Four-Month Outcomes of Minimal-Dose Radiation Compared With Standard-Dose Radiation in Endovascular Peripheral Intervention for Acute Limb Ischemia and Critical Limb Ischemia

Purpose Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. Materials and methods We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Results Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. Conclusion CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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Abstract 275: Angioscore Balloon in the Treatment of Collagen Plug Occlusion and Acute Limb Ischemia: Case Report

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a275 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Pooja M Swamy ◽

Abeer Berry ◽

Mahir D Elder

Keyword(s):

Case Report ◽

Lower Extremity ◽

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Closure Device ◽

Acute Limb Ischemia ◽

Access Site ◽

Left Lower Extremity

BACKGROUND: Complications of the vascular access-site (VAS) are not uncommon. With the evolution of hemostatic techniques used in the access site closure, in the last two decades, the rate of VAS related complications has significantly reduced from 6% to 2%. However, they still remain to be an important cause of morbidity following catheterization procedures. The most common complications encountered with closure of VAS are hematoma formation, arterio-venous fistula, dissection, pseudo -aneurysm and limb ischemia. According to two meta-analyses, the incidences of these complications were very low. The incidence of collagen plug from an Angioseal(™) device causing acute leg ischemia is low and upon occurrence, the use of an Angioscore(™) balloon in successful revascularization has never been reported. CASE PRESENTATION: A 62-year-old male with known severe peripheral artery disease, diabetes mellitus, hypertension and hypercholesterolemia had a successful angioplasty of a 100% chronically occluded right superficial femoral artery (SFA) via the left common femoral artery. An Angioseal (™) closure device was used to achieve hemostasis. The patient was discharged home after an uneventful post procedural course. Two days later, he presented to the ER with a cold and numb left lower extremity. On exam, the left lower extremity had no palpable pulse from below right femoral artery, confirmed by Doppler. The extremity was cold to touch with decreased sensory perception. Patient was found to have critical left lower extremity ischemia. He was emergently taken for a selective left lower extremity angiogram using the right common femoral artery for access. Fragments of the closure device and a collagen plug causing a total occlusion of the left common femoral artery were found. After a pre-dilatation with a 4.0x 40 balloon under prolonged inflations, a lesion reduction from 100 % to 30% with a TIMI 0 to TIMI 3 flow was achieved using an Angioscore (™) 5.0x 40 balloon inflated at 10 atmospheres. Subsequently, using laser 2.0 atherectomy of the left common femoral artery was performed. Flow in the dorsalis pedis artery was confirmed with Doppler. DISCUSSION: The Angio-Seal(™) device has a polylactide and polyglycolide polymer anchor, a collagen plug and a suture contained within a carrier system. Hemostasis is achieved by compressing the arterial puncture site between the anchor and the collagen plug. With newer studies, it appears that the occurrence of critical limb ischemia from collagen plug is under recognized. We therefore, with this case report urge the physicians to be aware of this serious though rare complication of closure devise and also highlight the successful use of Angioscore (™) balloon in the emergent treatment of non-athermatous vascular occlusion causing critical limb ischemia.

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Neutrophil-to-lymphocyte Ratio Associated With an Increased Risk of Mortality in Patients With Critical Limb Ischemia

10.21203/rs.3.rs-243462/v1 ◽

2021 ◽

Author(s):

Min-I Su ◽

Cheng-Wei Liu

Keyword(s):

Critical Limb Ischemia ◽

Characteristic Curve ◽

Limb Ischemia ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Acute Limb Ischemia ◽

Lymphocyte Ratio ◽

Increased Risk ◽

Prognostic Prediction ◽

Related Mortality

Abstract Purpose: Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI.Materials and methods: We retrospectively enrolled consecutive CLI patients during 1/1/2013–12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality, and major adverse cardiovascular events (MACEs) and limb events (MALEs).Results: Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; BMI, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with an NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P=0.008), and MALE (28.1% vs. 13.0%, P=0.021) rates than those with an NLR<8. In multivariate logistic regression, an NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075-13.47, P<0.001) mortality, and an NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292-6.088, P=0.009).Conclusion: CLI patients with high NLRs had higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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Successful limb salvage by endovascular treatment for critical limb ischemia subsequent to acute limb ischemia

Oxford Medical Case Reports ◽

10.1093/omcr/omz103 ◽

2019 ◽

Vol 2019 (10) ◽

Author(s):

Tetsuya Nomura ◽

Satoshi Tasaka ◽

Kenshi Ono ◽

Yu Sakaue ◽

Naotoshi Wada ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Arterial Disease ◽

Major Amputation ◽

Sudden Onset ◽

Acute Limb Ischemia ◽

Below The Knee ◽

Tibial Arteries ◽

Chronic Critical Limb Ischemia ◽

Peripheral Arterial

Abstract Recently, there have been increasing opportunities to treat patients with peripheral arterial disease. Of those patients, both pathological conditions, such as acute limb ischemia (ALI) and chronic critical limb ischemia (CLI), are closely associated with high risks of major amputation, disability and death. We encountered a very rare case of CLI subsequent to ALI. An 83-year-old male showed the sudden onset of ALI, probably due to thromboembolism from an abdominal aortic aneurysm during an operation for gastric cancer. The patient was referred to another hospital for Fogarty thrombectomy. About 1 month after ALI onset, necrosis of the left first toe gradually progressed. On angiography of the left lower limb, we noted occlusions of both anterior and posterior tibial arteries. Then, we successfully conducted balloon angioplasty for the below-the-knee arteries. Thereby, favorable blood flow was achieved, which led to successful wound healing without amputations.

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Characteristics and outcomes of patients with peripheral artery disease undergoing endovascular revascularization: A community hospital perspective

Vascular ◽

10.1177/1708538120958858 ◽

2020 ◽

pp. 170853812095885

Author(s):

S Michael Gharacholou ◽

Zhuo Li ◽

Jonathan J Uy ◽

Lee H Eckstein ◽

Carolyn R Flock ◽

...

Keyword(s):

Intermittent Claudication ◽

Peripheral Artery Disease ◽

Critical Limb Ischemia ◽

Community Hospital ◽

Limb Ischemia ◽

Study Cohort ◽

Acute Limb Ischemia ◽

Peripheral Artery ◽

Endovascular Revascularization ◽

Artery Disease

Background There are limited data on outcomes for patients with peripheral artery disease undergoing endovascular revascularization by multi-disciplinary teams in a community hospital setting. Methods From January 2015 through December 2015, we assembled a multi-disciplinary program comprised of cardiologists, surgeons, radiologists, nurses, and administrative staff for managing patients with peripheral artery disease undergoing endovascular revascularization. Demographic, procedural, and outcomes data were collected with use of a template from the Society for Vascular Surgery Vascular Quality Initiative database. We compared characteristics and outcomes of patients with intermittent claudication and critical limb ischemia. We used Kaplan–Meier methods to estimate the rate of overall survival and freedom from rehospitalization between groups. Results After excluding patients with acute limb ischemia ( n = 5), peripheral intervention to the upper extremity ( n = 6), or abdominal aorta ( n = 11), there were 82 patients in the study cohort; 45 had intermittent claudication and 37 had critical limb ischemia. Baseline and procedural characteristics were similar between groups, although critical limb ischemia patients were more likely to have hyperlipidemia (75.7% vs. 53.3%, P = .42). Procedural success was achieved in 91.3% of cases. Actionable access site bleeding occurred in 2.4% of patients. High rates of aspirin (91.5%) and statin (87.8%) were noted at discharge. After two years of post endovascular revascularization, survival was 57.5% for critical limb ischemia patients and 94.4% for intermittent claudication patients ( P < .001). Freedom from rehospitalization was 32.7% for critical limb ischemia patients and 83.5% for intermittent claudication patients ( P < .001). Conclusions We found that favorable outcomes may be achieved with a multi-disciplinary peripheral artery disease program at community hospitals. The incorporation of quality improvement practices may further help to develop standardized and regionalized approaches to care delivery for patients with peripheral artery disease.

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Management of COVID-19-related Arterial Thrombosis Leading to Acute Limb-threatening Ischemia

10.1101/2021.03.20.21252888 ◽

2021 ◽

Author(s):

waqas raza ◽

omer ehsan

Keyword(s):

Critical Limb Ischemia ◽

Arterial Thrombosis ◽

Clinical Evidence ◽

Initial Period ◽

Case Series ◽

Limb Ischemia ◽

Vascular Involvement ◽

Low Molecular Weight ◽

Acute Limb Ischemia ◽

Patient Groups

Objective: Examine the occurrence and clinical outcomes of arterial thrombosis leading to limb- threatening ischemia in patients with coronavirus-2019 (COVID-19). Study design: Prospective, descriptive case series. Patients and Methods: Forty-four patients with COVID-19 infection presenting with critical limb ischemia were managed between March 2020 and December 2020. The patients were divided into three groups based on the mode of presentation: 1) those who had been admitted; 2) those presenting in the emergency department; and 3) those presenting to vascular clinics. Clinical evidence suggesting limb ischemia was evaluated with computerized tomographic angiogram. Vascular care was designed according to the need of individual patients, through anticoagulation, revascularization by thrombo-embolectomy, or bypass grafting and amputation. Results: Ten major amputations and 4 deaths (all in patients admitted) occurred among the 44 patients (9.1%). Most patients (32/44) were males, mean age was 55, and limb ischemia occurred among patients as young as 29. The initial period of ischemia was often not appreciated by patients and physicians. Critical limb ischemia was often not correlated with the severity of COVD symptoms: of 17 patients who presented through the emergency room with limb-threatening ischemia, 10 (58.9%) were asymptomatic for respiratory and general symptoms. Comorbidities were common among all 3 patient groups (26/44; 59%). Anticoagulants did not consistently prevent thromboembolic events since all admitted patients were receiving low molecular weight heparin. The rate of revascularization was lower in this population than in the general population with similar limb ischemia. Conclusion: Acute limb ischemia in patients with COVID-19 is a vascular emergency that can result in limb loss and even death. The severity of respiratory infection and other symptoms of COVID often are not consistent with the severity and level of vascular involvement. Timely recognition and tailored intervention is needed to save limbs in this population.

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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