scholarly journals Bovine Mesenteric Vein Graft (ProCol) in Critical Limb Ischaemia with Tissue Loss and Infection

2004 ◽  
Vol 27 (3) ◽  
pp. 251-253 ◽  
Author(s):  
J Schmidli ◽  
H Savolainen ◽  
G Heller ◽  
M.K Widmer ◽  
U Then-Schlagau ◽  
...  
Keyword(s):  
Vein Graft ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Mesenteric Vein

scholarly journals Toll-Like Receptors in Ischaemia and Its Potential Role in the Pathophysiology of Muscle Damage in Critical Limb Ischaemia

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Hemanshu Patel ◽  
Sidney G. Shaw ◽  
Xu Shi-Wen ◽  
David Abraham ◽  
Daryll M. Baker ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Muscle Damage ◽  
Potential Role ◽  
Arterial Disease ◽  
Severe Form ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Toll Like Receptors ◽  
Skeletal Muscle Damage

Toll-like receptors (TLRs) are key receptors of the innate immune system which are expressed on immune and nonimmune cells. They are activated by both pathogen-associated molecular patterns and endogenous ligands. Activation of TLRs culminates in the release of proinflammatory cytokines, chemokines, and apoptosis. Ischaemia and ischaemia/reperfusion (I/R) injury are associated with significant inflammation and tissue damage. There is emerging evidence to suggest that TLRs are involved in mediating ischaemia-induced damage in several organs. Critical limb ischaemia (CLI) is the most severe form of peripheral arterial disease (PAD) and is associated with skeletal muscle damage and tissue loss; however its pathophysiology is poorly understood. This paper will underline the evidence implicating TLRs in the pathophysiology of cerebral, renal, hepatic, myocardial, and skeletal muscle ischaemia and I/R injury and discuss preliminary data that alludes to the potential role of TLRs in the pathophysiology of skeletal muscle damage in CLI.

scholarly journals 1529 Management of A Rare Case of Bilateral Persistent Sciatic Artery Aneurysms Causing Critical Limb Ischaemia With Staged Embolisation And Femoropopliteal Bypass: A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Lau ◽  
C MacLeod ◽  
A Vesey ◽  
P F Lau ◽  
P Ghibu
Keyword(s):  
Case Report ◽  
Symptomatic Relief ◽  
Late Presentation ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Femoropopliteal Bypass ◽  
Contralateral Limb ◽  
Ct Angiogram ◽  
Internal Iliac

Abstract Introduction Bilateral persistent sciatic arteries (PSA) are rare with an incidence of 0.001%. They represent a persistence of the embryonic axial limb circulation via the internal iliac artery. Normally the PSA involutes and is replaced by the superficial femoral artery (SFA). Failure of regression leads to a PSA with varying configurations. Up to 50% of PSAs are aneurysmal and may present with rupture or acute/chronic ischaemia, typically at 40-50 years old. Case Report A 74-year-old female presented with limb threatening ischaemia manifesting with rest pain, sensory deficit and early tissue loss (Rutherford IIb). She had a left femoral pulse but absent pulses distally. Pedal pulses were noted on the contralateral limb. CT angiogram revealed bilateral complete PSAs with incomplete hypoplastic SFAs (Pillet-Gauffre 2a). Both PSAs were aneurysmal; the left PSA was acutely occluded distal to the aneurysm. She underwent staged intervention with percutaneous embolisation of the left PSA, followed by femoropopliteal bypass. She was discharged six days later with good symptomatic relief at one month follow up. We are planning to treat the contralateral limb in a similar manner electively in case complications occur. Conclusions PSAs are commonly associated with limb threatening complications but due to their rarity there are limited reports on the management of this condition. Here we can report a good outcome in a late presentation using staged embolisation with open reconstruction.

Stem cell and progenitor cell therapy in peripheral artery disease

2010 ◽  
Vol 103 (04) ◽  
pp. 696-709 ◽  
Author(s):  
Peter Bramlage ◽  
Berthold Amann ◽  
Holger Lawall
Keyword(s):  
Stem Cell ◽  
Cell Therapy ◽  
Peripheral Artery Disease ◽  
Mononuclear Cells ◽  
Ankle Brachial Index ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Artery ◽  
Artery Disease

SummaryAtherosclerotic peripheral artery disease (PAD) is a common manifestation of atherosclerosis. The occlusion of large limb arteries leads to ischaemia with claudication which can progress to critical limb ischaemia (CLI) with pain at rest, and to tissue loss. At present, common therapy for CLI is either surgical or endovascular revascularisation aimed at improving blood flow to the affected extremity. However, major amputation and death are still frequent complications. Exploring new strategies for revascularisation of ischaemic limbs is thus of major importance. Bone marrow (BM)-derived stem and progenitor cells have been identified as a potential new therapeutic option to induce therapeutic angiogenesis. Encouraging results of preclinical studies have rapidly led to several small clinical trials, in which BM-derived mononuclear cells were administered to patients with limb ischaemia. Clinical benefits were reported from these trials including improvement of ankle-brachial index (ABI), transcutaneous partial pressure of oxygen (TcPO2), re-duction of pain, and decreased need for amputation. Nonetheless, large randomised, placebo-controlled, double-blind studies are necessary and currently ongoing (BONMOT-CLI, JUVENTUS and NCT00498069). Further research relates to the optimal cell type and dosage, the isolation method, the role of colony-stimulating factors, administration route, and the supportive stimulation of cells with reduced functioning due to advanced PAD. Autologous stem cell therapy for ischaemic peripheral disease seems to be a promising new tool for the treatment of severe limb ischaemia. Preliminary evidence has established its safety, feasibility and effectiveness on several important endpoints. Several large endpoints studies are underway to further consolidate this evidence.

Clinical outcomes from profundoplasty performed as a sole procedure for revascularization in critically ischaemic limbs

Vascular ◽  
2020 ◽  
pp. 170853812096390
Author(s):  
Mohamed Elsharkawi ◽  
Mohammed Elkassaby ◽  
Niall McVeigh ◽  
Joseph Dowdall ◽  
Mary Barry ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Rest Pain ◽  
Pain Group ◽  
Femoral Artery Occlusion ◽  
Artery Disease

Objectives The aim of this study is to investigate the durability and clinical efficacy of profundoplasty as a sole procedure in patients presenting with critical limb ischaemia associated with profunda femoral artery disease and superficial femoral artery occlusion. Methods Retrospective analysis of outcomes from all patients who underwent surgical profundoplasty in a single tertiary referral centre was performed. Patients who presented with either rest pain or tissue loss and had combined profunda femoral artery disease and superficial femoral artery occlusion were included in the study. Outcomes were compared between the rest pain and the tissue loss groups. Results Between 2009 and 2019, 51 procedures were performed in 49 patients; 27 (53%) procedures were performed for rest pain and 24 (47%) for tissue loss. Technical success was 100% in both groups. Procedure success was significantly better in the rest pain group owing to lower procedure-related complications ( p = 0.037). Incidence of major adverse cardiovascular events was higher in the tissue loss group with five reported cases compared to only one in the rest pain group ( p = .05); 85.2% of patients with rest pain experienced clinical improvement compared to only 33.3% in the tissue loss group ( p < .001). Higher rates of re-intervention were recorded in the tissue loss group, but this was not statistically significant. Amputation-free survival at 3, 6 and 12 months was 96%, 96% and 92% in the rest pain group, respectively, compared to 77%, 67% and 54% in the tissue loss group ( p = .004). At one-year, freedom from major adverse limb events was lower in patients with tissue loss at 43% compared to 81% in patients with rest pain ( p = .009). Conclusions Profundoplasty performed as a sole procedure for revascularisation of the critically ischaemic limb is a viable straightforward option. However, our results suggest that it may be more effective in the treatment of rest pain rather than in the setting of tissue loss when a combined superficial femoral artery angioplasty or distal bypass may be required.

scholarly journals Endovascular management of Critical Limb Ischaemia: Study of 100 Cases

2019 ◽  
Vol 12 (1) ◽  
pp. 40-44
Author(s):  
Md Humayun Kabir ◽  
Munshi Md Mojibur Rahman ◽  
AKM Musa Khan ◽  
Rumman Idris
Keyword(s):  
Limb Ischemia ◽  
Major Amputation ◽  
Severe Form ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Military Hospital ◽  
Limb Ischaemia ◽  
Rest Pain ◽  
Excellent Outcome ◽  
Number Of Patients

Background: Critical limb ischemia (CLI) is the most severe form of Peripheral Artery Disease (PAD) and represents approximately 1% of the total number of patients with PAD. CLI is associated with a higher risk of limb loss in the absence of revascularization. Objectives of the study are to find out the modality of treatment in CLI, different types of endovascular therapy in CLI and their outcome. Methods: A retrospective study evaluated 100 patients with CLI reported to cardiovascular surgery department in Combined Military Hospital (CMH), Dhaka between July 2016 to June 2018. Patients with disabling claudication or rest pain and tissue loss are included in the study. All patients were evaluated by peripheral angiogram and revascularisation of limbs was done by endovascular procedure in 79 patients, by surgical intervention in 12 patients. Results: Forty-four patients (44%) presented with rest pain and disabling claudication, 56 patients (56%) presented with tissue loss. Revascularization of limbs was done in 91 patients (93%). No intervention could be done in 9 patients (9%). Endovascular interventions were done in 79 patients (87%). Twelve patients (13%) underwent surgical bypass. All patients with rest pain remains asymptomatic in 6 months follow up; 2 patients developed reocclusion within 1 year. No major amputation in patients with only rest pain. Conclusion: Revascularization is the main modality of treatment in CLI. Most of the patient can be treated by endovascular percuteneous procedure. Early intervention in CLI patient without tissue loss carries excellent outcome. Cardiovasc. j. 2019; 12(1): 40-44

Critical limb ischaemia in diabetes: definition, assessment, prognosis

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 21-27
Author(s):  
Luther
Keyword(s):  
Diabetic Foot ◽  
Laboratory Tests ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Clinical Use ◽  
Arterial Reconstruction ◽  
Arterial Circulation ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Fontaine Classification

In diabetic foot disease, critical limb ischaemia (CLI) cannot be precisely described using established definitions. For clinical use, the Fontaine classification complemented with any objective verification of a reduced arterial circulation is sufficient for decision making. For scientific purposes, objective measurement criteria should be reported. Assessment of CLI should rely on the physical examination of the limb arteries, complemented by laboratory tests like the shape of the PVR curve at ankle or toe levels, and arteriography. The prognosis of CLI in diabetic foot disease depends on the success of arterial reconstruction. The best prognosis for the patients is with a preserved limb. Reconstructive surgery is the best choice for the majority of patients.

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