Techniques in Vascular and... Sep 2022Peripheral arterial disease is a condition associated with high rates of cardiovascular morbidity and mortality, increased risk of adverse limb events, including...
Peripheral arterial disease is a condition associated with high rates of cardiovascular morbidity and mortality, increased risk of adverse limb events, including development of critical limb ischemia and amputation, and also with decreased quality of life. This manuscript provides an overview of the medical management of patients with peripheral arterial disease. We discuss contemporary therapies that decrease major adverse cardiovascular and limb events among patients with peripheral arterial disease, and also therapies that improve the patient's ability to walk and quality of life in general.
Topics: Amputation, Surgical; Critical Illness; Extremities; Humans; Ischemia; Limb Salvage; Peripheral Arterial Disease; Quality of Life; Risk Factors; Treatment Outcome
PubMed: 35842265
DOI: 10.1016/j.tvir.2022.100837 -
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... Sep 2022Chronic total occlusions are a common cause of both claudication and critical limb ischemia. Currently, 40%-50% of all individuals undergoing lower extremity...
Chronic total occlusions are a common cause of both claudication and critical limb ischemia. Currently, 40%-50% of all individuals undergoing lower extremity interventions will have a chronic total occlusion. Endovascular specialist should be familiar with the different treatment algorithms and classifications systems. Many different techniques have been shown to be successful in crossing the lesion and for re-entry when needed. The vascular access obtained to cross the lesion is frequently dictated by lesion location, lesion length, and the distal runoff in the affected limb.
Topics: Chronic Disease; Endovascular Procedures; Humans; Ischemia; Lower Extremity; Peripheral Arterial Disease; Retrospective Studies; Treatment Outcome; Vascular Patency
PubMed: 35842259
DOI: 10.1016/j.tvir.2022.100838 -
Methodist DeBakey Cardiovascular Journal 2023Exercise has a profound effect on cardiovascular disease, particularly through vascular remodeling and regeneration. Peripheral artery disease (PAD) is one such... (Review)
Review
Exercise has a profound effect on cardiovascular disease, particularly through vascular remodeling and regeneration. Peripheral artery disease (PAD) is one such cardiovascular condition that benefits from regular exercise or rehabilitative physical therapy in terms of slowing the progression of disease and delaying amputations. Various rodent pre-clinical studies using models of PAD and exercise have shed light on molecular pathways of vascular regeneration. Here, I review key exercise-activated signaling pathways (nuclear receptors, kinases, and hypoxia inducible factors) in the skeletal muscle that drive paracrine regenerative angiogenesis. The rationale for highlighting the skeletal muscle is that it is the largest organ recruited during exercise. During exercise, skeletal muscle releases several myokines, including angiogenic factors and cytokines that drive tissue vascular regeneration via activation of endothelial cells, as well as by recruiting immune and endothelial progenitor cells. Some of these core exercise-activated pathways can be extrapolated to vascular regeneration in other organs. I also highlight future areas of exercise research (including metabolomics, single cell transcriptomics, and extracellular vesicle biology) to advance our understanding of how exercise induces vascular regeneration at the molecular level, and propose the idea of "exercise-mimicking" therapeutics for vascular recovery.
Topics: Humans; Endothelial Cells; Vascular Endothelial Growth Factor A; Muscle, Skeletal; Ischemia; Peripheral Arterial Disease; Exercise; Regeneration; Neovascularization, Physiologic
PubMed: 38028974
DOI: 10.14797/mdcvj.1304 -
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 -
Advances in Surgery Sep 2022Acute limb ischemia (ALI) is a vascular emergency associated with high rates of limb loss and mortality. Management of these patients is challenging given the severe... (Review)
Review
Acute limb ischemia (ALI) is a vascular emergency associated with high rates of limb loss and mortality. Management of these patients is challenging given the severe systemic illness resulting from tissue ischemia and the high incidence of preexisting comorbid conditions and underlying peripheral arterial disease. Expeditious diagnosis, anticoagulation, and revascularization are of utmost importance in reducing morbidity. Revascularization may be accomplished using open, endovascular, or hybrid techniques. Approach to revascularization depends on the severity of ischemia, location of occlusion, cause, chance of recovery, comorbidities, and available resources.
Topics: Arterial Occlusive Diseases; Humans; Ischemia; Peripheral Arterial Disease; Risk Factors; Treatment Outcome
PubMed: 36096573
DOI: 10.1016/j.yasu.2022.03.004