scholarly journals Treatment of critical lower limb ischemia using a hybrid technique

2014 ◽  
Vol 13 (3) ◽  
pp. 257-261
Author(s):  
Ricardo Wagner da Costa Moreira ◽  
Pedro Victor Alcântara da Costa ◽  
David Domingos Rosado Carrilho
Keyword(s):  
Effective Treatment ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Treatment Method ◽  
Major Amputation ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Endovascular Techniques ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Critical ischemia of a lower limb is a condition that threatens its viability and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method and is performed using surgical or endovascular techniques. For patients with thoracoabdominal aortic aneurysms, combining these two approaches into a "hybrid technique" makes it possible to treat patients who could not be adequately treated by either technique in isolation. We report on a case of lower limb critical ischemia treated using a combination of surgery and endovascular techniques, in an application of the hybrid technique in a different arterial bed.

scholarly journals Endovascular treatment of chronic lower limb ischemia - the first experience of consecutive patients in the Kyrgyz Republic

2019 ◽  
Vol 3 (Issue 4) ◽  
pp. 188
Author(s):  
S.D. Chevgun ◽  
I.Z. Abdyldaev ◽  
A.S. Imankulova ◽  
I.H. Bebezov ◽  
D. Ch. Cholponbaev ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Lower Limb ◽  
Ad Hoc ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Regenerative Process ◽  
Modern World ◽  
Kyrgyz Republic ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Objective: Pure atherosclerosis and diabetes mellitus are often responsible for the lesion of lower limb arteries. As a result, critical ischemia may develop. Endovascular treatment of lower extremities chronic ischemia in the modern world one of the most effective methods of limbs salvage. This report is an analysis of the first experience of endovascular treatment in consecutive patients with chronic lower limb ischemia in the Kyrgyz Republic. Methods: In 2016-2018, there were 31 patients with chronic lower limb ischemia in IIb-IV Fontaine's stages who underwent endovascular treatment. The primary endpoint was 6-month painlessness or reduction of the Fontaine stage; freedom from amputation up to six months; active regenerative process or full recovery of ulcers/wounds up to six months. The secondary endpoints included 6-month all-cause mortality and reintervention rate. Results: Overall,  27 (87.1%) patients reached painless form (stage I according to Fontaine (ABI ≥0.9)), with complete regeneration or active reparative process observed in 20 (64. 5%) patients. In general, major amputation was avoided in 29 (93.5%) patients (two patients underwent amputation by E. Burgess). Minor amputations were performed below the level of foot dorsum (Sharp) in 35.5% (11 patients). Simultaneous percutaneous coronary interventions and peripheral interventions were performed in 6 (19. 4%) cases. In total, within 6 months one death was registered (3.2%). Conclusion:  The first endovascular treatment of consecutive patients showed encouraging 6-month results. Simultaneous («Ad-hoc») or stepwise (at the current hospitalization) procedures on coronary and peripheral arteries ensure safety and can provide more chances of  patient`s survival.

Safety aspect of intraoperative, local urokinase lysis in patients with acute lower limb ischemia

2021 ◽  
pp. 1-10
Author(s):  
Schierling Wilma ◽  
Bachleitner Kathrin ◽  
Kasprzak Piotr ◽  
Betz Thomas ◽  
Stehr Alexander ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Artery Occlusion ◽  
Outflow Tract ◽  
Intracranial Bleeding ◽  
Minor Bleeding ◽  
Free Survival ◽  
Lower Limb Ischemia

BACKGROUND: Acute lower limb ischemia (ALI) is associated with a high risk of limb loss and death. OBJECTIVE: The present study evaluates the safety of intraoperative, local urokinase lysis in patients with ALI and crural artery occlusion. METHODS: A total of 107 patients (115 legs) were treated surgically for ALI with additional intraoperative urokinase lysis to improve the outflow tract. Minor and major bleeding as well as efficacy of treatment and amputation-free survival were investigated. RESULTS: Complete restoration of at least one run-off vessel was achieved in 64%. Collateralization was improved in 34%. Lysis failed in 2%. Major amputation rate was 27%overall (12%within 30 days) and depended on Rutherford class of ALI (overall/30 day: IIa 11%/6%; IIb 20%/17%; III 37%/15%). Amputation-free survival turned out to be 82%after 30 days, 58%after one, and 41%after five years. Minor bleeding occurred in 21%(24/115) and major bleeding in 3.5%(4/115). One of these patients died of haemorrhage. No patient experienced intracranial bleeding. CONCLUSION: Intraoperative urokinase lysis improves limb perfusion and causes low major and intracranial bleeding. It can be safely applied to patients with severe ischaemia when surgical restoration of the outflow tract fails.

scholarly journals NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

2020 ◽  
Vol 18 (6) ◽  
pp. 710-715
Author(s):  
N. N. Ioskevich ◽  
◽  
L. F. Vasilchuk ◽  
P. E. Vankovich ◽  
S. P. Antonenko ◽  
...  
Keyword(s):  
Lower Limb ◽  
Type I Diabetes ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Type I ◽  
Critical Ischemia ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

Hybrid Technique for Acute on chronic Lower Limb Ischemia, A single centre study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Islam Badry Mohammed ◽  
Amr Nabil Kamel ◽  
Mohammed Mahmoud Zaki
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Hybrid Procedure ◽  
Hybrid Technique ◽  
Technical Success ◽  
Hybrid Procedures ◽  
Lower Limb Ischemia ◽  
Single Centre Study ◽  
One Step ◽  
Salvage Rate

Abstract Background Several methods have been postulated for the treatment of acute on chronic lower limb ischemia; among them, the hybrid procedure (combined open thrombectomy and angioplasty) is gaining popularity .It is aimed at clearing the vessel and treating the underlying vessel lesion in one step. Patients and Methods A total of 23 patients admitted to the vascular department were eligible for inclusion in this study. They were subjected to thromboembolectomy, followed by endovascular balloon dilatation with or without stenting. Data regarding the risk factors, procedure success, and complications were recorded. Results Hybrid procedures showed 91.6% immediate technical success and 82.6% primary limb salvage rate up to 6 months with accepted minor complications. and no major complications Conclusion The hybrid procedure provides an accepted outcome in treating immediately limb- threatening acute on chronic lower limb ischemia.

scholarly journals The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia

2014 ◽  
Vol 59 (3) ◽  
pp. 729-736 ◽  
Author(s):  
Gianmarco de Donato ◽  
Francesco Setacci ◽  
Pasqualino Sirignano ◽  
Giuseppe Galzerano ◽  
Rosaria Massaroni ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Endovascular Techniques ◽  
Lower Limb Ischemia ◽  
Surgical Embolectomy

scholarly journals Pathogenesis of ischemia/reperfusion syndrome

2018 ◽  
Vol 99 (4) ◽  
pp. 640-644 ◽  
Author(s):  
D E Kutepov ◽  
M S Zhigalova ◽  
I N Pasechnik
Keyword(s):  
Blood Flow ◽  
Lower Limb ◽  
Ischemia Reperfusion ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Biologically Active ◽  
Lower Limbs ◽  
Ion Pump ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Ischemia/reperfusion syndrome is a collective concept that combines various pathological conditions developing against the background of the restoration of the main blood flow in the organ or limb segment, which has long been subjected to ischemia or traumatic amputation. Intensive care physicians often see ischemia/reperfusion syndrome after restoration of blood supply in patients with critical ischemia of the lower limb. The rate of critical ischemia of the lower limbs ranges from 400 to 1000 cases per 1 million of the population. The number of lower limb amputations due to critical lower limb ischemia in economically developed countries is 13.7-32.3 cases per 100,000 of the population. The main etiological factors of critical lower limb ischemia are atherosclerosis of peripheral vessels and vascular complications of diabetes. The pathogenesis of ischemia/reperfusion syndrome is based on a complex of pathophysiological changes resulting from the restoration of blood flow in previously ischemic lower limb. Restoration of blood circulation leads to massive flow into the systemic bloodstream of anaerobic metabolism products, free myoglobin, biologically active substances and inflammatory mediators. The main sources of reperfusion damage are activated forms of oxygen, in particular, superoxide radical О2-, nitric oxide, lipid peroxidation products. In the conditions of primary ischemia, and then tissue reperfusion, excessive production of activated oxygen forms leads to damage of biological structures (lipids, proteins, deoxyribonucleic acid), which causes disruption of normal cell functioning or its death due to necrosis or apoptosis, ion pump dysfunction, adhesion of leukocytes and increased vascular permeability.

scholarly journals Role of Hybrid Interventions in Management of Critical Lower Limb Ischemia

2020 ◽  
pp. 229-237
Author(s):  
Samy R. Zekilah ◽  
Adel H. Kamhawy ◽  
Hassan A. Hassan ◽  
Mohamed A. El-heniedy ◽  
Ahmed M. Ismael
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
University Hospital ◽  
Tissue Loss ◽  
Hybrid Technique ◽  
Lower Limb Ischemia ◽  
Endovascular Interventions ◽  
Ischemic Ulcer ◽  
Work Up

Aims: To evaluate safety and efficacy of the hybrid technique in revascularization of multilevel lower limb arterial occlusive disease in patients with critical lower limb ischemia. Study Design: A prospective non comparative interventional study. Place and Duration of Study: It was conducted between February 2017 and June 2019 in the Department of Vascular Surgery, Tanta University hospital. Methodology: The study included 23 patients were treated with hybrid intervention techniques, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up like duplex scanning with or without CT angiography. All patients were undergone hybrid interventions in an operating room with imaging facilities (mobile c-arm device) where both surgical and endovascular interventions were done simultaneously. Results: Twenty three patients were treated for unilateral critical lower limb ischemia using single session elective hybrid intervention. The patients age ranged from 46 to 76 (mean 62.6) with 19 males. 8 patients (34.8%) presented with ischemic rest pain and the remainder (65.2%) presented with tissue loss (ischemic ulcer or gangrene). most common inflow procedure was femoro-popliteal supragenicular bypass, and the commonest outflow procedure was tibial angioplasty. Technical success was achieved in 22 patients. Mean ABI was improved from 0.49 preoperatively to 0.84 in early post-operative measurements. Out of 23 limbs treated there were 20 limbs saved from amputation (87% limb salvage rate). We had three mortalities from other co-morbidities and four minor complications treated conservatively and resolved. Conclusion: Hybrid interventions were proved to be reasonable, effective and safe option for treatment of critical lower limb ischemia.

scholarly journals Plasma creatine kinase indicates major amputation or limb preservation in acute lower limb ischemia

2007 ◽  
Vol 45 (4) ◽  
pp. 733-739 ◽  
Author(s):  
Ian S. Currie ◽  
Sonia J. Wakelin ◽  
Amanda J. Lee ◽  
Roderick T. Chalmers
Keyword(s):  
Creatine Kinase ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lower Limb Ischemia ◽  
Limb Preservation ◽  
Plasma Creatine Kinase
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