Assessment of Critical Limb Ischemia in Patients with Diabetes: Comparison of MR Angiography and Digital Subtraction Angiography

2005 ◽  
Vol 185 (6) ◽  
pp. 1641-1650 ◽  
Author(s):  
Matthieu Lapeyre ◽  
Hicham Kobeiter ◽  
Pascal Desgranges ◽  
Alain Rahmouni ◽  
Jean-Pierre Becquemin ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Critical Limb Ischemia ◽  
Mr Angiography ◽  
Limb Ischemia ◽  
Digital Subtraction ◽  
Patients With Diabetes

Evaluation of Tissue Perfusion by Wound Blush and 2D Color-Coded Digital Subtraction Angiography During Endovascular Intervention and Its Impact on Limb Salvage in Critical Limb Ischemia

2021 ◽  
pp. 152660282110659
Author(s):  
Hassan Lotfy ◽  
Ahmed Abou El-Nadar ◽  
Wael Shaalan ◽  
Ali El Emam ◽  
Akram Ibrahim ◽  
...  
Keyword(s):  
Wound Healing ◽  
Digital Subtraction Angiography ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Tissue Perfusion ◽  
Technical Failure ◽  
Digital Subtraction ◽  
Reliable Technique ◽  
Significant Difference

Purpose: Critical limb ischemia (CLI) is an entity with high mortality if not properly treated. The primary aim of CLI revascularization is to enhance wound healing, which greatly depends on microvascular circulation. The available tools for assessment of revascularization success are deficient in the evaluation of local microvascular tissue perfusion, that wound blush (WB) reflects. A reliable technique that assesses capillary flow to foot lesions is needed. This study aims to assess WB angiographically at sites of interest in the foot after revascularization and its impact on limb salvage in CLI. Materials and Methods: 198 CLI patients (Rutherford category 5/6) with infrainguinal atherosclerotic lesions amenable for endovascular revascularization (EVR) were included. Limbs were directly or indirectly revascularized by EVR. Direct revascularization meant that successful revascularization of the area of interest according to the angiosome concept was achieved. A completion angiographic run was taken to assess WB. Patients were divided into 2 groups; positive and negative WB groups. In the event of a disagreement between the observational investigators, the digital subtraction angiography (DSA) series was analyzed for hemodynamic changes with a computerized 2D color-coded DSA (Syngo iFlow). Results: 176 limbs had successful revascularization in 157 patients. The successful revascularization rate was 88.9% (176/198), with technical failure encountered in 22 limbs. 121 patients had positive WB and 55 patients had negative WB. Direct revascularization of target areas was obtained in 98 limbs (55.7%). There was a significant difference in the rate of achieving direct flow to the lesion between the positive WB and negative WB groups (36.4% vs 19.3%, p≤0.001). We noticed a nonsignificant difference between patients who had direct revascularization of the foot lesion(s) and those who had indirect revascularization as regards limb salvage. Patients were followed up for 25.2 ± 12.7 months. By the end of the first year, limb salvage rate was significantly higher in patients who had positive WB (98% vs 63%, p<0.001, after 2 years (97% vs 58%, p<0.001) and after 3 years (94% vs 51.5%, p<0.001). Conclusions: WB is an important predictor and a prognostic factor for wound healing in CLI patients with soft tissue lesions.

Digital Subtraction Angiography Prior to an Amputation for Critical Limb Ischemia (CLI): An Expert Recommendation Statement From the CLI Global Society to Optimize Limb Salvage

2020 ◽  
Vol 27 (4) ◽  
pp. 540-546 ◽  
Author(s):  
Jihad A. Mustapha ◽  
Fadi A. Saab ◽  
Brad J. Martinsen ◽  
Constantino S. Pena ◽  
Thomas Zeller ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Digital Subtraction ◽  
Global Society ◽  
Expert Recommendation ◽  
Below The Knee ◽  
Artery Disease ◽  
Quality Imaging

Despite recent guideline updates on peripheral artery disease (PAD) and critical limb ischemia (CLI) treatment, the optimal treatment for CLI is still being debated. As a result, care is inconsistent, with many CLI patients undergoing an amputation prior to what many consider to be mandatory: consultation with an interdisciplinary specialty care team and a comprehensive imaging assessment. More importantly, quality imaging is critical in CLI patients with below-the-knee disease. Therefore, the CLI Global Society has put forth an interdisciplinary expert recommendation for superselective digital subtraction angiography (DSA) that includes the ankle and foot in properly indicated CLI patients to optimize limb salvage. A recommended imaging algorithm for CLI patients is included.

scholarly journals Outcome After Leg Bypass Surgery for Critical Limb Ischemia Is Poor in Patients With Diabetes: A population-based cohort study

Diabetes Care ◽  
2008 ◽  
Vol 31 (5) ◽  
pp. 887-892 ◽  
Author(s):  
J. Malmstedt ◽  
K. Leander ◽  
E. Wahlberg ◽  
L. Karlstrom ◽  
L. Alfredsson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critical Limb Ischemia ◽  
Bypass Surgery ◽  
Limb Ischemia ◽  
Population Based ◽  
Patients With Diabetes

Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia

2019 ◽  
Vol 15 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Hesham Ebrahim Ahmed Al-rudaini ◽  
Ping Han ◽  
Huimin Liang
Keyword(s):  
Digital Subtraction Angiography ◽  
Ct Angiography ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Definitive Treatment ◽  
Digital Subtraction ◽  
Arterial Tree ◽  
Lower Limb Ischemia ◽  
Significant Difference ◽  
Peripheral Arterial

Background:CT Angiography (CTA) of aortoiliac and lower extremity arteries is a relatively recent innovation of CT imaging that has changed after the introduction of multi-detector row scanners.Objective:The study aimed to evaluate the diagnostic accuracy of Multidetector Computed Tomographic Angiography (MDCTA) in the assessment of arterial tree in patients with Peripheral Arterial Occlusive Disease (PAOD), as compared to Digital Subtraction Angiography (DSA).Methods:A single-center nonrandomized prospective study was conducted on 50 patients complaining of peripheral arterial disease (chronic stage) from February 2017 to October 2017. All the patients were exposed to DSA and CTA prior to definitive treatment. The images were then analyzed using maximum intensity projection, volume-rendered, and curved multiplane reformation techniques.Results:All the patients involved in this study were susceptible according to their clinical presentation. The statistical analysis exposed a highly significant difference between CTA and DSA in the assessment of stenosis at the level of Femoropopliteal segment (P<0.01), while for infrapopliteal segment, there was no statistically significant difference between CTA and DSA having 8% versus 14% insignificant stenosis and 62% versus 47% significant stenosis in CTA and DSA, respectively. The overall accuracy of CT angiography in the femoropopliteal segments was 95.20% while in the infrapopliteal segment it was 94.5%.Conclusion:Multidetector CT angiography was found to be a reliable alternative mean for pathoanatomical description of the arterial lesions in critical lower limb ischemia and its subsequent management in comparison to digital subtraction angiography.

scholarly journals Myocardial revascularization in diabetic patients presenting with critical limbischemia

2010 ◽  
Vol 13 (4) ◽  
pp. 25-29
Author(s):  
Ivan Ivanovich Dedov ◽  
Victor Yur'evich Kalashnikov ◽  
Konstantin Vladimirovich Melkozerov
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Critical Limb Ischemia ◽  
Myocardial Revascularization ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Preoperative Risk Assessment ◽  
Therapeutic Modalities ◽  
Optimal Drug ◽  
Patients With Diabetes

The frequency of diabetic complications remains high despite the development of improved therapeutic modalities. Macroangiopathy continues to bethe predominant complication while coronary heart disease is the main cause of mortality.This paper considers clinical features of diabetic patientswith coronary heart disease and critical limb ischemia; various aspects of optimal drug therapy, preoperative examination and diagnostics precedingvascular non-cardiac surgery; preoperative risk assessment; indications for coronary angiography and myocardial revascularization. The authors emphasizethe importance of development of algorithms for the treatment of patients with diabetes, critical limb ischemia, and coronary heart disease.

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