LOCAL TRANSMETATARSAL AMPUTATION IN ARTERIAL INSUFFICIENCY OF THE LOWER LIMB

Vascular injuries to the upper or lower limb in the context of significant soft tissue loss, fractures, or other life-threatening injuries are associated with a high amputation rate. Complex extremity vascular injuries in which acute arterial insufficiency combined with severe or prolonged shocks are unacceptable because warm, warm, skeletal muscle time is often exceeded before adequate revascularization, and are associated with extended ischemia periods or fractures or soft tissue wounds. Revascularizing the limb is essential for the success of the limb rescue. Selective intravascular temporary shunting hence allows better overall care of the patient and can therefore be predicted to increase both limb rescue and patient survival rates. The aim of this article was to review and summarize results of previous literature regarding effectiveness on intravascular shunting as management of limb trauma as well as reviewing its potential complications.

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A Survey of the Presence of Lower Limb Arterial Insufficiency in Diabetic Patients Attending the Surgery Department of Golestan Hospital for Reasons other than Vascular Diseases

Biomedical & Pharmacology Journal ◽

10.13005/bpj/877 ◽

2015 ◽

Vol 8 (2) ◽

pp. 1201-1208

Author(s):

HUSSEIN TORK ◽

FATEMEH TAJBAKHSH

Keyword(s):

Lower Limb ◽

Vascular Diseases ◽

Diabetic Patients ◽

Arterial Insufficiency ◽

Surgery Department

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Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽

10.1177/02676591211050608 ◽

2021 ◽

pp. 026765912110506

Author(s):

Natasha Habr ◽

Jamal J Hoballah ◽

Jamil Borgi ◽

Caroline Hamadi ◽

Pierre Sfeir ◽

...

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Major Amputation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Venous Cannulation ◽

Knee Amputation ◽

Venous Cannula ◽

Arterial Insufficiency ◽

Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

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Efficiency of the Endovascular Correction of Clinically Evident Degrees of Chronic Obliterating Lower Limb Diseases in Multisegment Lesions

Health and Ecology Issues ◽

10.51523/2708-6011.2020-17-1-3 ◽

2020 ◽

pp. 14-20

Author(s):

S. Yu. Gorokhovsky ◽

A. A. Lyzikov ◽

M. L. Kaplan ◽

V. E. Tihmanovich

Keyword(s):

Lower Limb ◽

Surgical Intervention ◽

Ankle Brachial Index ◽

Clinical Manifestations ◽

Limb Ischemia ◽

Lower Limbs ◽

Treatment Results ◽

Arterial Lesion ◽

Arterial Lesions ◽

Arterial Insufficiency

Objective: to evaluate the efficiency and extent of endovascular revascularization in patients with multisegment lesions in chronic obliterating diseases of the lower limb arteries.Material and methods. The outcomes of the endovascular correction of multisegment lesions of the lower limb arteries were analyzed in 10 patients. Results. After the treatment the patients revealed a statistically significant change (increase of the value) of the ankle-brachial index (ABI) (p = 0.001). The ABI value after the surgical intervention amounted to 0.81 (0.71; 0.87), which was connected with a favourable prognosis for such patients. Аccording to the established criteria, the outcomes of the interventions comprised the decrease of the degree of chronic arterial insufficiency (p < 0.01), all the patients were discharged having no clinical manifestations of critical lower limb ischemia or decreased evidence of intermittent claudication.Conclusion. The majority of patients with clinically evident ischemia of the lower limbs suffer from multisegment arterial lesion (the number of the segments exceeds 2), which entails the need of multiple corrections in one patient. Meanwhile, the evaluation of the treatment results is possible only in the postoperative period according to the indirect criteria. Therefore, during the operation there arises the need to develop a method of the objective intraoperative evaluation of the extent and efficiency of the performed correction of arterial lesions on each segment.

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Palpating Ankle Pulses is Insufficient in Detecting Arterial Insufficiency in Patients with Leg Ulceration

Phlebology The Journal of Venous Disease ◽

10.1177/026835559400900409 ◽

1994 ◽

Vol 9 (4) ◽

pp. 170-172 ◽

Cited By ~ 12

Author(s):

C. J. Moffatt ◽

M. I. Oldroyd ◽

R. M. Greenhalgh ◽

P. J. Franks

Keyword(s):

Lower Limb ◽

Outcome Measure ◽

Arterial Disease ◽

Ankle Brachial Pressure Index ◽

Main Outcome Measure ◽

Pressure Index ◽

Poor Predictor ◽

Pulse Palpation ◽

District Nurses ◽

Arterial Insufficiency

Objective: To investigate the ability of district nurses to detect lower limb arterial disease by palpation of ankle pulses. Design: Ankle pulse palpation of patients presenting with ulcerated limbs and comparison with Doppler ankle-brachial pressure index (ABPI). Patients: Sequential patients presenting to community ulcer clinics. Main outcome measure: Sensitivity and specificity of pulse palpation to detect arterial disease compared with ABPI. Results: Of 533 limbs with ulceration in 462 patients (mean age 74 years, 67% female), 167 (31%) had no detectable pulses at the ankle. Of the 93 limbs with ABPI <0.9, 34 (37%) had detectable pulses. Of those limbs with ABPI ≥ 0.9, 108 out of 440 (25%) had no detectable ankle pulses. Sensitivity for lack of pulses as a predictor of arterial disease (ABPI <0.9) was 63% with a specificity of 75% and positive predictive value of only 35%. Using only the absence of palpable pulses would lead to 37% of patients with arterial disease being treated inappropriately. Conclusion: Palpation of pedal pulses by community nurses is a poor predictor of leg arterial disease and must be used in combination with ABPI. Only when significant arterial disease is excluded should compression be applied.

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Cocaine-Associated Lower Limb Ischemia

Vascular ◽

10.2310/6670.2008.00048 ◽

2008 ◽

Vol 16 (5) ◽

pp. 297-299 ◽

Cited By ~ 4

Author(s):

Chris G. Collins ◽

Deirdre Seoighe ◽

Adrian Ireland ◽

David Bouchier-Hayes ◽

Frank McGrath

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Occlusive Disease ◽

Vascular Injuries ◽

Lower Limb Ischemia ◽

Prostacyclin Analogue ◽

Arterial Insufficiency

Cocaine-associated thrombosis has been reported in the literature with reports of vascular injuries to cardiac, pulmonary, intestinal, placental, and musculoskeletal vessels; however, injury of the pedal vessels is rare. We report on a 31-year-old man who presented 2 months following a cocaine binge with limb-threatening ischemia without an otherwise identifiable embolic source. Angiography confirmed extensive occlusive disease of the tibioperoneal vessels. The patient improved following therapy with heparin and a prostacyclin analogue. Cocaine-induced thrombosis should be considered in patients presenting with acute arterial insufficiency in the lower limb without any other identifiable cause.

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