Ischaemic heart disease in patients with diabetes mellitus and critical lower limb ischemia

Aims. To assess prevalence of ischemic heart disease (IHD) and clinical features of asymptomatic IHD in patients with diabetes mellitus(DM) and critical lower limb ischemia (LLI).Materials and Methods. We examined 118 patients with DM, who underwent hospitalization for critical LLI. Besides routinecardiologic examination, all patients were subject to color duplex ultrasonography of lower limbs and CT contrast angiography. Patientswith proper indications underwent coronary angiography. Statistical data was processed with SPSS v17.0.0. software package. Results. We have found 58.5% of patients with DM and critical LLI to suffer from IHD - and approximately 40% to have myocardialinfarction in their medical history. According to acquired coronary angiograms, 89% of asymptomatic cases were characterized byhemodynamically significant stenosis, while 68.7% of them had either three arteries affected or left main coronary artery lesions. Conclusion. Patients with DM and critical LLI require thorough examination, as subclinical IHD may be masked in them by lowerlimb angiopathy.

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The role of hypoxia-inducible factorin the syndrome of chronic lower limb ischemia and influence of diabetes mellitus on process of angiogenesis

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2017-16-3-4-9 ◽

2017 ◽

Vol 16 (3) ◽

pp. 4-9 ◽

Cited By ~ 1

Author(s):

M. N. Kudykin ◽

V. V. Beschastnov ◽

R. A. Deryabin ◽

G. E. Sheiko ◽

L. M. Celousova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Lower Limb ◽

Hypoxia Inducible Factor ◽

Limb Ischemia ◽

Peripheral Artery ◽

Lower Limb Ischemia ◽

Cell Responses ◽

Patients With Diabetes ◽

Artery Disease

In this review, we pay attention to the role of the hypoxia-inducible factor (HIF) in the development of response of the organism to hypoxia. Special attention is given to the regulation of the cell responses to hypoxia in chronic peripheral artery disease in patients with diabetes mellitus (DM). Cells can survive by activation of a transcription of genes, involved in angiogenesis, glucose metabolism and cell proliferation. Artificial rising of concentration and activity of HIF stimulates an angiogenesis and improves ulcers healing of the lower extremities. The data of the literature are provided on the possible methods of increasing HIF concentration in tissues, which could be a new way to stimulate wound healing in the patients with DM.

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One-year Results of pCMV-VEGF165 Gene Transfer in Patients with Critical Lower Limb Ischemia Due to Peripheral Atherosclerosis and Diabetes Mellitus

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.945 ◽

2019 ◽

Vol 58 (6) ◽

pp. e328-e329

Author(s):

Roman Kalinin ◽

Igor Suchkov ◽

Nina Mzhavanadze ◽

Andrey Krylov ◽

Maria Abyzova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gene Transfer ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

One Year

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Analysis of associated diseases in patients with acute critical lower limb ischemia

Medicinski pregled ◽

10.2298/mpns1302041m ◽

2013 ◽

Vol 66 (1-2) ◽

pp. 41-45 ◽

Cited By ~ 10

Author(s):

Vladimir Manojlovic ◽

Vladan Popovic ◽

Dragan Nikolic ◽

Djordje Milosevic ◽

Janko Pasternak ◽

...

Keyword(s):

Mortality Rate ◽

Lower Limb ◽

Balloon Catheter ◽

Limb Ischemia ◽

Lower Limbs ◽

Metabolic Decompensation ◽

Arterial Embolism ◽

Lower Limb Ischemia ◽

Associated Diseases ◽

Arterial Blood

Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number of arterial thrombosis demanded more complex ?inflow? and ?outflow? ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Conclusion. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

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Hyperfibrinogenemia in Peripheral Arterial Disease: Coexistent and Independent Risk Factor (A Report of Two Cases and Review of Literature)

PRILOZI ◽

10.2478/prilozi-2018-0046 ◽

2018 ◽

Vol 39 (2-3) ◽

pp. 93-96

Author(s):

Marijan Bosevski ◽

Gorjan Krstevski ◽

Irena Mitevska ◽

Emilija Antova ◽

Golubinka Bosevska

Keyword(s):

Diabetes Mellitus ◽

Risk Factor ◽

Lower Limb ◽

Case Reports ◽

Limb Ischemia ◽

Arterial Disease ◽

Lower Limb Ischemia ◽

Left Limb ◽

Peripheral Arterial

Abstract These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2. We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.

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Evaluation of the effectiveness of spinal cord stimulation in patients with critical lower limb ischemia using the WIQ Questionnaire

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2019-2-50-58 ◽

2019 ◽

Vol 23 (2) ◽

pp. 50

Author(s):

O. V. Kamenskaya ◽

A. S. Klinkova ◽

I. Yu. Loginova ◽

A. V. Ashurkov ◽

V. V. Lomivorotov ◽

...

Keyword(s):

Diabetes Mellitus ◽

Spinal Cord ◽

Coronary Heart Disease ◽

Conflict Of Interest ◽

Lower Limb ◽

Walking Speed ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

One Year

Aim. To evaluate various parameters of walking using the Walking Impairment Questionnaire (WIQ) in patients with critical lower limb ischemia (CLLI) before and one year after spinal cord stimulation (SCS). Methods. In 46 patients with CLLI aged 64.5 (54.9–72.6) years, the following parameters were assessed before and one year after SCS using the WIQ questionnaire: pain, distance, speed, stairs, where 100% no restrictions when walking. Results. In patients with CLLI, low WIQ values were initially identified for the scales of distance, speed, and stairs, less than 10%, and about 30% for the pain scale. One year after SCS, the values of pain, distance, and speed increased to 83.3% (68.4%–100%), 39.5% (17.9%–55.2%), and 24.4% (17.3%–35.8%), respectively, with significance at p < 0.001, p = 0.004, and p = 0.005, respectively. The lowest rates were on the scale of stairs: 6.2% (3.4%–7.3%), p = 0.06. Before the SCS, the factor adversely affecting the indicators of the distance scale was diabetes mellitus (β = –0.417; p = 0.002), and the age factor adversely affected the walking speed (β = –0.544; p = 0.005). After SCS, age exerted a negative effect on the walking speed (β = –0.497; p = 0.002). The scale for stairs was negatively affected by the presence of coronary heart disease (β = –0.421; p = 0.001) or diabetes mellitus (β = –0.325; p = 0.032). Conclusion. The use of SCS in patients with CLLI improves the parameters of walking in the long-term follow up after treatment, except for the ability to climb stairs. Age and the presence of diabetes mellitus or coronary heart disease are adverse factors that affect the walking parameters, both before and in the long-term period after SCS.Received 14 March 2019. Accepted 25 July 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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Tactical approach to staged treatment of patients with chronic lower limb ischemia in combination with coronary heart disease

The Bulletin of Bakoulev Center Cardiovascular Diseases ◽

10.24022/1810-0694-2019-20-9-10-818-822 ◽

2019 ◽

Vol 20 (9-10) ◽

pp. 818-822

Author(s):

V.S. Arakelyan ◽

O.A. Demidova ◽

N.A. Gidaspov ◽

R.N. Lysyy ◽

A.S. Gagloeva

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Staged Treatment

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Reasons to use cilostazol

Medycyna Faktów ◽

10.24292/01.mf.0321.10 ◽

2021 ◽

Vol 14 (3) ◽

pp. 281-284

Author(s):

Andrzej Wojtak

Keyword(s):

Lower Limb ◽

Collateral Circulation ◽

Progressive Disease ◽

Limb Ischemia ◽

Lower Limbs ◽

Disease Development ◽

Lower Limb Ischemia ◽

Initial Stage ◽

Variable Distance ◽

Male Sex

Occlusive atherosclerosis of the lower limbs in the initial stage is characterized by symptoms of intermittent claudication with a variable distance depending on the severity of its changes. As a progressive disease, it may lead to the obstruction of the arteries of the lower extremities and the formation of a collateral circulation network in the form of natural by-passes of obstructed sections of the arteries. Disease development is accelerated by: older age, male sex, smoking, diabetes, dyslipidemic disorders and arterial hypertension. One of the effective forms of treatment of chronic lower limb ischemia in the course of atherosclerosis is pharmacotherapy with cilostazol.

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Acute Thrombosis of an Infrarenal Abdominal Aortic Aneurysm Presenting as Bilateral Critical Lower Limb Ischemia

Vascular and Endovascular Surgery ◽

10.1177/1538574420954297 ◽

2020 ◽

pp. 153857442095429

Author(s):

Hai-Lei Li ◽

Yiu Che Chan ◽

Dong-Zhe Cui ◽

Stephen W. Cheng

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limbs ◽

Neurological Deficits ◽

Leg Pain ◽

Lower Limb Ischemia ◽

Acute Thrombosis ◽

Abdominal Aortic

Background: Intraluminal thrombosis in the aneurysm sac is commonly seen in abdominal aortic aneurysm (AAA). Complete acute thrombosis of an AAA is a rare and catastrophic event. Method: We report a patient with acute AAA thrombosis presenting as bilateral lower limbs critical ischemia. A79-year-old male with a past history of AAA presented with acute onset of bilateral leg pain, coolness, weakness and numbness. His lower extremity pulses including femorals were absent bilaterally on physical examination. Urgent computed tomography angiography showed an infrarenal AAA measuring 45 mm in diameter. The aneurysm sac and bilateral common iliac arteries were completely occluded. Emergency open repair of AAA and bilateral iliac thrombectomy were successfully performed under general anesthesia. Result: Bilateral femoral pulses were present and the neurological deficits were completely resolved after operation. Patient recovered well and was asymptomatic at 3-month follow-up. Conclusion: Acute thrombosis of aortic aneurysm could be an unusual cause of lower limb ischemia, prompt diagnosis followed by surgical revascularization is essential to avoid prolonged ischemia.

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Contrast-Associated Acute Kidney Injury in Patients with and without Diabetes Mellitus Undergoing Computed Tomography Angiography and Local Thrombolysis for Acute Lower Limb Ischemia

Vascular and Endovascular Surgery ◽

10.1177/15385744211051503 ◽

2021 ◽

pp. 153857442110515

Author(s):

Talha Butt ◽

Leena Lehti ◽

Jan Apelqvist ◽

Anders Gottsäter ◽

Stefan Acosta

Keyword(s):

Diabetes Mellitus ◽

Acute Kidney Injury ◽

Lower Limb ◽

Kidney Injury ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Iodinated Contrast ◽

Increased Risk ◽

And Gender ◽

Iodine Dose

Purpose Repetitive iodinated contrast media exposure may be harmful for the kidneys. The aim of the present study was to evaluate if patients with diabetes mellitus (DM) undergoing CT angiography (CTA) and local continuous thrombolysis for acute lower limb ischemia (ALI) had an increased risk of developing contrast-associated acute kidney injury (CA-AKI) compared to patients without DM. Methods: This is a retrospective study of patients undergoing CTA and local continuous thrombolysis due to ALI between 2001 and 2018. CA-AKI was defined as a 25% increase in serum creatinine within 72 hours after latest contrast administration. Results: There was no difference ( P = .30) in the frequency of CA-AKI between patients with (27.9%; n = 43) and without DM (20.6%; n = 170). Among patients with CA-AKI, patients with DM had a lower ( P < .001) estimated glomerular filtration rate (eGFR) at discharge (55 ml/min/1.73 m2) than at admission (70 ml/min/1.73 m2), while no such difference was found in the group without DM ( P = .20). The gram-iodine dose/eGFR ratio was higher ( P < .001) in patients with CA-AKI (median 1.49, [IQR 1.34-1.81]) than in those who did not develop CA-AKI (median 1.05 [IQR 1.00-1.13]). There was a trend that gram-iodine dose/eGFR ratio (OR 1.42/standard deviation increment, 95% CI 1.00-2.02; P = .050) was associated with an increased risk of CA-AKI, after adjusting for DM, age, and gender. Conclusions: The frequency of CA-AKI was high after CTA and local continuous thrombolysis for ALI without shown increased frequency for the DM group. Among patients with CA-AKI, however, patients with DM had worse renal function at discharge than those without DM. The gram-iodine dose/eGFR ratio in these patients needs to be lower to improve renal outcomes, particularly in patients with DM.

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Efficacy and safety of intramuscular administration of allogeneic adipose tissue derived and expanded mesenchymal stromal cells in patients with critical limb ischemia and type 2 diabetes with no possibility of revascularization: Study protocol for a randomized controlled double-blind phase II clinical trial (The NOMA Trial).

10.21203/rs.3.rs-321347/v1 ◽

2021 ◽

Author(s):

Barbara Soria-Juan ◽

Mariano Garcia-Arranz ◽

Lucía Llanos ◽

César Aparicio ◽

Alejandro Gonzalez ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Cell Therapy ◽

Stromal Cells ◽

Lower Limb ◽

Limb Ischemia ◽

Therapeutic Angiogenesis ◽

Double Blind ◽

Lower Limb Ischemia

Abstract Background: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. Methods: A multicenter, randomized double-blind, placebo-controlled trial has been designed. 90 eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: the control group (n=30), low cell dose treatment group (n=30), and high cell dose treatment group (n=30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. Discussion: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future.Trial registration: ClinicalTrials.gov NCT04466007. Registered on January 07, 2020.

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