Hybrid Technique for Acute on chronic Lower Limb Ischemia, A single centre study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Islam Badry Mohammed ◽  
Amr Nabil Kamel ◽  
Mohammed Mahmoud Zaki
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Hybrid Procedure ◽  
Hybrid Technique ◽  
Technical Success ◽  
Hybrid Procedures ◽  
Lower Limb Ischemia ◽  
Single Centre Study ◽  
One Step ◽  
Salvage Rate

Abstract Background Several methods have been postulated for the treatment of acute on chronic lower limb ischemia; among them, the hybrid procedure (combined open thrombectomy and angioplasty) is gaining popularity .It is aimed at clearing the vessel and treating the underlying vessel lesion in one step. Patients and Methods A total of 23 patients admitted to the vascular department were eligible for inclusion in this study. They were subjected to thromboembolectomy, followed by endovascular balloon dilatation with or without stenting. Data regarding the risk factors, procedure success, and complications were recorded. Results Hybrid procedures showed 91.6% immediate technical success and 82.6% primary limb salvage rate up to 6 months with accepted minor complications. and no major complications Conclusion The hybrid procedure provides an accepted outcome in treating immediately limb- threatening acute on chronic lower limb ischemia.

Hybrid procedures for chronic lower limb ischemia: what determines the outcome?

2017 ◽  
Vol 36 (2) ◽  
Author(s):  
Konstantinos Spanos ◽  
Georgios A. Antoniou ◽  
Vasileios Saleptsis ◽  
Athanasios Athanasoulas ◽  
Aikaterini Drakou ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Hybrid Procedures ◽  
Lower Limb Ischemia

scholarly journals Limb Salvage in Early Versus Delayed Revascularization of Acute Lower Limb Ischemia

2021 ◽  
Vol 15 (9) ◽  
pp. 2239-2241
Author(s):  
Salman Jamil Noor ◽  
Nauman Imtiaz ◽  
Wishal Shaukat ◽  
Athar Abbas Gilani ◽  
Palwasha Shahid ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Lower Limb ◽  
Limb Ischemia ◽  
P Value ◽  
Limb Salvage Rate ◽  
Lower Limb Ischemia ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Salvage Rate

Aim: To compare the limb salvage rate in early versus late presenting patients of Rutherford class IIB acute lower extremity ischemia undergoing revascularization. Study Design: Comparative/observational study Place and duration of study: Department of Surgery, CMH Peshawar from January 2019 to March 2021 Methodology: Twenty eight patients of both genders with ages 20 to 70 years presented with Rutherford class IIB acute lower limb ischemia were enrolled in this study. Patients were divided into two groups. Group I (presented after 6 hours of onset of symptoms) consisted of 20 patients and group II (presented within 6 hours of onset of symptoms) consisted of 8 patients. All the patients underwent femoral embolectomy. Limb salvage rate between both groups was examined at postoperative 3rd month. Data was analyzed by SPSS 24.0. P-value <0.05 was taken as significant. Results: There were 16(80%) male and 4(20%) females with mean age 50.52±11.74 years in group I, in group II 6(75%) were male and 2(25%) were females with mean age 50.08±10.94 years. No significant difference was observed between both groups regarding age and gender with p-value >0.05. In group I, limb salvage found in 19(95%) patients while in group II limb salvage found in 5(62.5%) patients, a significant difference was observed regarding limb salvage rate between both groups (p-value <0.05). Mortality rate was high in group II (delayed presentation) as compared to group I (12.5% Vs 0%) with p-value <0.05. Conclusion: The limb salvage rate was high in early presenting patients than late presenting patients with a significant difference. 30 days mortality rate and amputation rate were significantly high in delayed presentation as compared to early presented cases. Keywords: Acute lower limb ischemia, revascularization, limb salvage

scholarly journals Treatment of critical lower limb ischemia using a hybrid technique

2014 ◽  
Vol 13 (3) ◽  
pp. 257-261
Author(s):  
Ricardo Wagner da Costa Moreira ◽  
Pedro Victor Alcântara da Costa ◽  
David Domingos Rosado Carrilho
Keyword(s):  
Effective Treatment ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Treatment Method ◽  
Major Amputation ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Endovascular Techniques ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Critical ischemia of a lower limb is a condition that threatens its viability and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method and is performed using surgical or endovascular techniques. For patients with thoracoabdominal aortic aneurysms, combining these two approaches into a "hybrid technique" makes it possible to treat patients who could not be adequately treated by either technique in isolation. We report on a case of lower limb critical ischemia treated using a combination of surgery and endovascular techniques, in an application of the hybrid technique in a different arterial bed.

scholarly journals Role of Hybrid Interventions in Management of Critical Lower Limb Ischemia

2020 ◽  
pp. 229-237
Author(s):  
Samy R. Zekilah ◽  
Adel H. Kamhawy ◽  
Hassan A. Hassan ◽  
Mohamed A. El-heniedy ◽  
Ahmed M. Ismael
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
University Hospital ◽  
Tissue Loss ◽  
Hybrid Technique ◽  
Lower Limb Ischemia ◽  
Endovascular Interventions ◽  
Ischemic Ulcer ◽  
Work Up

Aims: To evaluate safety and efficacy of the hybrid technique in revascularization of multilevel lower limb arterial occlusive disease in patients with critical lower limb ischemia. Study Design: A prospective non comparative interventional study. Place and Duration of Study: It was conducted between February 2017 and June 2019 in the Department of Vascular Surgery, Tanta University hospital. Methodology: The study included 23 patients were treated with hybrid intervention techniques, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up like duplex scanning with or without CT angiography. All patients were undergone hybrid interventions in an operating room with imaging facilities (mobile c-arm device) where both surgical and endovascular interventions were done simultaneously. Results: Twenty three patients were treated for unilateral critical lower limb ischemia using single session elective hybrid intervention. The patients age ranged from 46 to 76 (mean 62.6) with 19 males. 8 patients (34.8%) presented with ischemic rest pain and the remainder (65.2%) presented with tissue loss (ischemic ulcer or gangrene). most common inflow procedure was femoro-popliteal supragenicular bypass, and the commonest outflow procedure was tibial angioplasty. Technical success was achieved in 22 patients. Mean ABI was improved from 0.49 preoperatively to 0.84 in early post-operative measurements. Out of 23 limbs treated there were 20 limbs saved from amputation (87% limb salvage rate). We had three mortalities from other co-morbidities and four minor complications treated conservatively and resolved. Conclusion: Hybrid interventions were proved to be reasonable, effective and safe option for treatment of critical lower limb ischemia.

scholarly journals Therapeutic effect of liposomal prostaglandin E1 in acute lower limb ischemia as an adjuvant to hybrid procedures

2013 ◽  
Vol 5 (6) ◽  
pp. 1760-1764 ◽  
Author(s):  
JIANLIN LI ◽  
BING WANG ◽  
YUE WANG ◽  
FEI WU ◽  
PANFENG LI ◽  
...  
Keyword(s):  
Therapeutic Effect ◽  
Lower Limb ◽  
Prostaglandin E1 ◽  
Limb Ischemia ◽  
Hybrid Procedures ◽  
Lower Limb Ischemia

scholarly journals ROLE OF HYBRID PROCEDURES IN TREATMENT OF CRITICAL LOWER LIMB ISCHEMIA

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
elsayed elbosraty ◽  
Mohamed Abdelhamid ◽  
Hany Abd El-fattah
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Hybrid Procedures ◽  
Lower Limb Ischemia

Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽  
2008 ◽  
Vol 37 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Koutouzis ◽  
Sfyroeras ◽  
Moulakakis ◽  
Kontaras ◽  
Nikolaou ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Cardiac Troponin ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Limb Ischemia ◽  
Elevated Troponin ◽  
Troponin Elevation ◽  
Lower Limb Ischemia ◽  
Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

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