scholarly journals Open Surgery as First-Line Treatment of Infrainguinal Multilevel TASC D Arterial Disease With Critical Limb Ischemia

2019 ◽  
Vol 58 (6) ◽  
pp. e53-e54
Author(s):  
Mohammad Abualhin ◽  
Mauro Gargiulo ◽  
Alessia Sonetto ◽  
Gianluca Faggioli ◽  
Rodolfo Pini ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Open Surgery ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals Endovascular Therapy Versus Bypass Surgery as First-Line Treatment Strategies for Critical Limb Ischemia

2016 ◽  
Vol 9 (24) ◽  
pp. 2557-2565 ◽  
Author(s):  
Theodosios Bisdas ◽  
Matthias Borowski ◽  
Konstantinos Stavroulakis ◽  
Giovanni Torsello ◽  
Farzin Adili ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Bypass Surgery ◽  
Treatment Strategies ◽  
Limb Ischemia ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals Current practice of first-line treatment strategies in patients with critical limb ischemia

2015 ◽  
Vol 62 (4) ◽  
pp. 965-973.e3 ◽  
Author(s):  
Theodosios Bisdas ◽  
Matthias Borowski ◽  
Giovanni Torsello ◽  
Farzin Adili ◽  
Kai Balzer ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Current Practice ◽  
Treatment Strategies ◽  
Limb Ischemia ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

One-Year Results of First-Line Treatment Strategies in Patients With Critical Limb Ischemia (CRITISCH Registry)

2018 ◽  
Vol 25 (3) ◽  
pp. 320-329 ◽  
Author(s):  
Konstantinos Stavroulakis ◽  
Matthias Borowski ◽  
Giovanni Torsello ◽  
Theodosios Bisdas ◽  
Farzin Adili ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Critical Limb Ischemia ◽  
Bypass Surgery ◽  
Treatment Strategies ◽  
Limb Ischemia ◽  
Treatment Choice ◽  
Line Treatment ◽  
First Line ◽  
Endovascular Revascularization ◽  
First Line Treatment

Purpose: To examine the outcomes of all first-line strategies for the treatment of critical limb ischemia (CLI), identify factors that influenced the treatment choice, and determine the risk of amputation or death after each treatment. Methods: CRITISCH ( ClinicalTrials.gov identifier NCT01877252) is a multicenter, national, prospective registry evaluating all available treatment strategies applied in 1200 consecutive CLI patients in 27 vascular centers in Germany. The recruitment started in January 2013 and was completed in September 2014. Treatment options were endovascular revascularization (642, 53.5%), bypass surgery (284, 23.7%), femoral artery patchplasty (126, 10.5%) with or without concomitant peripheral intervention, conservative treatment (118, 9.8%), and primary major amputation (30, 2.5%). The primary endpoint of this study was amputation-free survival (AFS). The Society of Vascular Surgery’s suggested objective performance goal (OPG) for AFS (71%) was used as the effectiveness criterion. Multivariable regression methods were employed to identify variables that influenced the treatment selection and AFS after each treatment; results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 12-month AFS estimates following endovascular therapy, bypass grafting, femoral patchplasty, and conservative treatment were 75%, 72%, 73%, and 72%, respectively. Factors influencing treatment choice were age, chronic kidney disease (CKD), diabetes, smoking, prior vascular procedures in the index leg, TransAtlantic Inter-Society Consensus II C/D lesions, and absence of runoff vessels. Cox regression analysis identified CKD (HR 2.07, 95% CI 1.26 to 3.41, p=0.004), the use of a prosthetic bypass conduit (HR 1.97, 95% CI 1.23 to 3.14, p=0.004), and previous vascular intervention in the index limb (HR 1.52, 95% CI 0.94 to 2.43, p=0.085) as independent risk factors for diminished AFS after bypass surgery. CKD (HR 1.47, 95% CI 1.09 to 1.99, p=0.012) and Rutherford category 6 (HR 1.81, 95% CI 1.30 to 2.52, p<0.001) compromised the performance of endovascular revascularization. Conclusion: CRITISCH registry data revealed that all first-line treatment strategies selected and indicated by the treating physicians met the suggested OPGs. CKD was an important determinant of patient prognosis after treatment regardless of the revascularization method.

scholarly journals Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Samuel Heller ◽  
Jean-Claude Lubanda ◽  
Petr Varejka ◽  
Miroslav Chochola ◽  
Pavel Prochazka ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Limb Ischemia ◽  
Performance Outcomes ◽  
Amputation Rate ◽  
Acute Limb Ischemia ◽  
Line Treatment ◽  
First Line ◽  
Invasive Treatment ◽  
Percutaneous Mechanical Thrombectomy ◽  
First Line Treatment

Purpose. To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. Methods. In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. Results. Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. Conclusion. Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

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