Early Identification of Argatroban Resistance and the Consideration of Factor VIII

2019 ◽  
pp. 089719001988523 ◽  
Author(s):  
Janelle O. Poyant ◽  
Augustus M. Gleason
Keyword(s):  
Case Report ◽  
Factor Viii ◽  
Critical Limb Ischemia ◽  
Early Identification ◽  
Single Case ◽  
Limb Ischemia ◽  
Thrombin Inhibitor ◽  
Early Assessment ◽  
Vascular Intervention ◽  
Heparin Resistance

Background: Argatroban, a synthetic, parenteral, nonheparin anticoagulant, is a direct thrombin inhibitor indicated for the prophylaxis or treatment of venous thromboembolism (VTE) in patients with heparin-induced thrombocytopenia with thrombosis (HITT) and for use during percutaneous coronary intervention (PCI) in patients who have or are at risk for developing HITT. Although heparin resistance occurs in approximately 0.5% to 5% of heparin-treated patients and is well documented in the literature, argatroban resistance is limited to a single case report. The objective of this case is to describe a case in which argatroban resistance was suspected in a patient with critical limb ischemia. Methods: This is a case report of a single patient. Results: A 68-year-old female admitted for critical limb ischemia requiring vascular intervention was treated for presumed HITT with argatroban. A therapeutic activated partial thromboplastin time (aPTT) was not attained (31 seconds) despite multiple uptitrations of the dose to 2.8 μg/kg/min (adjusted based on the institutional protocol and with consideration of organ dysfunction). A coagulopathy workup revealed a high level of factor VIII (265%). Conclusion: This case supports early assessment of factor VIII levels and the consideration of argatroban resistance and in patients who have a subtherapeutic aPTT, despite multiple increases in dose with an elevated factor VIII level. Early identification should prompt the use of an alternative anticoagulant to ensure efficacy.

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

2021 ◽  
pp. 153857442110264
Author(s):  
Hee Korleski ◽  
Laura DiChiacchio ◽  
Luiz Araujo ◽  
Michael R. Hall
Keyword(s):  
Case Report ◽  
General Anesthesia ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Treatment Modality ◽  
Conventional Treatment ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

Isolated femoral artery revascularisation with or without iliac inflow improvement – a less invasive surgical option in critical limb ischemia

VASA ◽  
2021 ◽  
pp. 1-7
Author(s):  
Andreas S. Peters ◽  
Katrin Meisenbacher ◽  
Dorothea Weber ◽  
Theodosios Bisdas ◽  
Giovanni Torsello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Negative Impact ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lesion Length ◽  
Vascular Intervention ◽  
Selection Of Variables ◽  
Surgical Option

Summary: Background: Isolated femoral artery revascularisation (iFAR) represents a well-established surgical method in the treatment of peripheral arterial disease (PAD) involving common femoral artery disease. Data for iFAR in multilevel PAD are inconsistent, particularly in patients with critical limb ischemia (CLI). The aim of the study was to evaluate the outcome of iFAR in CLI regarding major amputation and reintervention and to identify associated risk factors for this outcome. Patients and methods: The data used have been derived from the German Registry of Firstline Treatment in Critical Limb Ischemia (CRITISCH). A total of 1200 patients were enrolled in 27 vascular centres. This sub-analysis included patients, which were treated with iFAR with/without concomitant iliac intervention. For detection of risk factors for the combined endpoint of major amputation and/or reintervention, selection of variables for multiple regression was conducted using stepwise forward/backward selection by Akaike’s information criterion. Results: 95 patients were included (mean age: 72 years ± 10.82; 64.2% male). Of those, 32 (33.7%) participants reached the combined endpoint. Risk factor analysis revealed continued tobacco use (odds ratio [OR] 2.316, confidence interval [CI] 0.832–6.674), TASC D-lesion (OR: 2.293, CI: 0.869–6.261) and previous vascular intervention in the trial leg (OR: 2.720, CI: 1.037–7.381) to be associated with reaching the combined endpoint. Conclusions: iFAR provides a reasonable, surgical option to treat CLI. Lesion length (TASC D) seems to have a negative impact on outcome. Further research is required to better define the future role of iFAR for combined femoro-popliteal lesions in CLI – best in terms of a randomised controlled trial.

SARS-CoV-2 Virus Infection-Related Arterial Thromboembolism Leading to Critical Limb Ischemia and Amputation

2021 ◽  
Author(s):  
Jenna Smith ◽  
Aleem Mirza ◽  
Jesse Manunga ◽  
Nedaa Skeik
Keyword(s):  
Case Report ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Thromboembolic Events ◽  
Arterial Thromboembolism ◽  
Abdominal Aortic ◽  
Aortic Thrombus ◽  
Venous Thromboembolic Events ◽  
Increase Risk ◽  
Venous Thromboembolic

AbstractCOVID-19 infection has been shown to increase risk for thromboembolism. With most studies reporting mainly venous thromboembolic events, there is a lack of literature regarding the incidence of arterial thromboses in patients with COVID-19 infection. We report a dramatic case of a 55-year-old male with confirmed COVID-19 infection who presented with acute left critical limb ischemia leading to amputation as a result of thromboembolism from a distal abdominal aortic thrombus. Our case report contributes to the limited body of literature on COVID-19-related arterial thromboembolism. The patient consented to publish this case.

Readmissions to an alternate hospital in patients undergoing vascular intervention for claudication and critical limb ischemia associated with significantly higher mortality

2019 ◽  
Vol 70 (6) ◽  
pp. 1960-1972 ◽  
Author(s):  
Rennier A. Martinez ◽  
Kelsey N. Franklin ◽  
Alexandra E. Hernandez ◽  
Joshua Parreco ◽  
Nicholas Cortolillo ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Vascular Intervention

Article Commentary: Current Status of Heroic Limb Salvage for Critical Limb Ischemia

2008 ◽  
Vol 74 (4) ◽  
pp. 275-284
Author(s):  
Spence M. Taylor
Keyword(s):  
Critical Limb Ischemia ◽  
Current Method ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Current Status ◽  
Limb Amputation ◽  
Vascular Intervention ◽  
Ambulatory Ability ◽  
Original Measure ◽  
Peripheral Arterial

The treatment of chronic lower extremity peripheral arterial disease is in a state of flux. During the past decade, vascular surgeons have assumed the responsibility for the endovascular care of patients needing vascular intervention. Once surgeons began performing these procedures, a change in attitude toward angioplasty resulted in an “endovascular explosion” and an overall reassessment of the traditional approaches to critical limb ischemia. Our current method of assessing outcomes is also in a state of flux. The original measure of procedural success, reconstruction patency, has been found to be a poor predictor of both patient palliation and functional success. A shift toward determining more accurate, patient-oriented outcome measures is ongoing. Until then, evidence would suggest that there are patients with such severe medical comorbidities, which include impaired ambulatory ability at presentation, that the benefits of revascularization seem to be insignificant. As our patient population ages and our healthcare system continues to fail financially, economic rationing motivated by lack of evidence-based data to the contrary may dictate that these patients are best served by primary limb amputation.

scholarly journals Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

2016 ◽  
Vol 22 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Caitlin W Hicks ◽  
Alireza Najafian ◽  
Alik Farber ◽  
Matthew T Menard ◽  
Mahmoud B Malas ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Multivariable Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Primary Patency ◽  
Tissue Loss ◽  
Vascular Intervention ◽  
Below The Knee ◽  
Endovascular Interventions ◽  
One Year

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

Abstract 275: Angioscore Balloon in the Treatment of Collagen Plug Occlusion and Acute Limb Ischemia: Case Report

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Pooja M Swamy ◽  
Abeer Berry ◽  
Mahir D Elder
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Closure Device ◽  
Acute Limb Ischemia ◽  
Access Site ◽  
Left Lower Extremity

BACKGROUND: Complications of the vascular access-site (VAS) are not uncommon. With the evolution of hemostatic techniques used in the access site closure, in the last two decades, the rate of VAS related complications has significantly reduced from 6% to 2%. However, they still remain to be an important cause of morbidity following catheterization procedures. The most common complications encountered with closure of VAS are hematoma formation, arterio-venous fistula, dissection, pseudo -aneurysm and limb ischemia. According to two meta-analyses, the incidences of these complications were very low. The incidence of collagen plug from an Angioseal(™) device causing acute leg ischemia is low and upon occurrence, the use of an Angioscore(™) balloon in successful revascularization has never been reported. CASE PRESENTATION: A 62-year-old male with known severe peripheral artery disease, diabetes mellitus, hypertension and hypercholesterolemia had a successful angioplasty of a 100% chronically occluded right superficial femoral artery (SFA) via the left common femoral artery. An Angioseal (™) closure device was used to achieve hemostasis. The patient was discharged home after an uneventful post procedural course. Two days later, he presented to the ER with a cold and numb left lower extremity. On exam, the left lower extremity had no palpable pulse from below right femoral artery, confirmed by Doppler. The extremity was cold to touch with decreased sensory perception. Patient was found to have critical left lower extremity ischemia. He was emergently taken for a selective left lower extremity angiogram using the right common femoral artery for access. Fragments of the closure device and a collagen plug causing a total occlusion of the left common femoral artery were found. After a pre-dilatation with a 4.0x 40 balloon under prolonged inflations, a lesion reduction from 100 % to 30% with a TIMI 0 to TIMI 3 flow was achieved using an Angioscore (™) 5.0x 40 balloon inflated at 10 atmospheres. Subsequently, using laser 2.0 atherectomy of the left common femoral artery was performed. Flow in the dorsalis pedis artery was confirmed with Doppler. DISCUSSION: The Angio-Seal(™) device has a polylactide and polyglycolide polymer anchor, a collagen plug and a suture contained within a carrier system. Hemostasis is achieved by compressing the arterial puncture site between the anchor and the collagen plug. With newer studies, it appears that the occurrence of critical limb ischemia from collagen plug is under recognized. We therefore, with this case report urge the physicians to be aware of this serious though rare complication of closure devise and also highlight the successful use of Angioscore (™) balloon in the emergent treatment of non-athermatous vascular occlusion causing critical limb ischemia.

Sign in / Sign up

Export Citation Format

Share Document