scholarly journals Trans-iliac Bypass for Critical Limb Ischaemia with Groin Necrosis: A Case Report

2019 ◽  
Vol 42 ◽  
pp. 31-33 ◽  
Author(s):  
Youcef Lounes ◽  
Baris A. Ozdemir ◽  
Pierre Alric ◽  
Ludovic Canaud
Keyword(s):  
Case Report ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia

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.

scholarly journals A Case Report of Angioplasty and Stenting Experience for Peripheral Arte-rial Disease of the Lower Limbs at Annapurna Neurological Institute

2021 ◽  
Vol 1 (1) ◽  
pp. 38-41
Author(s):  
Sandeep Raj Pandey ◽  
Anik Jha ◽  
Sudikchya Acharya ◽  
Sudan Dhakal
Keyword(s):  
Case Report ◽  
Early Stage ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Primary Stenting ◽  
Artery Disease ◽  
Peripheral Arterial

Atherosclerosis leading to stenosis or blockage in the major vessels of lower extremities causes peripheral arterial disease(PAD). PAD may be asymptomatic in early stage. But in late stage PAD present in the form of intermittent claudication (IC) or critical limb ischaemia (CLI) . The Fontaine classification is commonly used to measure the severity of disease which is staged from l-asymtomatic to lV-gangrene. PAD can be treated by medical , endovascular and surgical management The purpose of this case report is to consider the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities.  

scholarly journals Endovascular thrombectomy for critical lower limb ischaemia in a patient with COVID-19

2021 ◽  
Vol 14 (11) ◽  
pp. e244941
Author(s):  
Subhash Kumar ◽  
Anup Kumar ◽  
Ruchi Sinha ◽  
Mala Mahto
Keyword(s):  
Case Report ◽  
Pulmonary Disease ◽  
Lower Limb ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
The Novel ◽  
Endovascular Thrombectomy ◽  
Novel Coronavirus ◽  
Infrapopliteal Arteries ◽  
Severe Pulmonary Disease

Hypercoagulable and proinflammatory states induced by the novel coronavirus (SARS-CoV-2) lead to thrombotic and embolic events. In this case report, the authors describe how they successfully managed acute critical limb ischaemia in a patient of COVID-19 illness with severe pulmonary disease and high thrombus burden in the infrapopliteal arteries.

scholarly journals COVID-19 associated multi organ embolism and critical limb ischaemia followed by limb salvage: A case report

2020 ◽  
Vol 8 (2) ◽  
pp. 124-125
Author(s):  
SMG Kibria ◽  
Jan Mohammed ◽  
Joyita Barua
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Severe Morbidity ◽  
Multiple Organs ◽  
Radiological Evidence ◽  
High Incidence

First reported in Wuhan, China, SARS-COVID 19 infection is now fairly well described but understanding the disease is evolving and is associated with high incidence of fatal pneumonia. However, concomitant vascular thromboembolism is also being recognized as contributing to mortality and severe morbidity. We report limb salvage in a COVID-19 patient despite presenting late with critical limb ischaemia and radiological evidence of embolism in multiple organs. Bangladesh Crit Care J September 2020; 8(2): 124-125

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.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

Vascular trauma of the hand – a systematic review

VASA ◽  
2019 ◽  
Vol 48 (3) ◽  
pp. 205-215 ◽  
Author(s):  
Uwe Wahl ◽  
Ingmar Kaden ◽  
Andreas Köhler ◽  
Tobias Hirsch
Keyword(s):  
Duplex Sonography ◽  
Vascular Trauma ◽  
Vascular Lesions ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Limited Information ◽  
Endovascular Interventions ◽  
Provocation Tests ◽  
Objective Basis ◽  
Allen Test

Abstract. Hypothenar or thenar hammer syndrome (HHS) and hand-arm vibration syndrome (HAVS) are diseases caused by acute or chronic trauma to the upper extremities. Since both diseases are generally related to occupation and are recognised as occupational diseases in most countries, vascular physicians need to be able to distinguish between the two entities and differentiate them from other diagnoses. A total of 867 articles were identified as part of an Internet search on PubMed and in non-listed occupational journals. For the analysis we included 119 entries on HHS as well as 101 papers on HAVS. A professional history and a job analysis were key components when surveying the patient’s medical history. The Doppler-Allen test, duplex sonography and optical acral pulse oscillometry were suitable for finding an objective basis for the clinical tests. In the case of HHS, digital subtraction angiography was used to confirm the diagnosis and plan treatment. Radiological tomographic techniques provided very limited information distal to the wrist. The vascular component of HAVS proved to be strongly dependent on temperature and had to be differentiated from the various other causes of secondary Raynaud’s phenomenon. The disease was medicated with anticoagulants and vasoactive substances. If these were not effective, a bypass was performed in addition to various endovascular interventions, especially in the case of HHS. Despite the relatively large number of people exposed, trauma-induced circulatory disorders of the hands can be observed in a comparatively small number of cases. For the diagnosis of HHS, the morphological detection of vascular lesions through imaging is essential since the disorder can be accompanied by critical limb ischaemia, which may require bypass surgery. In the case of HAVS, vascular and sensoneurological pathologies must be objectified through provocation tests. The main therapeutic approach to HAVS is preventing exposure.

Overview of Treatment Options for Critical Limb Ischaemia Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 51 ◽  
Author(s):  
Frederic Baumann ◽  
Nicolas Diehm ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Arterial Revascularisation ◽  
Planning Treatment ◽  
Treatment Concepts ◽  
Peripheral Arterial ◽  
Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

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