scholarly journals Infrapopliteal Artery Occlusive Disease: An Overview of Vessel Preparation and Treatment Options

2020 ◽  
Vol 9 (10) ◽  
pp. 3321
Author(s):  
Srini Tummala ◽  
Ayush Amin ◽  
Ankit Mehta
Keyword(s):  
Treatment Options ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Occlusive Disease ◽  
Tissue Loss ◽  
Infrapopliteal Artery ◽  
Life Threatening ◽  
Healing Of Wounds ◽  
Prevalence Of Diabetes Mellitus ◽  
Vessel Preparation

Critical limb ischemia (CLI) is defined as chronic rest pain and/or the presence of tissue loss (ulcers or gangrene) in the lower extremities secondary to ischemia. CLI is a limb and potentially life-threatening disease associated with a poor prognosis with only 50% of patients being able to preserve both limbs within 12 months of diagnosis. CLI related to diabetes is often more extensive with multi-level long segmental arterial disease resulting in a 5–30-fold increased rate of amputation. As the incidence and prevalence of diabetes mellitus increases within our aging society, the rate of infrapopliteal artery occlusive disease (IPOD) and the need for intervention rises with it. The aim of this manuscript is to provide the reader with an overview of the various devices available for vessel preparation (VP) and treatment of IPOD in order to optimize patency rates, symptom resolution, healing of wounds, and minimize complications.

Health related quality of life in patients with critical limb ischemia

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 78-88 ◽  
Author(s):  
Lawall ◽  
Zemmrich ◽  
Bramlage ◽  
Amann
Keyword(s):  
Quality Of Life ◽  
Critical Limb Ischemia ◽  
Treatment Options ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Peripheral Arterial

Critical limb ischemia (CLI) is the terminal stage of peripheral artery disease. Research in recent years has been largely focussed on treatment options such as bypass surgery / endovascular treatment, surgery / primary amputation and additional benefits of supportive pharmacotherapy. Despite this plethora of treatment options, however, patients continue to have a reduced health related quality of life (HRQoL). Aim of the present work was to review the available evidence of improvement of HRQoL with regard to different treatment options. We found that a number of clinical studies have been conducted using HRQoL measures mostly as secondary outcomes in patients with CLI and other less severe forms of peripheral arterial disease. The studies demonstrate a consistent improvement of HRQoL over baseline within the first few months after the intervention. Prostaglandins, but no other pharmacotherapies, appear to be effective in patients without an option for revascularization. Due to a largely differing patient population under investigation and the different degrees of disease progression it appears difficult however to compare different treatment options with respect to their impact on HRQoL. HRQoL improvement as a predefined endpoint of novel therapeutic approach studies should be considered more consequently.

Coronary arterial bypass surgery with beating heart in a patient with heparin-induced thrombocytopenia: Usage of thrombin inhibitor (Lepirudin; r-hirudin)

Open Medicine ◽  
2010 ◽  
Vol 5 (2) ◽  
pp. 150-153
Author(s):  
Bilgehan Erkut ◽  
Necip Becit ◽  
Serpil Diler ◽  
Munacettin Ceviz
Keyword(s):  
Bypass Surgery ◽  
Treatment Options ◽  
Arterial Disease ◽  
Thrombin Inhibitor ◽  
Heparin Induced Thrombocytopenia ◽  
Arterial Bypass ◽  
Coronary Arterial Disease ◽  
Prevention Of Thrombosis ◽  
Life Threatening ◽  
History Of

AbstractOne of the most important adverse drug reactions that physicians encounter is the life-threatening prothrombotic syndrome known as heparin-induced thrombocytopenia (HIT). In patients with a history of heparin-induced thrombocytopenia and coronary arterial disease, alternative anticoagulatory regimens are needed during cardiac surgery for prevention of thrombosis. Treatment options for such patients now generally include the use of alternative anticoagulants such as lepirudin, bivalirudin, argatroban or danaparoid. In this article, we present a case where heparin-induced thrombocytopenia was properly performed coronary arterial bypass grafting by using lepirudin. (This sentence is confusing)

Current Assessment of Endovascular Therapy for Infrainguinal Arterial Occlusive Disease in Patients with Diabetes

2010 ◽  
Vol 100 (5) ◽  
pp. 424-428 ◽  
Author(s):  
Daniel M. Ihnat ◽  
Joseph L. Mills
Keyword(s):  
Endovascular Therapy ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Arterial Occlusive Disease ◽  
Occlusive Disease ◽  
Data Limitations ◽  
Patients With Diabetes ◽  
Current Assessment ◽  
Peripheral Arterial

Endovascular therapy has increasingly become the initial clinical option for the treatment of lower-extremity peripheral arterial occlusive disease not only for patients with claudication but also for those with critical limb ischemia. Despite this major clinical practice paradigm shift, the outcomes of endovascular therapy for peripheral arterial disease are difficult to evaluate and compare with established surgical benchmarks because of the lack of prospective randomized trials, incomplete characterization of indications for intervention, mixing of arterial segments and extent of disease treated, the multiplicity of endovascular therapy techniques used, the exclusion of early treatment failures, crossover to open bypass during follow-up, and the frequent lack of intermediate and long-term patency and limb salvage rates in life-table format. These data limitations are especially problematic when one tries to assess the outcomes of endovascular therapy in patients with diabetes. The purpose of the present article is to succinctly review and objectively analyze available data regarding the results of endovascular therapy in patients with diabetes. (J Am Podiatr Med Assoc 100(5): 424–428, 2010)

scholarly journals Endovascular Intervention for Critical Lower Limb Ischemia; a Review of Outcomes after Percutaneous Transluminal Angioplasty using Balloon Catheter

2018 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Parviz Farshid ◽  
Nasrin Noori ◽  
Lutz Bluemel ◽  
Marion Berndt ◽  
Alexander Mundinger
Keyword(s):  
Lower Limb ◽  
Treatment Options ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Patient Characteristics ◽  
Transluminal Angioplasty ◽  
Life Threatening ◽  
Associated Risk Factors ◽  
Percutaneous Transluminal

<p><em>Peripheral </em><em>A</em><em>rterial </em><em>D</em><em>isease (PAD) of lower limb with variable morbidity can be manifested as an asymptomatic, sever or life threatening disease. It is also a major cause of disability in many cases. </em></p><p><em>The management of patients with PAD can be defined from a number of different treatment options in the terms of conservative-, interventional- and surgical therapies.</em></p><p><em>Percutaneous </em><em>T</em><em>ransluminal </em><em>A</em><em>ngioplasty (PTA) using balloon catheter as a revascularization procedure has been used with acceptable outcomes. The method results are highlighted with comparable success—and patency rates, low complications, improving the quality of life and survival.</em><em> We reviewed published studies and found that PTA is an appropriate alternative in the management of patient with </em><em>C</em><em>ritical </em><em>L</em><em>imb </em><em>I</em><em>schemia (CLI). Better outcomes have been achieved using </em><em>D</em><em>rug </em><em>C</em><em>oated </em><em>B</em><em>alloons (DCB) as well as </em><em>D</em><em>rug </em><em>E</em><em>luting </em><em>S</em><em>tents (DES). Atherectomy remains with controversial results. </em><em>Patient characteristics, the presence of associated risk factors, characteristics of lesions and accompanied cardiopulmonary disease may be the main challenges to use of these treatment options in the future.</em></p>

scholarly journals Critical Limb Ischemia In a Diabetes Mellitus Patient with Atrial Fibrilation

2020 ◽  
Vol 1 (2) ◽  
pp. 25
Author(s):  
Caesar Lagaliggo Givani ◽  
Hermina Novida
Keyword(s):  
Diabetes Mellitus ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Diabetes Mellitus Patient ◽  
Arterial Disease ◽  
Clinical Syndrome ◽  
Tissue Loss ◽  
Ischemic Pain ◽  
Atrial Fibrilation ◽  
Peripheral Arterial

Critical Limb Ischemia (CLI) is a clinical syndrome in the form of ischemic pain, especially at rest or a tissue loss condition, such as an ulcer or gangrene that does not heal, associated with Peripheral Arterial Disease (PAD). Diabetes mellitus (DM) accelerates atherosclerosis and becomes one of the risks of PAD. It is also known to accelerate the worsening of PAD with a 4x greater risk of developing CLI compared to patients without DM. At the other side, 60-95% of patients who are operated on as a result of limb ischemia are diagnosed with atrial fibrillation (AF). This paper is a case report regarding a patient with CLI as a complication of DM and AF.

New techniques for endovascular treatment of peripheral artery disease with focus on chronic critical limb ischemia

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Zeller ◽  
Sixt ◽  
Rastan
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Limb Loss ◽  
Infrapopliteal Artery ◽  
Below The Knee ◽  
Chronic Critical Limb Ischemia ◽  
Artery Disease ◽  
Peripheral Arterial

Chronic critical limb ischemia (CLI) represents the most advanced stage of peripheral arterial disease. CLI is associated with a high risk for limb loss and revascularization, either by surgical or endovascular means, is absolutely mandatory. With traditional techniques such as balloon angioplasty, limb salvage was reported in 80 to 90%. However, in case of failed revascularization attempt, limb loss was 40 to 50% and mortality approximately 20%. This review summarizes new developments in endovascular techniques which increase the acute and chronic success rate of endovascular procedures and therefore potentially further improve limb salvage rates. Special crossing and re-entry devices designed for femoro-popliteal application may even facilitate recanalization of long chronic occlusions. Improved stent design, atherectomy devices and drug coated balloons improve patency rates and may result in improved wound healing rates. Moreover, downsizing the catheter tools for infrapopliteal artery disease opens new horizons also for the treatment of complex below-the-knee lesions representing an increasing patient population due to the increasing prevalence of diabetes and end-stage renal failure.

scholarly journals Delayed Yet Successful Mechanical Thrombectomy for Phlegmasia Cerulea Dolens in a Limb with Severe Arterial Disease and May-Thurner Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ahmad Said ◽  
Phillip Kraft ◽  
Luay Sayed
Keyword(s):  
Spinal Surgery ◽  
Mechanical Thrombectomy ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Iliac Vein ◽  
Percutaneous Mechanical Thrombectomy ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Life Threatening Complication ◽  
Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens (PCD) is a rare but life-threatening complication of acute deep venous thrombosis that lacks consensus regarding the approach to management. We present a case of PCD developing shortly after a spinal surgery and manifesting as acute swelling and discoloration in a leg with existing severe atherosclerotic arterial disease. The patient’s critical limb ischemia was completely and rapidly reversed by percutaneous mechanical thrombectomy using the ClotTriever device despite a delay in treatment. An underlying iliac vein compression “May-Thurner” syndrome was discovered using intravascular ultrasound and treated with angioplasty. This case identifies mechanical thrombectomy using the ClotTriever system as a possible effective and safe treatment for PCD.

scholarly journals Clinical study of peripheral arterial occlusive disease of lower extremities

2018 ◽  
Vol 5 (4) ◽  
pp. 1388
Author(s):  
Prasad C. ◽  
Santosh Nayak K.
Keyword(s):  
Peripheral Arterial Disease ◽  
Peripheral Arterial Occlusive Disease ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Arterial Occlusive Disease ◽  
Occlusive Disease ◽  
Age Group ◽  
History Of ◽  
Peripheral Arterial

Background: Peripheral arterial occlusive disease or commonly known as peripheral arterial disease (PAD) comprises those entities which result in obstruction to blood flow in the arteries, exclusive of the coronary and intracranial vessels and the term is usually applied to disease involving the arteries of lower extremity. Peripheral arterial disease is an important manifestation of atherosclerosis involving the arteries of legs. Vascular surgeons continue to encounter complications of atherosclerosis as their most common clinical challenge. Objective of this study was to know the various etiologies and different clinical presentation of Peripheral arterial occlusive disease.Methods: This was a cross sectional observational study of 50 cases diagnosed with Peripheral Arterial disease of the lower extremities, done during the period from January 2013 to June 2014 among the Patients with Peripheral Arterial disease of the lower extremities admitted to surgical wards of SCBMCH, Cuttack.Results: All the cases in the present study fall under the category of chronic lower limb ischemia and no cases of acute limb ischemia. Majority of the cases in atherosclerosis were above the age of 50 years, while in the TAO group majority belong to the age group between 31 to 50 years. TAO was usually limited to the distal part of the limb. All patients with TAO had a history of smoking and 61% of atherosclerotic patients gave history of smoking.Conclusions: TAO and Atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. TAO presented at a younger age group whereas atherosclerosis presented in the older age group.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 201-212 ◽  
Author(s):  
Birgit Linnemann ◽  
Matthias Erbe
Keyword(s):  
Quality Of Life ◽  
Angiotensin Receptor Blockers ◽  
Raynaud’S Phenomenon ◽  
Treatment Options ◽  
Raynaud's Phenomenon ◽  
Tissue Loss ◽  
Receptor Antagonists ◽  
Skin Ulcers ◽  
Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

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