scholarly journals Critical limb ischaemia in a diabetic population from an Asian Centre: angiographic pattern of disease and 3-year limb salvage rate with percutaneous angioplasty as first line of treatment

2010 ◽  
Vol 6 (4) ◽  
Author(s):  
M Tan ◽  
U Pua ◽  
DES Wong ◽  
SJ Punamiya ◽  
GC Chua ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Limb Salvage Rate ◽  
Percutaneous Angioplasty ◽  
First Line ◽  
Diabetic Population ◽  
Salvage Rate

Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Anouk Grandjean ◽  
Katia Iglesias ◽  
Céline Dubuis ◽  
Sébastien Déglise ◽  
Jean-Marc Corpataux ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Hybrid Approach ◽  
Arterial Disease ◽  
Early Mortality ◽  
Secondary Patency ◽  
Limb Salvage Rate ◽  
Peripheral Arterial ◽  
Salvage Rate

Abstract. Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

Isolated limb perfusion for soft-tissue sarcoma and regional melanoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10579-10579
Author(s):  
Olfa Derbel ◽  
Eve-Marie Neidhardt ◽  
Adeline Stoltz ◽  
Pierre Meeus ◽  
Aurelien Dupre ◽  
...  
Keyword(s):  
Partial Response ◽  
Limb Salvage ◽  
Response Rate ◽  
Complete Response ◽  
Isolated Limb Perfusion ◽  
High Dose ◽  
Limb Salvage Rate ◽  
Limb Perfusion ◽  
Melanoma Patients ◽  
Salvage Rate

10579 Background: Isolated limb perfusion (ILP) represents a treatment option for locally advanced melanoma and sarcoma confined to a limb. The advantage of this approach is to deliver high-dose regional chemotherapy without serious systemic effects. However, the ILP technique involves a complex and invasive operative procedure, requiring accurate monitoring to avoid major local toxicity. Methods: From November 2004 to December 2011, 58 patients underwent IPL for unresectable soft tissu sarcoma (STS= 34) and advanced in-transit melanoma (n=24). IPLs were performed at mild hyperthermic conditions with 1-2 mg of TNF and 40-80 mg of melphalan (M) for arm and leg perfusions, respectively. The response rate, disease free intervals, overall survival, toxicity and limb salvage rate were evaluated. Results: Median age was 68 years (range: 29-91 years), with 58% of women. For sarcoma patients, median tumor size was 60 mm, 16 patients (47%) had a high grade STS. Twenty-one patients (61%) received IPL before definitive surgery. Eight patients finally underwent amputation, giving a long-term limb salvage of 77%. The overall response rate was 73.5% (Complete response rate 14.7%, partial response rate 58.8 %). For melanoma patients, 9 (38%) had an AJCC stage III disease, the median thickness of the primary tumor was 3.5 mm. A complete response was obtained in 21% of patients while 54% exhibited a partial response. The local and metastatic recurrence rates were similar between sarcoma and melanoma patients (41% and 33% respectively). All but one of the patients with non-operated sarcoma presented a local or metastatic relapse.There was no mortality and no systemic toxicity. Regional toxicity (Wieberdink scale) was: grade I (no reaction) 53 %, II (erythema, oedema) 34%, III (blistering) 8% and IV 3%. The median local relapse-free survival was 40 months in sarcoma group (26.6 months for non operated patients) and 10 months in melanoma one. The overall 3-years survival rate was 44% for sarcoma and 25% for melanoma patients. Conclusions: ILP induces a high tumour response rate, leads to a high limb salvage rate but is associated with an important recurrence rate. It provides a limb salvage alternative to amputation when local control is necessary.

scholarly journals Clinical Factors Determining Limb-salvage Rate of Osteosarcoma Patients

2011 ◽  
Vol 60 (4) ◽  
pp. 689-691
Author(s):  
Satoshi Nagano ◽  
Masahiro Yokouchi ◽  
Mitsuhiro Kaieda ◽  
Arisa Tsuru ◽  
Michihisa Zenmyo ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Limb Salvage Rate ◽  
Clinical Factors ◽  
Salvage Rate

Reconstructive Surgery in Gangrene

1976 ◽  
Vol 21 (4) ◽  
pp. 194-196 ◽  
Author(s):  
J. O'Connor ◽  
W. Reid ◽  
J. K. Watt ◽  
J. G. Pollock
Keyword(s):  
Limb Salvage ◽  
Reconstructive Surgery ◽  
Limb Salvage Rate ◽  
Reconstructive Arterial Surgery ◽  
Salvage Rate

The results of reconstructive arterial surgery in 113 critically ischaemic limbs during 1958 to 1972 are presented. There were 61 aorto-iliac reconstructions with 4 operative deaths (6.5%), resulting in a limb salvage rate of 75.4 per cent and 49 femoro-popliteal operations with 3 deaths (6.1%) and a limb salvage rate of 73.5 per cent.

scholarly journals Limb Salvage in Early Versus Delayed Revascularization of Acute Lower Limb Ischemia

2021 ◽  
Vol 15 (9) ◽  
pp. 2239-2241
Author(s):  
Salman Jamil Noor ◽  
Nauman Imtiaz ◽  
Wishal Shaukat ◽  
Athar Abbas Gilani ◽  
Palwasha Shahid ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Lower Limb ◽  
Limb Ischemia ◽  
P Value ◽  
Limb Salvage Rate ◽  
Lower Limb Ischemia ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Salvage Rate

Aim: To compare the limb salvage rate in early versus late presenting patients of Rutherford class IIB acute lower extremity ischemia undergoing revascularization. Study Design: Comparative/observational study Place and duration of study: Department of Surgery, CMH Peshawar from January 2019 to March 2021 Methodology: Twenty eight patients of both genders with ages 20 to 70 years presented with Rutherford class IIB acute lower limb ischemia were enrolled in this study. Patients were divided into two groups. Group I (presented after 6 hours of onset of symptoms) consisted of 20 patients and group II (presented within 6 hours of onset of symptoms) consisted of 8 patients. All the patients underwent femoral embolectomy. Limb salvage rate between both groups was examined at postoperative 3rd month. Data was analyzed by SPSS 24.0. P-value <0.05 was taken as significant. Results: There were 16(80%) male and 4(20%) females with mean age 50.52±11.74 years in group I, in group II 6(75%) were male and 2(25%) were females with mean age 50.08±10.94 years. No significant difference was observed between both groups regarding age and gender with p-value >0.05. In group I, limb salvage found in 19(95%) patients while in group II limb salvage found in 5(62.5%) patients, a significant difference was observed regarding limb salvage rate between both groups (p-value <0.05). Mortality rate was high in group II (delayed presentation) as compared to group I (12.5% Vs 0%) with p-value <0.05. Conclusion: The limb salvage rate was high in early presenting patients than late presenting patients with a significant difference. 30 days mortality rate and amputation rate were significantly high in delayed presentation as compared to early presented cases. Keywords: Acute lower limb ischemia, revascularization, limb salvage

scholarly journals Predictors of post-operative outcomes in patients with peripheral arterial disease and critical limb ischaemia: a systematic review and meta-analysis

2021 ◽  
Vol 55 (1) ◽  
pp. 69-76
Author(s):  
Lily P. Wu ◽  
Nadraj G. Naidoo ◽  
Olatunji O. Adetokunboh
Keyword(s):  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Graft Patency ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Wound Complications ◽  
Limb Ischaemia ◽  
Operative Outcomes ◽  
One Year ◽  
Peripheral Arterial

Background: A very small proportion (1%) of patients with peripheral artery disease (PAD) present with critical limb threatening ischaemia (CLTI) with poor prognosis. The present review showcased several pre-operative predictors and key post-operative outcomes. Identification of any modifiable predictors may impact positively on surgical outcomes.Design: PubMed/Medline, Google scholar and Cochrane databases were searched using terms such as “peripheral arterial disease” AND “critical limb ischemia,” “post-operative outcome,” AND “predictors of post-operative outcomes”. Search was for relevant English-language articles published between January 1997 and December 2007 Selected articles were screened first by title and abstract, and selection of full articles was based on relevance using our inclusion and exclusion criteria and quality ratings performed with the MINORS score.Results: The included studies were published between 1997 and 2007. Only six (6) articles out of a total of 2,114 were deemed suitable for analysis. Ambulatory recovery was >70% at six months, 86.7% and 70.0% at one year and five years respectively. Rate of local wound complications was between 12% and 24%. Reported limb salvage rates were >90% at six months, >70% at one year and 70.0-90.0% at five years. Primary graft patency rate at one year ranged from 63% and 76.6%. Gangrene, diabetes and impaired pre-operative ambulatory function are associated with more wound complications, low limb salvage, reduced graft patency and poor functional outcome.Conclusion: Pre-operative ambulatory status was the most important predictor of post-operative ambulatory recovery. Diabetes mellitus was an important risk factor for prolonged wound healing, local wound complications and major amputation.

scholarly journals Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

2021 ◽  
Author(s):  
Pablo S. Corona ◽  
Carla Carbonell-Rosell ◽  
Matías Vicente ◽  
Jordi Serracanta ◽  
Kevin Tetsworth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Local Flap ◽  
Tissue Loss ◽  
Functional Score ◽  
Limb Salvage Rate ◽  
Soft Tissue Loss ◽  
Infection Eradication ◽  
Salvage Rate

Abstract Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.

scholarly journals Penetrating Popliteal Vascular Injury: Surgical Management and Early Outcome During Current War in Taiz –Yemen

2021 ◽  
Author(s):  
Abudar Abdo AL ganadi ◽  
Naseem Saeed Al-Ossabi ◽  
Ismail Samer Alshameri ◽  
Mamon K Al-Mekhlafi ◽  
Maha A Hizam ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Vascular Injury ◽  
Graft Infection ◽  
Limb Loss ◽  
Team Approach ◽  
Vascular Injuries ◽  
Limb Salvage Rate ◽  
Graft Thrombosis ◽  
Salvage Rate

Abstract Background: Popliteal vascular injury remains a challenging entity, and carries the greatest risk of limb loss among lower extremity vascular injuries. We aim to review our experience with complex penetrating popliteal vascular injuries, thereby focusing on therapeutic challenges, and early outcomes.Methods: From September 2015 to December 2019, we managed total of 728 penetrating vascular injuries with 163 popliteal vascular injuries presented to Authority of Althawra hospital in Taiz. Of 125 patients, 103 patients were fulfilling the inclusion criteria. Variables were retrospectively collected included patient demographics, mechanism and type of injuries, limb ischemia time, type of vascular reconstruction, associated complications, limb salvage, and mortality.Results: 157 vascular reconstructions were performed for 103 patients with penetrating popliteal vascular injuries, the majority 94 (91.3%) were male. Mean age was 27.3 ± 12.3 years. Popliteal vascular injuries were the second most common accounting for 35% of lower extremity vascular injuries and 22.4% of the total vascular injuries. Nearly half 54 (52.4%) of patients sustained complex popliteal vascular injuries (arterial and venous injuries), 31 (30.1%) isolated arterial injuries, and 18 (17.5%) isolated venous injuries. Management of vascular injury was repaired by interposition graft in 68 (66%), end-to-end anastomosis in 16 (15.5%), and venous patch in 1(1%). Venous injury was repaired in 53 (51.4%) and ligated in 18 (17.5%). Less than 6 hours from injury to completed revascularization was achieved in 58 (56.3%) patients. The overall fasciotomy was 28 (27.2%) which significantly increased length of hospital stays (17 days vs 7 days, P= 0.0003). The overall limb-salvage rate in our study was 94.2%. During the study period, the most common complication was 14 (13.6%) wound infection, 14 (13.6%) graft thrombosis, 6 (5.8%) bleeding, 4 (3.9%) graft infection. Early limb loss occurred in 6 (5.8%) and the mortality rate was (1.9%).Conclusions: Wartime penetrating popliteal vascular injury is a real challenge. However, team approach and promptly vascular repair found to associate with a remarkable limb salvage rate of 94.2%. We advocate repair of arterial injury with vein graft as the treatment of choice whenever possible.

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