scholarly journals Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients with Critical Limb Ischemia and Tissue Loss from the Perspective of an Angiosome-Oriented Revascularization Strategy

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Francisco Acín ◽  
César Varela ◽  
Ignacio López de Maturana ◽  
Joaquín de Haro ◽  
Silvia Bleda ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Ulcer Healing ◽  
Endovascular Procedures ◽  
Limb Ischemia ◽  
Tissue Loss ◽  
Diabetic Patients ◽  
Critical Ischemia ◽  
Ischemic Ulcer ◽  
Anatomical Classification ◽  
Ischemic Ulcers

Our aim was to describe our experience with infrapopliteal endovascular procedures performed in diabetic patients with ischemic ulcers and critical ischemia (CLI). A retrospective study of 101 procedures was performed. Our cohort was divided into groups according to the number of tibial vessels attempted and the number of patent tibial vessels achieved to the foot. An angiosome anatomical classification of ulcers were used to describe the local perfusion obtained after revascularization. Ischemic ulcer healing and limb salvage rates were measured. Ischemic ulcer healing at 12 months and limb salvage at 24 months was similar between a single revascularization and multiple revascularization attempts. The group in whom none patent tibial vessel to the foot was obtained presented lower healing and limb salvage rates. No differences were observed between obtaining a single patent tibial vessel versus more than one tibial vessel. Indirect revascularization of the ulcer through arterial-arterial connections provided similar results than those obtained after direct revascularization via its specific angiosome tibial artery. Our results suggest that, in CLI diabetic patients with ischemic ulcers that undergo infrapopliteal endovascular procedures, better results are expected if at least one patent vessel is obtained and flow is restored to the local ischemic area of the foot.

Transluminal angioplasty of isolated crural arterial lesions in diabetics with critical limb ischemia

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 186-191 ◽  
Author(s):  
Sigala ◽  
Menenakos ◽  
Sigalas ◽  
Baunach ◽  
Langer ◽  
...  
Keyword(s):  
Limb Ischemia ◽  
Transluminal Angioplasty ◽  
Tissue Loss ◽  
Peroneal Artery ◽  
Diabetic Patients ◽  
Critical Ischemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Crural Arteries

Background: We investigated the long-term clinical results of transluminal angioplasty of isolated infrapopliteal arteries in diabetic patients with severe ischaemic foot lesions and the influence of different parameters on primary success, the long-term outcome and the survival rate. Patients and methods: Between January 2001 and May 2004 we performed 50 transluminal angioplasties in 52 (10 female, 42 male, mean age 69.3 years) diabetics with isolated lesions of crural arteries (tibio-peroneal trunk 41, anterior tibial 13, posterior tibial 5, peroneal artery 14) and limb threatening ischaemia (rest pain 12, tissue loss 40). In two patients the dilatation could not be performed due to vessel perforation and impossibility to catheter localization. The morphological classification of infrapopliteal lesions was determined according to guidelines provided by TransAtlantic Inter-Society Consensus (TASC) (17 type A, 16 type B, 13 type C, 4 type D). Results: Initial technical success after angioplasty of crural arteries could be obtained in 96%.Kaplan-Meier analysis showed a cumulative limb salvage of 92%,85% and 68, 9% after 6 months,one and two years, respectively. Patients falling in TASC group C had significantly higher risk of amputation. Overall survival at 1 year was calculated at 85% and at 2 years at 65%. Conclusion: Our results suggest that depending on the extent of lesions transluminal angioplasty of infrapopliteal artery stenoses and occlusions is considered as an effective and save therapy modality to avoid limb loss in diabetics with critical ischemia.

scholarly journals Insulin use is associated with poor limb salvage and survival in diabetic patients with chronic limb ischemia

2010 ◽  
Vol 51 (5) ◽  
pp. 1178-1189 ◽  
Author(s):  
Hasan H. Dosluoglu ◽  
Purandath Lall ◽  
Nader D. Nader ◽  
Linda M. Harris ◽  
Maciej L. Dryjski
Keyword(s):  
Limb Salvage ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Insulin Use ◽  
Chronic Limb Ischemia

Results of isolated infrapopliteal percutaneous transluminal angioplasty for critical limb ischemia in high-risk diabetic patients

Vascular ◽  
2016 ◽  
Vol 24 (5) ◽  
pp. 515-522 ◽  
Author(s):  
E Tartaglia ◽  
A Lejay ◽  
Y Georg ◽  
M Roussin ◽  
F Thaveau ◽  
...  
Keyword(s):  
High Risk ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Primary Patency ◽  
Diabetic Patients ◽  
Secondary Patency ◽  
Cerebrovascular Event ◽  
Arterial Lesions ◽  
Infrapopliteal Angioplasty

Aim Infrapopliteal occlusive arterial lesions mostly characterize diabetic patients arteriopathy. Diabetic patients are prone to multiple comorbidities that make them candidates for low-invasive therapeutic options. The aim of this study was to evaluate the safety of infrapopliteal angioplasty in high-risk diabetic patients. Methods We undertook a study (retrospective study of a prospectively collected database) of all infrapopliteal endovascular revascularizations performed for critical limb ischemia in high-risk (≥3 major comorbidities) diabetic patients in our institution between 2008 and 2010. Study end points were safety, technical success rate, healing rate, overall 1-year survival, primary patency, secondary patency and limb salvage rates. Results A total of 101 high-risk diabetic patients (160 arterial lesions: 94 stenosis and 66 occlusions) underwent infrapopliteal endovascular surgery. No major adverse cardiovascular or cerebrovascular event was recorded within 30 days. Two major adverse limb events (two thromboses requiring major amputation) and seven minor adverse events were recorded. Technical and healing rates were, respectively, 83% and 78%. The 1-year survival, primary patency, secondary patency and limb salvage rates were, respectively, 86%, 67%, 83% and 84%. Conclusion Infrapopliteal angioplasty can be considered as a safe and feasible option for high-risk diabetic patients with critical limb ischemia.

Use of Integra Dermal Regeneration Template for Limb Salvage in Diabetic Patients With No-Option Critical Limb Ischemia

2020 ◽  
pp. 153473462090574 ◽  
Author(s):  
Luca Dalla Paola ◽  
Paolo Cimaglia ◽  
Anna Carone ◽  
Giulio Boscarino ◽  
Giuseppe Scavone
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Group Versus ◽  
Limb Ischemia ◽  
Control Group ◽  
Diabetic Patients ◽  
Dermal Substitute ◽  
End Point ◽  
Dermal Regeneration Template ◽  
Dermal Regeneration

We have analyzed in a retrospective study of consecutive diabetic patients affected by no-option critical limb ischemia (CLI) the efficacy of the dermal substitute Integra Dermal Regeneration Template for treatment of complicated foot lesions. The primary end point was limb salvage and 1-year amputation-free survival. The secondary end point was healing time of surgical site. Between October 2014 and October 2017, 1024 patients with diabetic foot ulcer (DFU) and CLI were admitted. In 84 patients (8.2%), there was a failure in distal revascularization with a persistent CLI after the procedure. Despite the persistent CLI, a group of 26 patients of this cohort obtained complete wound healing. Among them, 13 patients were treated with surgical debridement or open amputations and application of dermal substitute Integra Dermal Regeneration Template and the other 13 patients were treated without any dermal substitute. The Integra group healed within a mean time of 83.5 days, and the control group healed within a mean of 139 days ( P = .028). No major amputation was carried out at 1-year follow-up in the Integra group versus 15% in the control group. A conservative foot surgery or an approach with minor amputation in diabetic patients with no-option CLI may achieve limb salvage. The use of Integra Dermal Regeneration Template in patients with DFU and no-option CLI may be a useful option in a limb salvage program.

Infrapopliteal arterial occlusive disease in diabetics with critical foot ischaemia: The role of distal-origin bypass grafts

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 40-43 ◽  
Author(s):  
Woelfle ◽  
Bruijnen ◽  
Loeprecht
Keyword(s):  
Renal Function ◽  
Limb Salvage ◽  
Impaired Renal Function ◽  
Tissue Loss ◽  
Diabetic Patients ◽  
Secondary Patency ◽  
Vein Grafts ◽  
Infrapopliteal Artery ◽  
Stage Renal Disease ◽  
Esrd Patients

Background: The underlying cause for severe ischaemic foot lesions in diabetics is not infrequently a specific occlusion pattern exclusively involving infrapopliteal arteries. To attain limb salvage in this setting, since the early eighties short vein grafts originating from infragenicular arteries (distal-origin bypasses) were used to bypass the occluded crural vessels. This presentation describes our 15-year experience with this strategy and, in addition, assesses the outcome in patients suffering from end stage renal disease (ESRD). Patients and methods: Since May 1986, 135 diabetic patients underwent 143 so-called "distal-origin bypasses" in the presence of extended infrapopliteal arterial occlusions and critical foot ischaemia (rest pain 3, tissue loss 140). The mean age in this group was 70,1 years. 43 patients had impaired renal function including 16 cases with ESRD. Results: The 30 day mortality in our series was 2.1%. During the follow-up a total of 82 patients died, mainly from cardiovascular causes. Using life-table analysis, primary and secondary patency rates for these bypasses with distal graft origination were 90% and 97% at 30 days, 76% and 83% at 1 year and 46% and 51% at 7 years, respectively. The corresponding limb salvage rates for the whole group amounted to 94%, 80% and 64%. Comparing patients having normal or slightly impaired renal function with those diagnosed of ESRD, a significantly different result with higher limb salvage rates in favour of the first patient subgroup was noted after 5 years (77% vs. 39%; p = 0.0023). Conclusion: In our series, the importance of short vein grafts to avoid limb loss in diabetic patients with infrapopliteal artery occlusions and critical foot ischaemia has been well established. Despite poorer limb salvage rates achieved in ESRD-patients, our results suggest, that even these high risk patients should not be denied arterial reconstruction.

scholarly journals PS126. Limb Salvage and Survival Rate After Endovascular Treatment of Infrapopliteal Artery Occlusion in Diabetic Patients With Critical Limb Ischemia

2010 ◽  
Vol 51 (6) ◽  
pp. 54S
Author(s):  
Francesco Setacci ◽  
Pasqualino Sirignano ◽  
Francesca Iacoponi ◽  
Gianmarco de Donato ◽  
Emiliano Chisci ◽  
...  
Keyword(s):  
Survival Rate ◽  
Endovascular Treatment ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Diabetic Patients ◽  
Infrapopliteal Artery

scholarly journals Procalcitonin Is a Prognostic Marker of Hospital Outcomes in Patients with Critical Limb Ischemia and Diabetic Foot Infection

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Laura Giurato ◽  
Enrico Brocco ◽  
Michele Ferrannini ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Hospital Outcomes ◽  
Diabetic Foot Infection ◽  
The Mean

Aim. To evaluate the prognostic role of procalcitonin (PCT) in patients with diabetic foot infection (DFI) and critical limb ischemia (CLI). Materials and Methods. The study group was composed of diabetic patients with DFI and CLI. All patients were treated according to a preset limb salvage protocol which includes revascularization, wound debridement, antibiotic therapy, and offloading. Inflammatory markers, including PCT, were evaluated at admission. Only positive values of PCT, greater than 0.5 ng/ml, were considered. Hospital outcomes were categorized as limb salvage (discharge with preserved limb), major amputation (amputation above the ankle), and mortality. Results. Eighty-six patients were included. The mean age was 67.3±11.4 years, 80.7% were male, 95.1% had type 2 diabetes, and the mean diabetes duration was 20.5±11.1 with a mean HbA1c of 67±16 mmol/mol. 66/86 (76.8%) of patients had limb salvage, 7/86 (8.1%) had major amputation, and 13/86 (15.1%) died. Patients with positive PCT baseline values in comparison to those with normal values showed a lower rate of limb salvage (30.4 versus 93.6%, p=0.0001), a higher rate of major amputation (13 versus 6.3%, p=0.3), and a higher rate of hospital mortality (56.5 versus 0%, p<0.0001). At the multivariate analysis of independent predictors found at univariate analysis, positive PCT was an independent predictor of major amputation [OR 3.3 (CI 95% 2.0-5.3), p=0.0001] and mortality [OR 4.1 (CI 95% 2.2-8.3), p<0.0001]. Discussion. Positive PCT at admission increased the risk of major amputation and mortality in hospital patients with DFI and CLI.

scholarly journals Limb Revascularization in Patients with Diabetes Mellitus

2019 ◽  
Vol 23 (4) ◽  
pp. 349-363
Author(s):  
L. A. Bokeria ◽  
V. S. Arakelyan ◽  
V. G. Papitashvili ◽  
Sh. Sh. Tsurtsumiya
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Ulcer Healing ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Peripheral Arteries ◽  
Ischemic Ulcer ◽  
Patients With Diabetes ◽  
Basic Treatment

The review describes morbidity, mortality and possible complication rates for diabetic patients with peripheral arteries disease. The article demonstrates the modern tendency in the surgical treatment of peripheral arteries atherosclerosis, shows and compares worldwide results of endovascular and open revascularization. The authors have assessed the risk of amputation for patients with diffuse peripheral arteries disease and described basic treatment principals for better chronic ischemic ulcer healing.

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