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Cardiovascular Research Mar 2019Current treatment of ischaemic vascular diseases such as coronary and peripheral artery disease includes angioplasty and bypass grafting, as well as lipid lowering... (Review)
Review
Current treatment of ischaemic vascular diseases such as coronary and peripheral artery disease includes angioplasty and bypass grafting, as well as lipid lowering therapies and control of other cardiovascular risk factors. Numerous members of the tumour necrosis factor superfamily (TNFSF) have recently shown emerging roles in both the protection and progression of such diseases. Understanding the role TNFSF members play in ischaemic vascular disease may provide insight into the development of novel therapeutics to prevent or treat diseases relating to atherosclerosis and ischaemia. This review summarizes the most recent findings relating to TNFSF members and the mechanisms that precede ischaemic vascular disease progression, particularly endothelial dysfunction, chronic inflammation, and atherosclerotic plaque development. This review also explores recent translational research on the role of TNFSF therapies in cardiovascular disease.
Topics: Animals; Arteries; CD40 Ligand; Cytokine TWEAK; Humans; Ischemia; Receptors, Tumor Necrosis Factor; Signal Transduction; TNF-Related Apoptosis-Inducing Ligand; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha; Tumor Necrosis Factors; Vascular Diseases
PubMed: 30816914
DOI: 10.1093/cvr/cvz042 -
The Cochrane Database of Systematic... Dec 2016Critical lower limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that is seen in patients with typical chronic ischaemic rest pain or patients... (Review)
Review
BACKGROUND
Critical lower limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that is seen in patients with typical chronic ischaemic rest pain or patients with ischaemic skin lesions - ulcers or gangrene - for longer than 2 weeks. Critical lower limb ischaemia is the most severe form of PAD, and interventions to improve arterial perfusion become necessary. Although surgical bypass has been the gold standard for revascularisation, the extent or the site of disease may be such that the artery cannot be reconstructed or bypassed. These patients require other modalities of treatment, for example, vasodilatation by drugs or lumbar sympathectomy to relieve pain at rest and to avoid amputations. A systematic review of randomised controlled trials is required to evaluate the effects of lumbar sympathectomy in treating patients with CLI due to non-reconstructable PAD.
OBJECTIVES
The objective of this review is to assess the effects of lumbar sympathectomy by open, laparoscopic and percutaneous methods compared with no treatment or compared with any other method of lumbar sympathectomy in patients with CLI due to non-reconstructable PAD.
SEARCH METHODS
The Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (January 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12). In addition, the CIS searched clinical trials databases for details of ongoing and unpublished studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing any of the treatment modalities of lumbar sympathectomy, such as open, laparoscopic and chemical percutaneous methods, with no treatment or with any other method of lumbar sympathectomy for CLI due to non-reconstructable PAD were eligible. To decrease the bias of including participants that may be incorrectly diagnosed with CLI, review authors defined CLI as persistently recurring ischaemic rest pain requiring regular analgesia for more than two weeks, or ulceration or gangrene of the foot or toes, attributable to objectively proven arterial occlusive disease by measurement of ankle pressure of < 50 mmHg or toe pressure < 30 mmHg. We defined non-reconstructable PAD as a resting ankle brachial index (ABI) < 0.9 when no reasonable open surgical or endovascular revascularisation treatment option is available, as determined by individual trial vascular specialists.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions.
MAIN RESULTS
We identified no studies that met the predefined inclusion criteria. To decrease the bias of including participants who may be incorrectly diagnosed with CLI, we based our inclusion criteria on objective tests, as described above. The randomised trials identified by the literature search were performed before such objective criteria for selection were applied and therefore were not eligible for inclusion in the review.
AUTHORS' CONCLUSIONS
We identified no RCTs assessing effects of lumbar sympathectomy by open, laparoscopic and percutaneous methods compared with no treatment or compared with any other method of lumbar sympathectomy in patients with CLI due to non-reconstructable PAD. High-quality studies are needed.
Topics: Chronic Disease; Humans; Ischemia; Lower Extremity; Lumbosacral Plexus; Peripheral Arterial Disease; Sympathectomy; Sympathectomy, Chemical
PubMed: 27959471
DOI: 10.1002/14651858.CD011519.pub2 -
Proceedings of the Royal Society of... Jul 1962
Topics: Humans; Ischemia; Peripheral Vascular Diseases; Vascular Diseases
PubMed: 13888965
DOI: No ID Found -
Journal of Vascular Surgery May 2010
Topics: Angioplasty, Balloon; Constriction, Pathologic; Cost-Benefit Analysis; Health Care Costs; Humans; Ischemia; Lower Extremity; Multicenter Studies as Topic; Peripheral Vascular Diseases; Quality of Life; Radiography; Randomized Controlled Trials as Topic; Research Design; Severity of Illness Index; Treatment Outcome; Vascular Surgical Procedures
PubMed: 20435257
DOI: 10.1016/j.jvs.2010.02.002 -
Journal of Wound Care Jul 2021Local intramuscular transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilised peripheral blood mononuclear cells (PB-MNC) has been shown to be effective...
OBJECTIVE
Local intramuscular transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilised peripheral blood mononuclear cells (PB-MNC) has been shown to be effective for treating patients with no-option critical limb ischaemia (CLI) who are not considered suitable to undergo surgical bypass or percutaneous transluminal angioplasty. The aim of this study was to investigate the effectiveness and safety of PB-MNCs as a treatment for no-option CLI patients.
METHOD
This prospective cohort study was conducted between April 2013 and December 2017. Patients with no-option CLI were treated with G-CSF 5-10 µg/kg/day for 3 days. PB-MNCs (7.1±2.2×10) with CD34+ cells (2.1±1.2×10) were collected by blood cell separator and then injected into the calf or thigh of ischaemic limbs. Ankle-brachial index, toe-brachial index and transcutaneous oxygen tension were recorded at 1 and 3 months after injection. The amputation rate and the wound healing rate were also recorded.
RESULTS
Eight patients took part in the study. Two patients experienced rest pain relief 1 month after PB-MNC therapy. Five patients had healed ulcer at 6 months after PB-MNC therapy. Limb ischaemia did not improve after PB-MNC therapy in one patient. Below-knee amputation was performed in that patient due to extension of gangrene. Two patients required reinjection of PB-MNCs because of recurrence of ischaemic ulcer. The limb salvage rate after 1 year was 87.5%.
CONCLUSION
Local intramuscular transplantation of G-CSF-mobilised PB-MNCs might be a safe and effective treatment for no-option CLI patients.
Topics: Amputation, Surgical; Humans; Ischemia; Leukocytes, Mononuclear; Limb Salvage; Peripheral Vascular Diseases; Prospective Studies; Transplantation, Autologous; Treatment Outcome
PubMed: 34256601
DOI: 10.12968/jowc.2021.30.7.562 -
Cardiovascular Surgery (London, England) Jun 1993Buerger's disease is characterized by peripheral arterial occlusion of the extremities in young male smokers. In true Buerger's disease lesions rarely occur in the... (Review)
Review
Buerger's disease is characterized by peripheral arterial occlusion of the extremities in young male smokers. In true Buerger's disease lesions rarely occur in the proximal arteries. The incidence of the disease is low in Europe and the USA, but its management remains a major problem for vascular surgeons in Asia where its incidence is higher. Aetiology of the disease remains unknown, but there is a clear relationship between tobacco abuse and its occurrence or recurrence; complete cessation of smoking renders the disease benign. Despite a high incidence of digital gangrene or ulceration, a functional foot or hand can generally be preserved because of the good healing potential of the trophic lesions. Specificity of the disease is characterized by peripheral ischaemia of an inflammatory nature and with a self-limiting course. The clinical term Buerger's disease is preferred to the pathological term thromboangiitis obliterans. Diagnosis is based on knowledge of the natural history of the disease, which aids prognosis and the decision to undertake surgical or conservative management. Treatment of Buerger's disease should avoid premature, possibly unnecessary, surgery. The condition is no longer a disease of misconceptions; its diagnosis and management should be based on a clear understanding of the pathophysiology.
Topics: Adult; Aged; Amputation, Surgical; Combined Modality Therapy; Diagnosis, Differential; Female; Humans; Ischemia; Leg; Male; Middle Aged; Thromboangiitis Obliterans
PubMed: 8076031
DOI: No ID Found -
British Journal of Nursing (Mark Allen... Jul 2021This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases... (Review)
Review
This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse-patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.
Topics: Chronic Disease; Humans; Ischemia; Peripheral Arterial Disease
PubMed: 34288743
DOI: 10.12968/bjon.2021.30.14.846 -
BMJ (Clinical Research Ed.) Jan 2018
Topics: Aged; Chronic Disease; Diagnosis, Differential; Foot; Humans; Ischemia; Male; Peripheral Arterial Disease
PubMed: 29326105
DOI: 10.1136/bmj.j5460 -
Journal of Plastic, Reconstructive &... Sep 2013A 63 year old woman sustained an extravasation of vasopressor during a successful in hospital cardiopulmonary resuscitation resulting in an acutely ischaemic hand. This... (Review)
Review
A 63 year old woman sustained an extravasation of vasopressor during a successful in hospital cardiopulmonary resuscitation resulting in an acutely ischaemic hand. This was treated with multiple washouts of the hand due to incipient recurrence of the ischaemia. Extravasation of vasopressor is exceedingly rare and potentially devastating. This case highlights the specific problems associated with extravasation of vasopressor. We present an algorithm for treatment of these and identify the potential need to use specific antidotes for the vasoconstriction caused by adrenaline extravasation.
Topics: Cardiopulmonary Resuscitation; Extravasation of Diagnostic and Therapeutic Materials; Female; Follow-Up Studies; Hand; Heart Arrest; Humans; Ischemia; Middle Aged; Risk Assessment; Severity of Illness Index; Therapeutic Irrigation; Treatment Outcome
PubMed: 23660283
DOI: 10.1016/j.bjps.2013.03.047 -
International Anesthesiology Clinics 2000In the future, the indications for HBO therapy in acute peripheral ischemic injuries will likely be based on objective criteria rather than, as at present, on clinical... (Review)
Review
In the future, the indications for HBO therapy in acute peripheral ischemic injuries will likely be based on objective criteria rather than, as at present, on clinical diagnoses alone. This chapter offers objective criteria for using HBO in crush injuries and compartment syndromes. The pathophysiology of ATPI are well defined. Hyperbaric oxygen mediates the effects of ATPI through four mechanisms: hyperoxygenation, vasoconstriction, reperfusion, and host factors. The cost benefits of using HBO will be substantial, since complications from ATPI are very expensive. As objective criteria replace the presently used subjective criteria, hyperbaric oxygen therapy will become an integral part of trauma management of these injuries.
Topics: Acute Disease; Compartment Syndromes; Crush Syndrome; Extremities; Humans; Hyperbaric Oxygenation; Ischemia; Wounds and Injuries
PubMed: 10723673
DOI: 10.1097/00004311-200001000-00009