scholarly journals Endovascular Therapy for Critical Limb Ischemia Accompanied with Severe Aortic Valve Stenosis: A Case Report

2013 ◽  
Vol 53 (February) ◽  
pp. 33-38
Author(s):  
Akihiro Nakamura ◽  
Akiyo Abe ◽  
Yuta Kagawa ◽  
Katsuya Kohzu ◽  
Kenjiro Sato ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia

Predictors of non-healing in patients with critical limb ischemia and tissue loss following successful endovascular therapy

2014 ◽  
Vol 85 (5) ◽  
pp. 850-858 ◽  
Author(s):  
Norihiro Kobayashi ◽  
Keisuke Hirano ◽  
Masatsugu Nakano ◽  
Toshiya Muramatsu ◽  
Reiko Tsukahara ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Tissue Loss

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

2021 ◽  
pp. 153857442110264
Author(s):  
Hee Korleski ◽  
Laura DiChiacchio ◽  
Luiz Araujo ◽  
Michael R. Hall
Keyword(s):  
Case Report ◽  
General Anesthesia ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Treatment Modality ◽  
Conventional Treatment ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

scholarly journals Co-Existence of Severe Coarctation of the Aorta and Aortic Valve Stenosis in a 65-Year-Old Woman: A Case Report

2014 ◽  
Vol 20 (Supplement) ◽  
pp. 750-753 ◽  
Author(s):  
Daisuke Onohara ◽  
Aiko Sato ◽  
Yuichi Tasaki ◽  
Takafumi Yamada
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Coarctation Of The Aorta

scholarly journals No Association of Diabetic Duration or Insulin Use with the Prognosis of Critical Limb Ischemia after Endovascular Therapy

2011 ◽  
Vol 18 (12) ◽  
pp. 1102-1109 ◽  
Author(s):  
Mitsuyoshi Takahara ◽  
Hideaki Kaneto ◽  
Osamu Iida ◽  
Naoto Katakami ◽  
Fumie Sakamoto ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Insulin Use

scholarly journals Functional prognosis of critical limb ischemia and efficacy of restoration of direct flow below the ankle

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 38-45
Author(s):  
Tadashi Furuyama ◽  
Toshihiro Onohara ◽  
Ryosuke Yoshiga ◽  
Keiji Yoshiya ◽  
Yutaka Matsubara ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Ulcer Healing ◽  
Therapy Group ◽  
Limb Ischemia ◽  
Direct Flow ◽  
Free Survival ◽  
Ambulatory Status ◽  
Bypass Group ◽  
One Year

Objective Patients with critical limb ischemia have serious systemic comorbidities and are at high risk of impairment of limb function. In this study, we assessed the prognostic factors of limbs after revascularization. Methods In this retrospective single-center cohort study, from April 2008 to December 2012, we treated 154 limbs of 121 patients with critical limb ischemia by the endovascular therapy-first approach based on the patients’ characteristics. The primary end point was amputation-free survival. Secondary end points were patency of a revascularized artery, major adverse limb events, or death. Furthermore, we investigated the ambulatory status one year after revascularization as prognosis of limb function. Results Endovascular therapy was performed in 85 limbs in 65 patients as the initial therapy (endovascular therapy group) and surgical reconstructive procedures (bypass group) were performed in 69 limbs in 56 patients. Early mortality within 30 days was not observed in either group. The primary patency rate was significantly better in the bypass group than in the endovascular therapy group ( p < 0.0001). Furthermore, the secondary patency rate was similar between the two groups ( p = 0.0096). There were no significant differences in amputation-free survival and major adverse limb event between the two groups. Univariate analysis showed that ulcer healing ( p < 0.0001), no hypoalbuminemia ( p = 0.0019), restoration of direct flow below the ankle ( p = 0.0219), no previous cerebrovascular disease ( p = 0.0389), and Rutherford 4 ( p = 0.0469) were predictive factors for preservation of ambulatory status one year after revascularization. In multivariate analysis, ulcer healing ( p < 0.0001) and restoration of direct flow below the ankle ( p = 0.0060) were significant predictors. Conclusions Ulcer healing and restoration of direct flow below the ankle are independently associated with prognosis of limb functions in patients who undergo infrainguinal arterial reconstruction.

Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Grant W Reed ◽  
Negar Salehi ◽  
Pejman Raeisi-Giglou ◽  
Umair Malik ◽  
Rami Kafa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Proportional Hazards ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Kaplan Meier

Introduction: There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy. Methods: In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis. Results: A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005). Conclusions: A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.

SARS-CoV-2 Virus Infection-Related Arterial Thromboembolism Leading to Critical Limb Ischemia and Amputation

2021 ◽  
Author(s):  
Jenna Smith ◽  
Aleem Mirza ◽  
Jesse Manunga ◽  
Nedaa Skeik
Keyword(s):  
Case Report ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Thromboembolic Events ◽  
Arterial Thromboembolism ◽  
Abdominal Aortic ◽  
Aortic Thrombus ◽  
Venous Thromboembolic Events ◽  
Increase Risk ◽  
Venous Thromboembolic

AbstractCOVID-19 infection has been shown to increase risk for thromboembolism. With most studies reporting mainly venous thromboembolic events, there is a lack of literature regarding the incidence of arterial thromboses in patients with COVID-19 infection. We report a dramatic case of a 55-year-old male with confirmed COVID-19 infection who presented with acute left critical limb ischemia leading to amputation as a result of thromboembolism from a distal abdominal aortic thrombus. Our case report contributes to the limited body of literature on COVID-19-related arterial thromboembolism. The patient consented to publish this case.

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