TCTAP C-259 Successful Limb Salvage from Critical Limb Ischemia Due to Aortoiliac Occlusive Disease with Severe Calcification

Current treatment of complex aortoiliac occlusive disease (AIOD) includes the aortobifemoral bypass or the femoral-femoral bypass. However, because of bilateral groin exposure and associated risks, there is a significant morbidity associated with these procedures. In appropriate patients with unilateral AIOD, the iliofemoral bypass graft (IFBPG) via a lower abdominal retro-peritoneal incision can be an acceptable alternative. The purpose of this study is to review the safety and efficacy as well as long-term outcomes of IFBPG in patients with unilateral AIOD. From July 1997 through June 2006, 40 patients (64.3 ± 11.2-years-old, range 41–89-years-old, 57.5% critical limb ischemia, 70% male, 95% smokers) with unilateral AIOD were treated with IFBPG. Perioperative complications and symptom resolution were measured and Kaplan-Meier life table analysis was used to analyze outcomes of primary and secondary patency, survival, limb salvage, contralateral intervention, and maintenance of ambulation and independent living status. The perioperative complication rate was 12.5 per cent (n = 5) including one patient who developed atrial-fibrillation and one who developed acute renal failure. Both patients experienced resolution of these symptoms before discharge. Other complications included one limb thrombosis and two wound infections. There were no perioperative deaths. Secondary patency was 97.5 per cent and 93.3 per cent at 1 and 5 years. Limb salvage in patients with critical limb ischemia (CLI) was 85.1 per cent and 79.1 per cent at 1 and 5 years. Limb amputation occurred due to infection (n = 2), or failed IFBPG (n = 2). Thirty-one patients (77.5%) experienced symptom resolution including 15 (88.2%) of the patients treated for claudication. Two patients (5%) required contralateral iliac intervention. Patient survival was 97.5 per cent and 64.5 per cent at 1 and 5 years. Greater than 90 per cent of patients maintained their functional independence at 5 years. IFBPG achieved excellent technical and functional outcomes, particularly in patients treated for vasculogenic claudication. This procedure is relatively safe and efficacious in a population of patients with complex unilateral AIOD and can be an acceptable alternative to the aortobifemoral bypass or fem-fem procedure.

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Retrograde Approach Using Surgical Cutdown Technique for Limb Salvage in a Case of Critical Limb Ischemia With Severely Calcified Tibial Occlusive Disease

Vascular and Endovascular Surgery ◽

10.1177/1538574416644528 ◽

2016 ◽

Vol 50 (4) ◽

pp. 295-298

Author(s):

Tatsuya Shiraki ◽

Osamu Iida ◽

Kotaro Suemitsu ◽

Yoriko Tsuji ◽

Masaaki Uematsu

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Occlusive Disease ◽

Retrograde Approach

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Arterial collateral circulation pathways in patients with aortoiliac occlusive disease

Vascular ◽

10.1177/1708538119859795 ◽

2019 ◽

Vol 27 (6) ◽

pp. 677-683

Author(s):

Ioannis Katsaros ◽

Efstratios Georgakarakos ◽

Konstantinos Frigkas ◽

Kalliopi-Maria Tasopoulou ◽

Vasileios Souftas ◽

...

Keyword(s):

Intermittent Claudication ◽

Blood Supply ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Occlusive Disease ◽

Arterial Blood Supply ◽

Aortoiliac Occlusive Disease ◽

Iliac Arteries ◽

Arterial Blood ◽

Collateral Pathways

Objectives Aortoiliac occlusive disease is a leading cause of morbidity and mortality worldwide. Patients typically present with intermittent claudication or critical limb ischemia but the majority of them remain asymptomatic. Collateral arterial pathways restore the arterial blood supply distal to the lesions. The objective of this study is the description of collateral pathways’ patterns of aortoiliac occlusive disease. Methods Records from the Department of Vascular Surgery of University General Hospital of Alexandroupolis were retrospectively searched from March 2016 to August 2018 for patients suffering from aortoiliac occlusive disease. Results Thirty-three patients (24 males, 9 females) with a mean age of 64.2 ± 11.8 years were included in this study. Twenty-two patients had diabetes mellitus, 25 hypertension, and 16 dyslipidemia. Twenty-two were active smokers. Seventeen patients suffered from intermittent claudication and 16 patients presented with critical limb ischemia. Seven patients had TASC-II B lesions, 10 TASC-II C lesions, and 16 patients had TASC-II D lesions. Systemic collateral pathways were dominant in 17 patients, whereas visceral pathways were prominent in 16 patients. While 62.5% of patients having lesions in the abdominal aorta presented systemic pathways, the lesions located only in the iliac arteries followed visceral patterns or systematic patterns equally. Conclusions Collateral anastomotic networks provide blood supply to regions distal to aortoiliac occlusive lesions. Their pattern is defined mainly by the location of the lesion and does not seem to associate with comorbid factors or the extent of the lesion. Failure to recognize these networks during surgery could lead to limb threatening situations.

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Risk assessment of vascular reconstruction by patients with critical limb ischemia and aortoiliac occlusive disease

Cardiovascular Surgery News ◽

10.24022/2588-0284-2019-3-2-87-93 ◽

2019 ◽

Vol 3 (2) ◽

pp. 87-93

Author(s):

A.N. Vachev ◽

A.V. Krugomov

Keyword(s):

Risk Assessment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Vascular Reconstruction ◽

Occlusive Disease ◽

Aortoiliac Occlusive Disease

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Improvement in asymmetric dimethylarginine and oxidative stress in patients with limb salvage after autologous mononuclear stem cell application for critical limb ischemia

Stem Cell Research & Therapy ◽

10.1186/s13287-017-0622-2 ◽

2017 ◽

Vol 8 (1) ◽

Cited By ~ 3

Author(s):

Juraj Madaric ◽

Martina Valachovicova ◽

Ludovit Paulis ◽

Jana Pribojova ◽

Renata Mateova ◽

...

Keyword(s):

Oxidative Stress ◽

Stem Cell ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Asymmetric Dimethylarginine ◽

Limb Ischemia ◽

And Oxidative Stress

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TCTAP C-222 Successful Limb Salvage Case of Critical Limb Ischemia Patient with Systemic Sclerosis Treated by Endovascular Therapy in Combination with Lumbar Sympathetic Nerve Blockade

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.03.459 ◽

2017 ◽

Vol 69 (16) ◽

pp. S309-S310

Author(s):

Takumi Inoue ◽

Susumu Odajima ◽

Kentaro Yamashita ◽

Taro Kamada ◽

Shun Yokota ◽

...

Keyword(s):

Systemic Sclerosis ◽

Limb Salvage ◽

Endovascular Therapy ◽

Critical Limb Ischemia ◽

Sympathetic Nerve ◽

Limb Ischemia ◽

Nerve Blockade

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Evaluation of Tissue Perfusion by Wound Blush and 2D Color-Coded Digital Subtraction Angiography During Endovascular Intervention and Its Impact on Limb Salvage in Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/15266028211065957 ◽

2021 ◽

pp. 152660282110659

Author(s):

Hassan Lotfy ◽

Ahmed Abou El-Nadar ◽

Wael Shaalan ◽

Ali El Emam ◽

Akram Ibrahim ◽

...

Keyword(s):

Wound Healing ◽

Digital Subtraction Angiography ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Tissue Perfusion ◽

Technical Failure ◽

Digital Subtraction ◽

Reliable Technique ◽

Significant Difference

Purpose: Critical limb ischemia (CLI) is an entity with high mortality if not properly treated. The primary aim of CLI revascularization is to enhance wound healing, which greatly depends on microvascular circulation. The available tools for assessment of revascularization success are deficient in the evaluation of local microvascular tissue perfusion, that wound blush (WB) reflects. A reliable technique that assesses capillary flow to foot lesions is needed. This study aims to assess WB angiographically at sites of interest in the foot after revascularization and its impact on limb salvage in CLI. Materials and Methods: 198 CLI patients (Rutherford category 5/6) with infrainguinal atherosclerotic lesions amenable for endovascular revascularization (EVR) were included. Limbs were directly or indirectly revascularized by EVR. Direct revascularization meant that successful revascularization of the area of interest according to the angiosome concept was achieved. A completion angiographic run was taken to assess WB. Patients were divided into 2 groups; positive and negative WB groups. In the event of a disagreement between the observational investigators, the digital subtraction angiography (DSA) series was analyzed for hemodynamic changes with a computerized 2D color-coded DSA (Syngo iFlow). Results: 176 limbs had successful revascularization in 157 patients. The successful revascularization rate was 88.9% (176/198), with technical failure encountered in 22 limbs. 121 patients had positive WB and 55 patients had negative WB. Direct revascularization of target areas was obtained in 98 limbs (55.7%). There was a significant difference in the rate of achieving direct flow to the lesion between the positive WB and negative WB groups (36.4% vs 19.3%, p≤0.001). We noticed a nonsignificant difference between patients who had direct revascularization of the foot lesion(s) and those who had indirect revascularization as regards limb salvage. Patients were followed up for 25.2 ± 12.7 months. By the end of the first year, limb salvage rate was significantly higher in patients who had positive WB (98% vs 63%, p<0.001, after 2 years (97% vs 58%, p<0.001) and after 3 years (94% vs 51.5%, p<0.001). Conclusions: WB is an important predictor and a prognostic factor for wound healing in CLI patients with soft tissue lesions.

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