The Ability of Fluorescence Angiography to Detect Local Ischemia in Patients With Heel Ulceration

2018 ◽  
Vol 11 (3) ◽  
pp. 269-276
Author(s):  
Valerie S. Marmolejo ◽  
Jonathan F. Arnold
Keyword(s):  
Objective Assessment ◽  
Case Series ◽  
Tissue Perfusion ◽  
Arterial Disease ◽  
Fluorescence Angiography ◽  
Vascular Studies ◽  
Term Care ◽  
Vascular Intervention ◽  
Indocyanine Green Fluorescence ◽  
Peripheral Arterial

Heel ulcerations are a significant burden of care in both hospital and long-term care settings. The presence of peripheral arterial disease as a contributing factor to delayed healing is often not recognized, resulting in prolonged healing and high patient morbidity and mortality. Formal vascular evaluation and intervention is often not performed as these patients can have palpable pedal pulses while having localized ischemia of the heel. As routine noninvasive vascular studies can be affected by medial calcinosis and collateralization and do not specifically assess tissue perfusion to the heel, a false sense of security of adequate perfusion for healing can result. Indocyanine green fluorescence angiography (ICGFA) allows for real-time visualization and objective assessment of site specific tissue perfusion not limited by the factors that can make routine noninvasive vascular studies unreliable or unobtainable. A retrospective medical record review of a subset of patients with chronic heel ulceration from a prospective institutional review board–approved study in which serial ICGFA was performed during their treatment course was performed. ICGFA was able to identify local heel ischemia and expedite vascular intervention. ICGFA should be considered as an additional vascular study in patients presenting with chronic, nonhealing heel ulcerations. Levels of Evidence: Level IV: Diagnostic, Case series

Noninvasive Assessment of Lower-extremity Hemodynamics in Individuals with Diabetes Mellitus

2010 ◽  
Vol 100 (5) ◽  
pp. 406-411 ◽  
Author(s):  
Charles A. Andersen
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Objective Assessment ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Arterial Disease ◽  
Vascular Studies ◽  
Patients With Diabetes ◽  
Noninvasive Assessment ◽  
Peripheral Arterial

The timely and accurate noninvasive assessment of peripheral arterial disease is a critical component of a limb preservation initiative in patients with diabetes mellitus. Noninvasive vascular studies can be useful in screening patients with diabetes for peripheral arterial disease. In patients with clinical signs or symptoms, noninvasive vascular studies provide crucial information on the presence, location, and severity of peripheral arterial disease and an objective assessment of the potential for primary healing of an index wound or a surgical incision. Appropriately selected noninvasive vascular studies are important in the decision-making process to determine whether and what type of intervention might be most appropriate given the clinical circumstances. Hemodynamic monitoring is likewise important after either an endovascular procedure or a surgical bypass. Surveillance studies, usually with a combination of physiologic testing and imaging with duplex ultrasound, accurately identify recurrent disease before the occurrence of thrombosis, allowing targeted reintervention. Noninvasive vascular studies can be broadly grouped into three general categories: physiologic or hemodynamic measurements, anatomical imaging, and measurements of tissue perfusion. These types of tests and suggestions for their appropriate application in patients with diabetes are reviewed. (J Am Podiatr Med Assoc 100(5): 406–411, 2010)

scholarly journals Review of 20 years of vascular surgery research in Australasia: Defining future directions

2019 ◽  
Vol 7 ◽  
pp. 205031211987106
Author(s):  
Judy Wang ◽  
Jasamine Coles-Black ◽  
Matija Radojcic ◽  
Jason Chuen ◽  
Philip Smart
Keyword(s):  
New Zealand ◽  
Peripheral Arterial Disease ◽  
Vascular Surgery ◽  
Case Series ◽  
Arterial Disease ◽  
Future Research ◽  
Hybrid Surgery ◽  
Peripheral Arterial ◽  
High Level ◽  
Over Time

Objectives: High-quality research is fundamental to the advancement of surgical practice. Currently, there is no quantitative assessment of the research output of vascular surgeons in Australia and New Zealand. By conducting this bibliometric analysis, we aim to provide an objective representation of the trends in vascular surgery and guide future research. Methods: A list of all current vascular surgeons in Australia and New Zealand was compiled from the Royal Australasian College of Surgeons ‘Find a Surgeon’ website tool and correlated with the Australia and New Zealand Society for Vascular Surgery database. A Scopus search of each surgeon’s author profile over the last 20 years was conducted. Results: In total, 2120 articles were published by 208 Australasian vascular surgeons between 1998 and July 2018, with an overall increase in publications over time. Audits or case series were the most published type of study and only 8% of the publications were of high-level evidence. The most popular topics were thoracoabdominal aortic pathologies (24%), followed by peripheral arterial disease (15%). Chronological analysis illustrates an increasing volume of peripheral arterial disease research over time and there is a clear trend towards more endovascular and hybrid surgery publications. The top 10 (5%) highest publishing authors by h-index account for 41% of all publications and 49% of all citations and are also responsible for producing significantly more high-level evidence research. Conclusion: Australasian vascular surgeons have made a significant contribution to medical research. However, the majority of these articles are of low-level evidence. In this time, there has been an increasing number of publications on endovascular and hybrid surgery in keeping with the trend in clinical practice. These areas, as well as research regarding peripheral arterial disease, show potential for high-evidence research in the future.

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 ATHerosclerosis of the lower extremIties as a liNKed comorbidity in Patients Admitted for carDiac rehabilitation (THINKPAD): rationale, design, and study group

2015 ◽  
Vol 78 (1) ◽  
Author(s):  
Marco Ambrosetti ◽  
Tommaso Diaco ◽  
Oreste Febo ◽  
Pasqualina Calisi ◽  
Giuseppe Favretto ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Case Series ◽  
Data Entry ◽  
Lower Extremities ◽  
Cardiovascular Prevention ◽  
Arterial Disease ◽  
Retrospective Case ◽  
Primary Indication ◽  
Wide Range ◽  
Peripheral Arterial

Peripheral arterial disease (PAD) is a frequent comorbidity among patients entering cardiac rehabilitation (CR) programmes and an important source of disability and impaired prognosis. The prevalence of PAD across the wide range of conditions for CR is poorly understood, as far as its impact on drug optimization and intervention delivered. The “ATHerosclerosis of the lower extremIties as a liNKed comorbidity in Patients Admitted for carDiac rehabilitation” (THINKPAD) study was carried out by the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) in order to explore PAD both as a comorbidity and a primary indication at the entry of CR. The study was a retrospective case series. In the study period (from May 1, 2012 to June 30, 2012), data on consecutive patients discharged from 17 CR units in Northern Italy were collected. Web-based electronic case report forms (e-CRF), accessible in a dedicated section of the IACPR website (www.iacpr.it), were used for data entry, and data were transferred via web to a central database. The data collection instrument was designed with a multiple choice format, with jump menus or select boxes and obligatory items. A sample size of 1,300 subjects is expected, with first data available by the end of 2012.

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