scholarly journals Letter by Czihal and Hoffmann Regarding Article, “Prevalence of Tibial Artery and Pedal Arch Patency by Angiography in Patients With Critical Limb Ischemia and Noncompressible Ankle Brachial Index”

2017 ◽  
Vol 10 (9) ◽  
Author(s):  
Michael Czihal ◽  
Ulrich Hoffmann
Keyword(s):  
Critical Limb Ischemia ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Tibial Artery

Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Vascular ◽  
2021 ◽  
pp. 170853812110298
Author(s):  
Görkem Yiğit
Keyword(s):  
Critical Limb Ischemia ◽  
Bypass Graft ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Rotational Atherectomy ◽  
Total Occlusion ◽  
The Mean ◽  
Knee Pathology ◽  
Drug Coated Balloon

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI

2021 ◽  
pp. 20210215
Author(s):  
Nikolaos Galanakis ◽  
Thomas G Maris ◽  
Georgios Kalaitzakis ◽  
Nikolaos Kontopodis ◽  
Nikolas Matthaiou ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Intravoxel Incoherent Motion ◽  
Healthy Individuals ◽  
Imaging Protocol ◽  
Percutaneous Transluminal

Objectives: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. Methods: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. Results: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10−5 mm2/s to 331.51 ± 31 10−5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10−5 mm2/s vs 332.47 ± 22.95 10−5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64–0.93). Conclusions: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. Advances in knowledge: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.

Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

2005 ◽  
Vol 71 (6) ◽  
pp. 474-480 ◽  
Author(s):  
Susan M. Trocciola ◽  
Rabih Chaer ◽  
Rajeev Dayal ◽  
Stephanie C. Lin ◽  
Naveen Kumar ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Duplex Ultrasound ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Endovascular Interventions

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.

scholarly journals High and immeasurable ankle-brachial index as predictor of poor amputation-free survival in critical limb ischemia

2018 ◽  
Vol 67 (6) ◽  
pp. 1864-1871.e3 ◽  
Author(s):  
Marlon I. Spreen ◽  
Hendrik Gremmels ◽  
Martin Teraa ◽  
Ralf W. Sprengers ◽  
Jasper M. Martens ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Free Survival

Real-Time Quantitative Measurements of Foot Perfusion in Patients With Critical Limb Ischemia

2019 ◽  
Vol 53 (4) ◽  
pp. 310-315 ◽  
Author(s):  
O. Mironov ◽  
R. Zener ◽  
N. Eisenberg ◽  
K.T. Tan ◽  
Graham Roche-Nagle
Keyword(s):  
Wound Healing ◽  
Real Time ◽  
Critical Limb Ischemia ◽  
Ankle Brachial Index ◽  
Microvascular Disease ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Rest Pain ◽  
Quantitative Measurements ◽  
Patients Experience

Introduction: Current methods of evaluating adequacy of endovascular procedures are imperfect and do not always predict which patients will do well. The purpose of this study was to evaluate the role of real-time quantitative measurements of perfusion among patients with critical limb ischemia. Materials and Methods: Thirty-four patients with critical limb ischemia undergoing endovascular treatment were recruited. Perfusion Images of the foot were obtained pre and post successful angioplasty using an SPY Elite System (Novadaq Technologies, Ontario, Canada). Patients were followed for 6 months. Subsequently a logistic regression was performed to determine whether intraprocedural perfusion parameters predicted the odds of wound healing. Results: Twenty-nine patients had successful angioplasty. Median age was 69.5% ± 8.3; 75% were men and 64% were diabetic. Rutherford stages were (4%-39%, 5%-57%, 6%-4%), and the average target limb ankle–brachial index (ABI) was 0.58 (SD 2.24). There was no significant correlation between the ABI and perfusion parameters. Inflow perfusion rate correlated significantly with Rutherford stage (Spearman rho 0.398, P = .036). After successful angioplasty 39% had a decrease in inflow rate and 57% had a decreased total inflow. In all, 25 patients completed 6 months of follow-up. Resolution of rest pain and/or healing of the ischemic wound occurred in 10 (40%) patients at 1 month, 4 (16%) at 3 months, and 2 (8%) at 6 months. One patient underwent a major amputation at 2 months. Eight (32%) patients never healed or had persistent rest pain. None of the real-time perfusion variables were significant predictors of wound healing. Conclusion: Many patients experience a paradoxical decrease in perfusion following successful angioplasty suggesting perfusion may not correlate with angiographic outcome, possibly due to microemboli, microvascular disease, or vasospasm. Real-time perfusion imaging following intra-arterial infusion of indocyanine green does not predict the odds of wound healing.

scholarly journals Single versus Multiple Vessel Endovascular Tibial Artery Revascularization for Critical Limb Ischemia: A Review of the Literature

2020 ◽  
Vol 29 (03) ◽  
pp. 175-179
Author(s):  
Gautam M. Anand ◽  
Allan M. Conway ◽  
Gary Giangola
Keyword(s):  
Critical Limb Ischemia ◽  
Retrospective Studies ◽  
Limb Ischemia ◽  
Tissue Loss ◽  
Tibial Artery ◽  
Randomized Controlled ◽  
Tibial Arteries ◽  
Run Off ◽  
Meta Analyses ◽  
Single Versus

AbstractVascular interventionalists have long debated on whether one or multiple patent tibial arteries (run-off) are necessary to treat critical limb ischemia, including ischemic rest pain and tissue loss. This review article seeks to clarify data surrounding this topic by including literature from retrospective studies, prospective studies, meta-analyses, and randomized controlled trials. Our conclusion is that revascularizing a single tibial artery to the foot is adequate for wound healing.

Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy Following Revascularization in Patients With Critical Limb Ischemia: A Preliminary Study

2019 ◽  
Vol 19 (1) ◽  
pp. 57-62
Author(s):  
Hideharu Nakamura ◽  
Takaya Makiguchi ◽  
Daisuke Atomura ◽  
Yukie Yamatsu ◽  
Ken Shirabe ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Critical Limb Ischemia ◽  
Perfusion Pressure ◽  
Limb Ischemia ◽  
Peripheral Circulation ◽  
Anterior Tibial Artery ◽  
Skin Perfusion ◽  
Ischemic Disease ◽  
Tibial Artery ◽  
Skin Perfusion Pressure

Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), –6.4±10.9, and –15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization.

scholarly journals Plasma NAP-2 levels are associated with critical limb ischemia in peripheral arterial disease patients

2019 ◽  
Vol 244 (1) ◽  
pp. 22-27
Author(s):  
Xiufang Wang ◽  
Juyi Li ◽  
Liming Gan ◽  
Qun Liu
Keyword(s):  
Confidence Intervals ◽  
Critical Limb Ischemia ◽  
Plasma Levels ◽  
Ankle Brachial Index ◽  
Area Under The Curve ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
Diagnostic Biomarker ◽  
Elevated Plasma ◽  
Novel Target

Our study evaluates the relationship between plasma neutrophil-activating peptide-2 (NAP-2) levels and critical limb ischemia (CLI); 189 subjects were enrolled in this study: 59 subjects with CLI and type 2 diabetes mellitus (T2DM), 45 subjects with CLI and no T2DM, 43 patients with T2DM and no CLI, and 42 without both T2DM and CLI. Subjects with CLI had higher plasma levels of NAP-2 than those of the healthy group (2.04 ± 0.06 ng/mL vs. 1.75 ± 0.09 ng/mL, P = 0.011). Subjects with CLI and T2DM had higher plasma levels of NAP-2 than those of the T2DM group (2.08 ± 0.08 ng/mL vs. 1.73 ± 0.10 ng/mL, P = 0.007). However, subjects with CLI including CLI and T2DM+CLI had higher plasma levels of NAP-2 than those of the non-CLI group including healthy and T2DM group (2.06 ± 0.05 ng/mL vs. 1.74 ± 0.07 ng/mL, P < 0.001). The ankle brachial index (ABI) and total cholesterol (TC) were significantly and negatively correlated with plasma NAP-2 levels (rho = −0.250, P = 0.001; rho = −0.162, P = 0.026, respectively). Systolic blood pressure (SBP) positively correlated with plasma NAP-2 levels (rho = 0.187, P = 0.010). When adjusting for the factors, plasma NAP-2 levels were still significantly correlated with CLI (odds ratio = 11.543, 95% confidence intervals: 1.327–100.403, P = 0.027). The area under the curve (AUC) of NAP-2+confounders was 0.992 (95% confidence intervals 0.981 to 1.003, P < 0.001) and it was higher than those of NAP-2 alone (95% confidence intervals 0.241 to 0.407, P < 0.001) and confounders alone (AUC = 0.990, 95% confidence intervals −0.013 to 0.018, P = 0.797). In conclusion, elevated plasma NAP-2 was independently associated with CLI, but it was not correlated with T2DM. Plasma NAP-2 levels might be an early CLI diagnostic biomarker and might provide a novel target for CLI treatment. Impact statement Critical limb ischemia (CLI) is a serious arterial obstruction, resulting in serious reduction of blood flow to the extremities. CLI is a symptomatic disorder and is frequently not diagnosed in time. This results in a high mortality and elevated risk of limb amputation. Serum or plasma biomarkers play important roles in disease prevention, diagnosis, and prognosis. Elevated plasma neutrophil-activating peptide-2 (NAP-2) was found independently associated with CLI, but not with T2DM. Plasma NAP-2 levels might be an early CLI diagnostic biomarker and might provide a novel target for CLI treatment.

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