scholarly journals The natural history of untreated severe or critical limb ischemia

2015 ◽  
Vol 62 (6) ◽  
pp. 1642-1651.e3 ◽  
Author(s):  
Abd Moain Abu Dabrh ◽  
Mark W. Steffen ◽  
Chaitanya Undavalli ◽  
Noor Asi ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Natural History ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
History Of

scholarly journals Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

2017 ◽  
Vol 22 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kavita B Khaira ◽  
Ellen Brinza ◽  
Gagan D Singh ◽  
Ezra A Amsterdam ◽  
Stephen W Waldo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Left Ventricular ◽  
Term Survival ◽  
Long Term Survival ◽  
Reduced Ejection Fraction ◽  
History Of

The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.

scholarly journals Critical Limb Ischemia: Laporan kasus

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Hermanto Quedarusman ◽  
Pearla Lasut
Keyword(s):  
Diabetes Mellitus ◽  
Blood Sugar ◽  
Critical Limb Ischemia ◽  
Clinical Symptoms ◽  
Limb Ischemia ◽  
Rest Pain ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease ◽  
Diabetes Melitus

Abstract: We reported a case of 56 years old man with critical limb ischemia. Diagnosis was made based on anamnesis, signs and clinical symptoms, as well as investigations that included the presence of rest pain in the left leg. Patient also had a history of diabetes mellitus. Echo- doppler and angiographic investigations supported the diagnosis of critical limb ischemia. In this patient, medicamentous treatment has been administered consisted of antiplatelet and cilostazol, blood sugar control by using insulin. The patient also underwent endovascular revascularization.Keywords: critical limb ischemia, peripheral artery diseaseAbstrak: Telah dilaporkan kasus critical limb ischemia pada seorang laki-laki berusia 56 tahun dengan keluhan nyeri seperti terbakar pada kaki kiri bahkan saat istirahat dengan riwayat diabetes melitus. Hasil pemeriksaan penunjang echo-doppler dan angiografi menyokong terdapatnya critical limb ischemia. Diagnosis ditegakkan berdasarkan anamnesis, tanda dan gejala klinis, serta pemeriksaan penunjang. Pada pasien ini, diberikan penatalaksanaan terapi medikamentosa yaitu antiplatelet dan cilostazol, kontrol gula darah dengan menggunakan insulin, dan dilakukan tindakan revaskularisasi endovaskular.Kata kunci: critical limb ischemia, peripheral artery disease

Long-term outcome of patients with mild intermittent claudication under secondary prevention

VASA ◽  
2009 ◽  
Vol 38 (4) ◽  
pp. 346-355 ◽  
Author(s):  
Taute ◽  
Thommes ◽  
Taute ◽  
Rapmund ◽  
Lindner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Natural History ◽  
Secondary Prevention ◽  
Intermittent Claudication ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Vascular Events ◽  
Vascular Death ◽  
Frequent Event

Background: The known natural history of peripheral arterial disease (PAD) is determined by the generalization of atherosclerosis with resulting high cardiovascular and cerebrovascular morbidity and mortality. The aim of this prospective study was to record all vascular and non-vascular events in patients with mild intermittent claudication (IC) undergoing secondary preventive measures in a 10-year follow-up and to determine the time-points at which systemic localizations of atherosclerotic events develop. Patients and methods: Patients who originally had an isolated Fontaine stage IIa PAD were included in the follow-up which involved assessments carried out on an annual basis. The incidence and timepoints of vascular (i.e., myocardial infarction, stroke, critical limb ischemia, vascular death), and nonvascular events (i.e., cancer, non vascular death) were recorded and compared with the known natural history. Results: 534 events (vascular: 433) concerning 109 claudicants (M/F: 88/21; 60.8 ± 8.8 years; ABI 0.66 ± 0.11) were recorded over an average follow-up period of 104 months. 25.7% of the claudicants died, 39% due to vascular events, 36% due to cancer disease and 25% due to other events. A deterioration of PAD (n = 108) was the most frequent event after 20 months, followed by angina pectoris (n = 41) and cancer diseases (n = 20) after 42 and 45 months, stroke (n = 19) after 58 months, myocardial infarction (n = 12) after 63 months, and finally critical limb ischemia (n = 27) and amputations (n = 10) after 80 and 114 months (median). 111 revascularizations were carried out. 62.3% of the claudicants developed a polyvascular disease, with 20% in a trivascular territory. Conclusions: A high vascular comorbidity also develops under secondary prevention as an expression of the continuing generalization of the atherosclerotic process in PAD. The causes for death are determined both by the vascular and the tumor related comorbidity.

History of the diagnosis and treatment of critical limb ischemia and diabetic foot

2018 ◽  
Vol 31 (2-4) ◽  
pp. 25-42 ◽  
Author(s):  
Angelo Argenteri ◽  
Gianmarco de Donato ◽  
Francesco Setacci ◽  
Domenico Benevento ◽  
Enrico Maria Marone ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Limb Ischemia ◽  
Diagnosis And Treatment ◽  
History Of

scholarly journals Intradialytic hypotension is an important risk factor for critical limb ischemia in patients on hemodialysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ryo Matsuura ◽  
Sumi Hidaka ◽  
Takayasu Ohtake ◽  
Yasuhiro Mochida ◽  
Kunihiro Ishioka ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Systolic Blood Pressure ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Intradialytic Hypotension ◽  
Subdistribution Hazard ◽  
History Of

Abstract Background Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are common complications in patients on hemodialysis (HD). However, limited data are available on whether IDH is related to CLI in these patients. The aim of this retrospective study was to evaluate whether IDH is a risk factor for CLI in HD patients. Methods We examined the frequency of IDH in 147 patients who received HD between January 1 and June 30, 2012. Blood pressure was measured during HD every 30 min and IDH was defined as a ≥ 20 mmHg fall in systolic blood pressure compared to 30 min before and a nadir intradialytic systolic blood pressure < 90 mmHg. The primary study outcome was newly developed CLI requiring revascularization treatment or CLI-related death. We assessed the association of IDH with outcome using a multivariable subdistribution hazard model with adjustment for male, age, smoking and history of cardiovascular disease. Results The median follow-up period was 24.5 months. Fifty patients (34%) had episodes of IDH in the study entry period. During follow-up, 14 patients received endovascular treatment and CLI-related death occurred in 1 patient. Factors associated with incident CLI in univariate analysis were age, smoking, diabetes mellitus, peripheral arterial disease, history of cardiovascular disease, and IDH. IDH was significantly associated with the outcome with the subdistribution hazard ratio of 3.13 [95% confidence interval, 1.05–9.37]. Conclusions IDH was an independent risk factor for incident CLI in patients on HD.

scholarly journals Mycotic Renal Artery Aneurysm Presenting as Critical Limb Ischemia in Culture-Negative Endocarditis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Vy Thuy Ho ◽  
Nathan K. Itoga ◽  
Tiffany Wu ◽  
Ehab Sorial ◽  
Manuel Garcia-Toca
Keyword(s):  
Aortic Valve ◽  
Renal Artery ◽  
Critical Limb Ischemia ◽  
Artery Aneurysm ◽  
Limb Ischemia ◽  
Knee Amputation ◽  
Renal Aneurysm ◽  
History Of ◽  
Culture Negative

Mycotic renal artery aneurysms are rare and can be difficult to diagnose. Classic symptoms such as hematuria, hypertension, or abdominal pain can be vague or nonexistent. We report a case of a 53-year-old woman with a history of intravenous drug abuse presenting with critical limb ischemia, in which CT angiography identified a mycotic renal aneurysm. This aneurysm tripled in size from 0.46 cm to 1.65 cm in a 3-week interval. Echocardiography demonstrated aortic valve vegetations leading to a diagnosis of culture-negative endocarditis. The patient underwent primary resection and repair of the aneurysm, aortic valve replacement, and left below-knee amputation after bilateral common iliac and left superficial femoral artery stenting. At 1-year follow-up, her serum creatinine is stable and repaired artery remains patent.

Abstract 714: Lipid Disorders Might Be Affected to Develop Critical Limb Ischemia in PAD Patients

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Noriyuki Miyama ◽  
Hideki Sakashita ◽  
Shunya Shindo ◽  
Hiroyoshi Komai
Keyword(s):  
Diabetes Mellitus ◽  
Critical Limb Ischemia ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Initial Symptom ◽  
Coronary Arterial Disease ◽  
Lipid Disorders ◽  
History Of ◽  
Different Characteristics

Introduction: Critical limb ischemia (CLI) is manifested by rest pain, non-healing ulcer and gangrene. Intermitted claudication (IC) is a representative initial symptom in patients with peripheral arterial disease (PAD), and CLI is a very severe condition of PAD. However, only 1-2% of PAD cases result in CLI, and some patients suddenly present with the symptoms of CLI, without a history of IC. We assessed the hypothesis that patients with CLI had different characteristics regarding lipid disorders and comorbidities, compared to patients with only IC. Methods: 131 patients with PAD, including 38 CLI and 93 IC patients, were included. The levels of serum small-dense LDL (sd-LDL), malondialdehyde Modified LDL (MDA-LDL), leptin, and adiponectin, all of which were related with atherosclerosis, were measured. Data were also analyzed regarding the association between CLI and patient characteristics, including a history of hypertension, diabetes mellitus, hyperlipidemia, chronic obstructive pulmonary disease (COPD), coronary arterial disease (CAD), and hemodialysis. Univariate and multivariate analyses were performed. Results: CLI patients showed lower sd-LDL (p< .0001), lower MDA-LDL (p=.0003), higher leptin (p=.015), and higher adiponectin (p=.0012), compared to IC patients. CLI was associated with a history of CAD (p<.0001), hemodialysis (p<.0001), diabetes mellitus (p=.040), and without hyperlipidemia (p=.040) in univariate analysis. In multivariate logistic analysis, low sd-LDL, a history of CAD and hemodialysis were significantly associated with CLI. Conclusions: CLI patients had different characteristics regarding lipid disorders and comorbidities, compared to IC patients. These data suggested that CLI patients had some lipid or metabolism disorders, potentially affected to presentation of CLI.

Sarcopenia is a risk factor for major adverse cardiac events after surgical revascularization for critical limb ischemia

Vascular ◽  
2022 ◽  
pp. 170853812110593
Author(s):  
Nehir Selçuk ◽  
Şebnem Albeyoğlu ◽  
Murat Bastopcu ◽  
İsmail Selçuk ◽  
Hakan Barutca ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Psoas Muscle ◽  
Limb Ischemia ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Surgical Revascularization ◽  
Computed Tomography Images ◽  
Adverse Cardiac Events ◽  
History Of ◽  
Low Sensitivity

Objectives We examined the effect of sarcopenia on early surgical outcomes in patients with critical limb ischemia (CLI) in terms of major adverse cardiac events (MACE) and major adverse limb events (MALE), as well as the value of inflammatory markers of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) as indicators of sarcopenia in CLI patients. Methods This was an observational retrospective single-center study. Patients who required surgical revascularization for CLI between October 2015 and December 2020 were identified. Psoas muscle areas were calculated from computed tomography images for psoas muscle index (PMI) calculations. Sarcopenia was defined as PMI < 5.5 cm2/m2 for men and PMI < 4.0 cm2/m2 for women. Risk factors for 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE) were analyzed. NLR and PLR were compared between sarcopenic and non-sarcopenic patients. Results The mean age of 217 study patients was 61.5 ± 10.9, and 16 (7.4%) patients were female. 82 (37.8%) patients were sarcopenic. Patients with sarcopenia were older (65.1 ± 9.3 vs 59.4 ± 11.2, p < .001) and history of myocardial infarction was more frequent (23.2% vs 12.6%, p = 0.042) among sarcopenic patients. Sarcopenic patients more frequently encountered MACE (9.8% vs 0.7%, p = 0.002), but not MALE. Sarcopenia increased early postoperative MACE in our cohort with an odds ratio of 11.925. NLR was not different between the two groups, while PLR was higher (127.16 vs 104.06, p = 0.010) among sarcopenic patients. The platelet-to-lymphocyte ratio of 125.11 had a sensitivity of 53.7% and a specificity of 68.1% for differentiating sarcopenia. Conclusions Sarcopenia was associated with more frequent 30-day MACE and perioperative mortality after revascularization for CLI. 30-day MALE was not increased in patients with sarcopenia. The use of PLR as a simple marker of sarcopenia is limited by its low sensitivity and specificity.

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