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Pediatric Cardiology 1999An 8.5-month-old male infant with Kawasaki disease (KD) received high-dose intravenous immunoglobulin (IVIG) therapy on the fifth day after fever onset. However,... (Review)
Review
An 8.5-month-old male infant with Kawasaki disease (KD) received high-dose intravenous immunoglobulin (IVIG) therapy on the fifth day after fever onset. However, multiple peripheral limb ischemias occurred 2 days later. Accordingly, heparin followed by dipyridamole was administered. Aside from a small amputation at the tip of the right middle finger, all other digital ischemias resolved. This presentation demonstrates that early recognition and management of peripheral gangrene in KD may keep its sequela to a minimum.
Topics: Amputation, Surgical; Fingers; Foot; Gangrene; Hand; Humans; Immunization, Passive; Infant; Ischemia; Male; Mucocutaneous Lymph Node Syndrome
PubMed: 9986892
DOI: 10.1007/s002469900422 -
Vascular Aug 2018Critical limb ischaemia is the end stage of peripheral arterial disease before limb loss. Contemporary interventions to restore blood flow have high morbidity and... (Review)
Review
Critical limb ischaemia is the end stage of peripheral arterial disease before limb loss. Contemporary interventions to restore blood flow have high morbidity and mortality and fail to provide sustained restoration of peripheral circulation. Cell-based therapies designed to promote neovascularisation or angiogenesis have been shown in trials to be safe but clinically ineffective. Notwithstanding endless research in the area, no headway has been made in identifying a successful therapy designed specifically to target muscle disease in critical lower limb ischaemia. Thus, the quest to find an effective, lasting solution for critical lower limb ischaemia continues and requires more innovative therapeutic tactics. Our aim is to highlight the crucially interlinked role of the capillary bed, skeletal muscle mass and mitochondria in critical lower limb ischaemia patients and to identify novel therapeutic mechanisms that the vascular interventionalist can add to their armamentarium.
Topics: Capillaries; Critical Illness; Humans; Ischemia; Lower Extremity; Microcirculation; Mitochondria, Muscle; Muscle, Skeletal; Neovascularization, Physiologic; Peripheral Arterial Disease; Regional Blood Flow; Treatment Outcome
PubMed: 29419359
DOI: 10.1177/1708538117753213 -
Cardiovascular Surgery (London, England) Jun 1997Near-infrared spectroscopy was performed perioperatively on the dorsum of the foot in 14 patients who underwent infrainguinal bypass surgery using a prosthesis or the...
Near-infrared spectroscopy was performed perioperatively on the dorsum of the foot in 14 patients who underwent infrainguinal bypass surgery using a prosthesis or the greater saphenous vein. Dual-wavelength continuous light spectroscopy was used to assess changes in tissue saturation before, during and after the operation. Following the use of peripheral vascular grafts an immediate postoperative increase in tissue saturation of median 28 (range -10 to +81) arbitrary units was noted (P < 0.01). Following distal clamping of the common femoral artery, maximal ischaemia corresponding to a median reduction in tissue saturation of 61 (range 6-94) units was reached after 26 (range 8-95) min (P < 0.01). The maximal tissue saturation following declamping was median 27 (range -16 to +100) units higher than the preoperative level (P < 0.01) and was reached after median 42 (range 8-125) min. The results indicate that near-infrared spectroscopy is appropriate for perioperative monitoring during vascular grafting.
Topics: Aged; Aged, 80 and over; Blood Vessel Prosthesis; Female; Foot; Humans; Intraoperative Complications; Ischemia; Leg; Male; Middle Aged; Monitoring, Intraoperative; Oxygen Consumption; Spectroscopy, Near-Infrared; Veins
PubMed: 9293366
DOI: 10.1016/s0967-2109(97)00015-x -
Der Radiologe Jan 2010Endoluminal therapy is indicated in lower extremity ischaemia with Fontaine grades IIb, III and IV. In the presence of significant limitations, interventions are carried... (Review)
Review
Endoluminal therapy is indicated in lower extremity ischaemia with Fontaine grades IIb, III and IV. In the presence of significant limitations, interventions are carried out even in grade IIa claudicants. In addition to the TASC A and B lesions, TASC C and D lesions are increasingly being treated endoluminally as well. Presently, technical success rates of revascularization procedures are above 90% in the iliac vessels and between 79% and 95% in the femoro-popliteal segments. Concentric, non-calcified iliac stenoses are primarily treated with balloon angioplasty (PTA) followed by optional stenting when necessary. For occlusions and heavily calcified lesions, primary stenting is recommended. Primary PTA is the mainstay of treatment in femoro-popliteal vessels with stents being used as a "bail-out" option in case of suboptimal PTA. However, initial reports proving the superiority of primary stenting over PTA with optional stenting have already appeared. Results of PTA with drug-coated balloons for prevention of early restenosis are promising. In the near future, primary PTA with optional stenting in the femoro-popliteal segments may give way to drug-coated balloon angioplasty or primary stenting.
Topics: Angiography; Angioplasty, Balloon; Antineoplastic Agents, Phytogenic; Arterial Occlusive Diseases; Calcinosis; Drug-Eluting Stents; Femoral Artery; Humans; Iliac Artery; Ischemia; Leg; Paclitaxel; Popliteal Artery; Secondary Prevention; Stents
PubMed: 20084499
DOI: 10.1007/s00117-009-1917-9 -
European Journal of Vascular and... May 2021
Topics: Humans; Ischemia; Peripheral Vascular Diseases
PubMed: 33589324
DOI: 10.1016/j.ejvs.2021.01.022 -
Experimental Physiology May 2005Therapeutic angiogenesis/vasculogenesis holds promise for the cure of ischaemic disease. The approach postulates the manipulation of spontaneous healing response by... (Review)
Review
Therapeutic angiogenesis/vasculogenesis holds promise for the cure of ischaemic disease. The approach postulates the manipulation of spontaneous healing response by supplementation of growth factors or transplantation of vascular progenitor cells. These supplements are intended to foster the formation of arterial collaterals and promote the regeneration of damaged tissues. Angiogenic factors are generally delivered in the form of recombinant proteins or by gene transfer using viral vectors. In addition, new non-viral methods are gaining importance for their safer profile. The association of growth factors with different biological activity might offer distinct advantages in terms of efficacy, yet combined approaches require further optimization. Alternatively, substances with pleiotropic activity might be considered, by virtue of their ability to target multiple mechanisms. For instance, some angiogenic factors not only stimulate the growth of arterioles and capillaries, but also inhibit vascular destabilization triggered by metabolic and oxidative stress. Transplantation of endothelial progenitor cells was recently proposed for the treatment of peripheral and myocardial ischaemia. Progenitor cells can be transplanted either without any preliminary conditioning or after ex vivo genetic manipulation. Delivery of genetically modified progenitor cells eliminates the drawback of immune response against viral vectors and makes feasible repeating the therapeutic procedure in case of injury recurrence. It is envisioned that these new approaches of regenerative medicine will open unprecedented opportunities for the care of life-threatening diseases.
Topics: Animals; Bioprosthesis; Blood Vessel Prosthesis; Genetic Therapy; Humans; Ischemia; Neovascularization, Physiologic; Regeneration; Stem Cell Transplantation; Tissue Engineering
PubMed: 15778410
DOI: 10.1113/expphysiol.2004.028571 -
Journal de Medecine Vasculaire 2022Demonstrate that simplified ERICVA (Valladolid Critical Limb Ischaemia Risk Scale) is useful in predicting amputation in chronic limb-threatening ischemia (CLI) after...
OBJECTIVE
Demonstrate that simplified ERICVA (Valladolid Critical Limb Ischaemia Risk Scale) is useful in predicting amputation in chronic limb-threatening ischemia (CLI) after one year of revascularization.
METHODS
A retrospective cohort study was performed. We analyzed the medical records of 93 patients over the age of 35 with the diagnosis of CLI who were treated in the Department of Internal Medicine, Orthopedics or in the Cardiovascular Surgery Unit of the Víctor Lazarte Echegaray Hospital and the High Complexity Virgen de La Puerta Hospital during the period 2015-2018. The simplified ERICVA score was determined in patients before surgical and endovascular revascularization. We included 31 patients who scored 2 or more points in the exposed group and 62 patients who scored less than 2 points in the group not exposed to amputation risk. The collected data was analyzed with the statistical program SPSS where the Relative Risk and significance was obtained with Pearson's Chi-square. The multivariate analysis was also carried out in order to obtain the adjusted relative risk.
RESULTS
It was identified that the simplified ERICVA score greater than or equal to 2 points was more frequent in those who underwent amputation (90.3%) compared to patients who did not undergo amputation (4.8%), increasing the risk of amputation in those patients with CLI who underwent revascularization (RR: 18.67, P<0.001). It was also possible to identify that within the group of patients that showed a high risk of amputation according to the ERICVA scale, they had a higher risk of major amputation (RR: 9.32, P<0.001) as opposed to the risk of minor amputation (RR: 1, 89, P=0.193). Among the items of the simplified ERICVA scale, the preoperative neutrophil-lymphocyte ratio and hematocrit were significantly higher in the group of amputated patients (P<0.001). In addition, it was possible to identify that the score greater than or equal to 2 was independently associated with the risk of amputation in patients revascularized with CLI (RR: 13.5, P<0.001).
CONCLUSION
In our patient population, the simplified ERICVA scale is useful in predicting major and minor amputation in critical limb ischemia after revascularization. The present data showed that the patients who had a simplified ERICVA score greater than or equal to 2 had a higher risk of major amputation compared to the risk of minor amputation. However, it is important to highlight that the impact on the prediction of minor amputation is greater because in some circumstances major amputation can appear as a complication of CLI.
Topics: Amputation, Surgical; Chronic Limb-Threatening Ischemia; Endovascular Procedures; Humans; Ischemia; Limb Salvage; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 36055680
DOI: 10.1016/j.jdmv.2022.07.002 -
Current Pharmaceutical Design 2013Diabetic patients suffer a high rate of amputation. There are two main reasons; infection which can spread rapidly leading to overwhelming tissue destruction and severe... (Review)
Review
Diabetic patients suffer a high rate of amputation. There are two main reasons; infection which can spread rapidly leading to overwhelming tissue destruction and severe peripheral arterial disease. Studies that have stratified patients according to the presence or absence of both peripheral arterial disease and infection have shown significantly worse outcomes in patients with both peripheral arterial disease and infection. There have been two crucial significant advances in diabetic foot care to improve the outlook of these diabetic patients. First, there has been the realisation that diabetic foot patients experience repeated crises from the rapid onset infection and need a special form of easily accessible care within a multidisciplinary diabetic foot service to provide prompt treatment of infection before it progresses to necrosis. Secondly, within such a service, prompt diagnosis of ischaemia and urgent revascularisation has been established as a further important aspect of successful management. The critical factor in saving limbs is making a rapid diagnosis of infection and ischaemia and administering the appropriate treatment early. In this way speedy healing can be achieved and this can prevent patients from needing amputations.
Topics: Anti-Bacterial Agents; Diabetic Foot; Disease Susceptibility; Drug Resistance, Bacterial; Foot; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Ischemia; Opportunistic Infections; Osteomyelitis; Practice Guidelines as Topic; Precision Medicine; Vascular Surgical Procedures
PubMed: 23278492
DOI: 10.2174/1381612811319270021 -
European Journal of Vascular and... Apr 2023This systematic review and meta-analysis reports the outcomes of catheter directed thrombolysis (CDT) in patients with not immediately threatening (Rutherford I) acute... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis reports the outcomes of catheter directed thrombolysis (CDT) in patients with not immediately threatening (Rutherford I) acute lower limb ischaemia (ALI).
DATA SOURCES
PubMed, Embase, and the Cochrane Library.
REVIEW METHODS
A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify observational studies and trials published between 1990 and 2022 reporting on the results of CDT in patients with Rutherford I ALI. A meta-analysis was performed using a random effects model with 95% confidence intervals (CIs). The outcomes of interests were treatment duration, angiographic success, bleeding complications, amputation and mortality rates, primary and secondary patency, and functional outcome expressed as pain free walking distance.
RESULTS
Thirty-nine studies were included, comprising 1 861 patients who received CDT for not immediately threatening ALI. Funnel plots showed an indication of publication bias, and heterogeneity was substantial. Data from 5 to 13 studies were included in the meta-analysis. The pooled treatment duration was 2 days (95% CI 1 - 2), with an angiographic success rate of 80% (95% CI 73 - 86) and a 30 day freedom of amputation rate of 98% (95% CI 92 - 100). The major bleeding rate was 5% (95% CI 2 - 14), with a 30 day mortality rate of 3% (95% CI 1 - 5). The amputation free survival rate was 71% (95% CI 62 - 80) at the one year and 63% (95% CI 51 - 73) at the three year follow up. Long term patency rates were retrieved from four studies: 48% at one year (95% CI 27 - 70). No data could be retrieved on patient walking distance.
CONCLUSION
Although CDT in the treatment of not immediately threatening ALI showed high angiographic success, the long term outcomes were relatively poor, with low patency and a substantial risk of major amputation. Further research is required to interpret the outcome of CDT in the context of potential confounders such as age and comorbidities.
Topics: Humans; Thrombolytic Therapy; Treatment Outcome; Peripheral Vascular Diseases; Arterial Occlusive Diseases; Ischemia; Catheters; Hemorrhage; Fibrinolytic Agents
PubMed: 36608784
DOI: 10.1016/j.ejvs.2022.12.030 -
European Journal of Vascular and... Mar 2017Critical limb ischaemia (CLI) is the end stage of peripheral artery disease (PAD) and is associated with high amputation and mortality rates and poor quality of life.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Critical limb ischaemia (CLI) is the end stage of peripheral artery disease (PAD) and is associated with high amputation and mortality rates and poor quality of life. For CLI patients with no revascularisation options, venous arterialisation could be a last resort for limb salvage.
OBJECTIVE
To review the literature on the clinical effectiveness of venous arterialisation for lower limb salvage in CLI patients with no revascularisation options.
METHOD
Different databases were searched for papers published between January 1966 and January 2016. The criteria for eligible articles were studies describing outcomes of venous arterialisation, published in English, human studies, and with the full text available. Additionally, studies were excluded if they did not report limb salvage, wound healing or amputation as outcome measures. The primary outcome measure was post-operative limb salvage at 12 months. Secondary outcome measures were 30 day or in-hospital mortality, survival, patency, technical success, and wound healing.
RESULTS
Fifteen articles met the inclusion criteria. The included studies described 768 patients. According to the MINORS score, methodological quality was moderate to poor. The estimated pooled limb salvage rate at one year was 75% (0.75, 95% CI 0.70-0.81). Thirty day or in-hospital mortality was reported in 12 studies and ranged from 0 to 10%. Overall survival was reported in 10 studies and ranged from 54% to 100% with a mean follow-up ranging from 5 to 60 months. Six studies reported on patency of the venous arterialisations performed, with a range of 59-71% at 12 months.
CONCLUSION
In this systematic review on venous arterialisation in patients with non-reconstructable critical limb ischaemia, the pooled proportion of limb salvage at 12 months was 75%. Venous arterialisation could be a valuable treatment option in patients facing amputation of the affected limb; however, the current evidence is of low quality.
Topics: Adult; Aged; Aged, 80 and over; Amputation, Surgical; Critical Illness; Female; Humans; Ischemia; Limb Salvage; Lower Extremity; Male; Middle Aged; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency; Vascular Surgical Procedures; Wound Healing
PubMed: 28027892
DOI: 10.1016/j.ejvs.2016.11.007