Clinical significance of perioperative changes in ankle-brachial index with regard to extremity-related outcome in non-diabetic patients with critical limb ischemia

Ten to 25 % of all diabetic patients will develop a lower limb ulcer in their lifetime. Ankle-brachial index is not accurate in diabetic patients .The resting systolic toe pressure (TP) may be a measure of small arterial function within the periphery. Objective: The purpose of this article is to consider the effect of below-knee angioplasty on systolic toe pressure changes in diabetic patients with critical limb ischemia. Methods/Materials: In this prospective study 114 patients, were included who satisfied the inclusion criteria: patients with critical limb ischemia in the form of tissue loss(ulcer or gangrene) or rest pain, presence of below-knee vessel lesion, and absence of proximal vessels lesion or stenosis. We evaluated the effect of angioplasty on toe pressure of diabetic patients and compared them to non-diabetics. Results: Among 114 patients, 78(68/4%) were men and 36(31/6%) were women. Diabetic patients were 96(84/2%) and non-diabetics were 18 (15.8%). In Paired T-Test analysis we compared toe pressure values of each patient before and after angioplasty and it was a significant difference in both Diabetic and non-diabetic groups.(0.00 and 0.008 respectively). The mean of systolic toe pressure before angioplasty had no difference between the 2 groups (PValue: 0.13). The mean of toe pressure in non-diabetic patients was 42±31.9 and in diabetics was 25.6 and after angioplasty, the mean of toe pressure raised 44.3 in non-diabetics and 19.4 in diabetics. Conclusions: Systolic toe pressure is a valuable tool to evaluate and predict angioplasty effect on below-knee ulcers especially in diabetic patients. Keywords: Below knee Angioplasty, Systolic toe pressure, Diabetes

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Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Vascular ◽

10.1177/17085381211029819 ◽

2021 ◽

pp. 170853812110298

Author(s):

Görkem Yiğit

Keyword(s):

Critical Limb Ischemia ◽

Bypass Graft ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Rotational Atherectomy ◽

Total Occlusion ◽

The Mean ◽

Knee Pathology ◽

Drug Coated Balloon

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.

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Long-Term Clinical Outcomes of Infrapopliteal Drug-Eluting Stent Placement for Critical Limb Ischemia in Diabetic Patients

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2015.06.034 ◽

2015 ◽

Vol 26 (10) ◽

pp. 1423-1430 ◽

Cited By ~ 11

Author(s):

Stavros Spiliopoulos ◽

Vasiliki Theodosiadou ◽

Konstantinos Katsanos ◽

Panagiotis Kitrou ◽

George C. Kagadis ◽

...

Keyword(s):

Clinical Outcomes ◽

Critical Limb Ischemia ◽

Stent Placement ◽

Limb Ischemia ◽

Drug Eluting Stent ◽

Diabetic Patients ◽

Drug Eluting

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Use of Tapered Balloons to Recanalize Occluded Below-the-Knee Arteries in Diabetic Patients with Critical Limb Ischemia

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.08.015 ◽

2016 ◽

Vol 31 ◽

pp. 105-110

Author(s):

Nicola Troisi ◽

Leonardo Ercolini ◽

Emiliano Chisci ◽

Piefrancesco Frosini ◽

Clara Pigozzi ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Below The Knee

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Myocardial revascularization in diabetic patients presenting with critical limbischemia

Diabetes Mellitus ◽

10.14341/2072-0351-6053 ◽

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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Cell therapy of critical limb ischemia in diabetic patients – State of art

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2017.02.028 ◽

2017 ◽

Vol 126 ◽

pp. 263-271 ◽

Cited By ~ 4

Author(s):

Michal Dubský ◽

Alexandra Jirkovská ◽

Robert Bem ◽

Andrea Nemcová ◽

Vladimira Fejfarová ◽

...

Keyword(s):

Cell Therapy ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

State Of Art

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Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI

British Journal of Radiology ◽

10.1259/bjr.20210215 ◽

2021 ◽

pp. 20210215

Author(s):

Nikolaos Galanakis ◽

Thomas G Maris ◽

Georgios Kalaitzakis ◽

Nikolaos Kontopodis ◽

Nikolas Matthaiou ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Percutaneous Transluminal Angioplasty ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Transluminal Angioplasty ◽

Lower Limbs ◽

Intravoxel Incoherent Motion ◽

Healthy Individuals ◽

Imaging Protocol ◽

Percutaneous Transluminal

Objectives: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. Methods: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. Results: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10−5 mm2/s to 331.51 ± 31 10−5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10−5 mm2/s vs 332.47 ± 22.95 10−5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64–0.93). Conclusions: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. Advances in knowledge: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.

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Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

The American Surgeon ◽

10.1177/000313480507100605 ◽

2005 ◽

Vol 71 (6) ◽

pp. 474-480 ◽

Cited By ~ 10

Author(s):

Susan M. Trocciola ◽

Rabih Chaer ◽

Rajeev Dayal ◽

Stephanie C. Lin ◽

Naveen Kumar ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Clinical Success ◽

Ankle Brachial Index ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Arterial Disease ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Endovascular Interventions

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.

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