Percutaneous Deep Foot Vein Arterialization IVUS-Guided in No-Option Critical Limb Ischemia Diabetic Patients

Purpose: To report our clinical experience with IVUS-guided percutaneous deep vein arterialization (pDVA) to treat chronic critical limb ischemia (cCLI) patients with no-endovascular or surgical options approach due to creation of an arteriovenous fistula (AVF). Materials and Methods: In a 2 years period, 14 no-option cCLI patients were treated with percutaneous deep vein arterialization (pDVA) by creating an AVF with a IVUS-guided system between posterior tibial artery and its satellite deep vein. Technical success was defined as successful AVF creation and venous perfusion of the wound site. Patients’ characteristics, procedure details, mortality and wound outcomes were assessed prospectively. Results: Successful pDVA was successfully performed in all patients (mean age 82 years) without any procedural complications. Clinical improvement was achieved in all patients with resolution of rest pain, tissue formation of granulation tissue or both; only 3 major amputations were performed within the study period with a limb salvage rate of 78%. Median wound healing time was 4.8 months. Conclusion: pDVA is a safe and feasible revascularization technique alternative in no-option cCLI patients.

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Adherence to guideline recommended medical therapies in type 2 diabetic patients with chronic critical limb ischemia

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2019.107898 ◽

2019 ◽

Vol 158 ◽

pp. 107898 ◽

Cited By ~ 2

Author(s):

Elisabetta Iacopi ◽

Alberto Coppelli ◽

Nicola Riitano ◽

Lorenza Abbruzzese ◽

Letizia Pieruzzi ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Chronic Critical Limb Ischemia ◽

Medical Therapies ◽

Type 2 Diabetic

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Infrapopliteal Balloon Angioplasty for Chronic Critical Limb Ischemia in Diabetic Patients with Uremia: When is it Worth the Effort?

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2008.11.022 ◽

2009 ◽

Vol 20 (3) ◽

pp. 342-346 ◽

Cited By ~ 13

Author(s):

Janne Kuusela ◽

Hannu I. Manninen ◽

Pauli Karhapää

Keyword(s):

Balloon Angioplasty ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Chronic Critical Limb Ischemia

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Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic Patients With Chronic Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1583/09-2793.1 ◽

2009 ◽

Vol 16 (5) ◽

pp. 604-612 ◽

Cited By ~ 45

Author(s):

Yue-Qi Zhu ◽

Jun-Gong Zhao ◽

Fang Liu ◽

Jian-Bo Wang ◽

Ying-Sheng Cheng ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Subintimal Angioplasty ◽

Chronic Critical Limb Ischemia

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A small case series of toe sparing surgery: excision of the first metatarsophalangeal joint in diabetic patients to facilitate wound healing

British Journal of Diabetes ◽

10.15277/bjd.2018.181 ◽

2018 ◽

Vol 18 (3) ◽

pp. 106-109

Author(s):

Alok Tiwari ◽

Ian Wilson ◽

Marianne DeBrito ◽

Miruna David ◽

Mujahid A Saeed

Keyword(s):

Wound Healing ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Healing Time ◽

Diabetic Patients ◽

Healing Ulcer ◽

Vascular Surgeon ◽

First Metatarsophalangeal Joint ◽

Surgical Options ◽

Wound Healing Time

AbstractAim: Various surgical options exist for failed antibiotic treatment of non-healing ulcer or osteomyelitis of the first metatarsophalangeal (MTP) joint. Our aim was to look at the outcome of patients undergoing toe-sparing surgery during excision of the first MTP.Methods: A prospective series of patients undergoing toe-sparing surgery of the first MTP joint under one vascular surgeon from 2014 to 2016 and looked after by the multidisciplinary diabetic foot team was studied. All patients undergoing surgery were followed up until wound healing. Complications and time to healing were recorded including any subsequent procedures.Results: Seven men (mean age 56.4 years) with diabetes underwent this procedure. Mean wound healing time was 9.5 weeks (range 5–16 weeks). All toes were preserved with no new ulcerations and minimal complications.Conclusion: In selected patients with first MTP joint ulceration and/or osteomyelitis, toe-sparing surgery can be undertaken with excellent results, preserving the toe with fast wound healing and no ischaemia to the adjacent toe.

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Midterm Outcomes From a Pilot Study of Percutaneous Deep Vein Arterialization for the Treatment of No-Option Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/1526602817719283 ◽

2017 ◽

Vol 24 (5) ◽

pp. 619-626 ◽

Cited By ~ 28

Author(s):

Steven Kum ◽

Yih Kai Tan ◽

Michiel A. Schreve ◽

Roberto Ferraresi ◽

Ramon L. Varcoe ◽

...

Keyword(s):

Wound Healing ◽

Pilot Study ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Clinical Results ◽

Symptomatic Improvement ◽

Healing Time ◽

Serious Adverse Events ◽

Technical Success Rate ◽

Deep Vein

Purpose: To report the initial clinical experience with percutaneous deep vein arterialization (PDVA) to treat critical limb ischemia (CLI) via the creation of an arteriovenous fistula. Methods: Seven patients (median age 85 years; 5 women) with CLI and no traditional endovascular or surgical revascularization options (no-option CLI) were recruited in a pilot study to determine the safety of PDVA. All patients were diabetic; 4 had Rutherford category 6 ischemia. Six were classified at high risk of amputation based on the Society for Vascular Surgery WIfI (wound, ischemia, and foot infection) classification. The primary safety endpoints were major adverse limb events and major adverse coronary events through 30 days and serious adverse events through 6 months. Secondary objectives included clinical efficacy based on outcome measures including thermal measurement, transcutaneous partial pressure of oxygen (TcPO2), clinical improvement at 6 months, and wound healing. Results: The primary safety endpoints were achieved in 100% of patients, with no deaths, above-the-ankle amputations, or major reinterventions at 30 days. The technical success rate was 100%. Two myocardial infarctions occurred within 30 days, each with minor clinical consequences. All patients demonstrated symptomatic improvement with formation of granulation tissue, resolution of rest pain, or both. Complete wound healing was achieved in 4 of 7 patients and 5 of 7 patients at 6 and 12 months, respectively, with a median healing time of 4.6 months (95% confidence interval 84–192). Median postprocedure peak TcPO2 was 61 mm Hg compared to a preprocedure level of 8 mm Hg (p=0.046). At the time of wound healing, 4 of 5 of patients achieved TcPO2 levels of >40 mm Hg. There were 2 major amputations, 1 above the knee after PDVA thrombosis and 1 below the knee for infection. Three patients died of causes unrelated to the procedure or study device at 6, 7, and 8 months, respectively. Limb salvage was 71% at 12 months. Conclusion: PDVA is an innovative approach for treating no-option CLI and represents an alternative option for the “desert foot,” potentially avoiding major amputation. Our results demonstrate its safety and feasibility, with promising early clinical results in this small cohort.

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Does Deep Femoral Artery Revascularization as an Isolated Procedure Play a Role in Chronic Critical Limb Ischemia?

Journal of Endovascular Therapy ◽

10.1583/03-1060.1 ◽

2004 ◽

Vol 11 (2) ◽

pp. 119-124 ◽

Cited By ~ 31

Author(s):

Nicolas Diehm ◽

Hannu Savolainen ◽

Felix Mahler ◽

Jürg Schmidli ◽

Do-Dai Do ◽

...

Keyword(s):

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Deep Femoral Artery ◽

Chronic Critical Limb Ischemia

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Long-Term Clinical Outcomes of Infrapopliteal Drug-Eluting Stent Placement for Critical Limb Ischemia in Diabetic Patients

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2015.06.034 ◽

2015 ◽

Vol 26 (10) ◽

pp. 1423-1430 ◽

Cited By ~ 11

Author(s):

Stavros Spiliopoulos ◽

Vasiliki Theodosiadou ◽

Konstantinos Katsanos ◽

Panagiotis Kitrou ◽

George C. Kagadis ◽

...

Keyword(s):

Clinical Outcomes ◽

Critical Limb Ischemia ◽

Stent Placement ◽

Limb Ischemia ◽

Drug Eluting Stent ◽

Diabetic Patients ◽

Drug Eluting

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Use of Tapered Balloons to Recanalize Occluded Below-the-Knee Arteries in Diabetic Patients with Critical Limb Ischemia

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.08.015 ◽

2016 ◽

Vol 31 ◽

pp. 105-110

Author(s):

Nicola Troisi ◽

Leonardo Ercolini ◽

Emiliano Chisci ◽

Piefrancesco Frosini ◽

Clara Pigozzi ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Below The Knee

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FACTORS RELATED TO AMPUTATION LEVEL AND WOUND HEALING IN DIABETIC PATIENTS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182605173445 ◽

2018 ◽

Vol 26 (5) ◽

pp. 342-345 ◽

Cited By ~ 5

Author(s):

Daniel Baumfeld ◽

Tiago Baumfeld ◽

Benjamim Macedo ◽

Roberto Zambelli ◽

Fernando Lopes ◽

...

Keyword(s):

Wound Healing ◽

Healing Time ◽

Diabetic Patients ◽

Distal Stump ◽

Vascular Intervention ◽

Laboratory Parameters ◽

Amputation Level ◽

Study Results ◽

Preoperative Antibiotics ◽

Wound Healing Time

ABSTRACT Objective: There are no specific criteria that define the level of amputation in diabetic patients. The objective of this study was to assess the influence of clinical and laboratory parameters in determining the level of amputation and the wound healing time. Methods: One hundred and thirty-nine diabetic patients were retrospectively assessed. They underwent surgical procedures due to infection and/or ischemic necrosis. Type of surgery, antibiotic use, laboratory parameters and length of hospital stay were evaluated in this study. Results: The most common amputation level was transmetatarsal, occurring in 26 patients (28.9%). The wound healing time increased with statistical significance in individuals undergoing debridement, who did not receive preoperative antibiotics and did not undergo vascular intervention. Higher levels of amputation were statistically related to limb ischemia, previous amputation and non-use of preoperative antibiotics. Conclusion: Patients with minor amputations undergo stump revision surgery more often, but the act of always targeting the most distal stump possible decreases energy expenditure while walking, allowing patients to achieve better quality of life. Risk factors for major amputations were ischemia and previous amputations. A protective factor was preoperative antibiotic therapy. Level of Evidence III, Retrospective Study.

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