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

Abstract Background: Critical limb ischemia is considered the most severe form of peripheral artery disease. High morbidity and mortality rates are associated with this pathology due to poor economic management of complications. Case summary: A 68-year-old female patient underwent a routine Doppler ultrasound which revealed the obstruction of both the common and superficial right femoral arteries, as well as the right deep femoral artery. In this case, an iliofemoral bypass was performed using the right deep femoral artery as the outflow artery. Conclusion: Revascularization of the deep femoral artery has a reasonable chance of preserving the ischemic lower limb whenever the common and superficial femoral arteries suffer major atherosclerotic blockages.

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Comparative analysis of mouse bone marrow and adipose tissue mesenchymal stem cells for critical limb ischemia cell therapy

Stem Cell Research & Therapy ◽

10.1186/s13287-020-02110-x ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Pegah Nammian ◽

Seyedeh-Leili Asadi-Yousefabad ◽

Sajad Daneshi ◽

Mohammad Hasan Sheikhha ◽

Seyed Mohammad Bagher Tabei ◽

...

Keyword(s):

Stem Cells ◽

Bone Marrow ◽

Mesenchymal Stem Cells ◽

Adipose Tissue ◽

Cell Therapy ◽

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia

Abstract Introduction Critical limb ischemia (CLI) is the most advanced form of peripheral arterial disease (PAD) characterized by ischemic rest pain and non-healing ulcers. Currently, the standard therapy for CLI is the surgical reconstruction and endovascular therapy or limb amputation for patients with no treatment options. Neovasculogenesis induced by mesenchymal stem cells (MSCs) therapy is a promising approach to improve CLI. Owing to their angiogenic and immunomodulatory potential, MSCs are perfect candidates for the treatment of CLI. The purpose of this study was to determine and compare the in vitro and in vivo effects of allogeneic bone marrow mesenchymal stem cells (BM-MSCs) and adipose tissue mesenchymal stem cells (AT-MSCs) on CLI treatment. Methods For the first step, BM-MSCs and AT-MSCs were isolated and characterized for the characteristic MSC phenotypes. Then, femoral artery ligation and total excision of the femoral artery were performed on C57BL/6 mice to create a CLI model. The cells were evaluated for their in vitro and in vivo biological characteristics for CLI cell therapy. In order to determine these characteristics, the following tests were performed: morphology, flow cytometry, differentiation to osteocyte and adipocyte, wound healing assay, and behavioral tests including Tarlov, Ischemia, Modified ischemia, Function and the grade of limb necrosis scores, donor cell survival assay, and histological analysis. Results Our cellular and functional tests indicated that during 28 days after cell transplantation, BM-MSCs had a great effect on endothelial cell migration, muscle restructure, functional improvements, and neovascularization in ischemic tissues compared with AT-MSCs and control groups. Conclusions Allogeneic BM-MSC transplantation resulted in a more effective recovery from critical limb ischemia compared to AT-MSCs transplantation. In fact, BM-MSC transplantation could be considered as a promising therapy for diseases with insufficient angiogenesis including hindlimb ischemia.

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

VASA ◽

10.1024/0301-1526/a000934 ◽

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.

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Multidisciplinary Care Improves Amputation-Free Survival in Patients with Chronic Critical Limb Ischemia 1

50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know ◽

10.1201/9780429434020-41 ◽

2020 ◽

pp. 206-208

Author(s):

Juan Carlos Jimenez ◽

Samuel Eric Wilson

Keyword(s):

Critical Limb Ischemia ◽

Multidisciplinary Care ◽

Limb Ischemia ◽

Free Survival ◽

Chronic Critical Limb Ischemia

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Opportunities for improvement of distal autologous reconstructions in patients with chronic critical limb ischemia

Zaporozhye Medical Journal ◽

10.14739/2310-1210.2019.1.155809 ◽

2019 ◽

Vol 0 (1) ◽

Author(s):

O. I. Gudz

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Chronic Critical Limb Ischemia

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Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/1526602817701251 ◽

2017 ◽

Vol 24 (3) ◽

pp. 331-336 ◽

Cited By ~ 3

Author(s):

Yukun Li ◽

Ali Esmail ◽

Konstantinos P. Donas ◽

Georgios Pitoulias ◽

Giovanni Torsello ◽

...

Keyword(s):

Endovascular Treatment ◽

Success Rate ◽

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Technical Success ◽

Femoral Access ◽

Technical Success Rate ◽

Below The Knee ◽

Antegrade Approach

Purpose: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI). Methods: Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups. Results: Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047). Conclusion: The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.

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