scholarly journals Critical Limb Ischemia In a Diabetes Mellitus Patient with Atrial Fibrilation

2020 ◽  
Vol 1 (2) ◽  
pp. 25
Author(s):  
Caesar Lagaliggo Givani ◽  
Hermina Novida
Keyword(s):  
Diabetes Mellitus ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Diabetes Mellitus Patient ◽  
Arterial Disease ◽  
Clinical Syndrome ◽  
Tissue Loss ◽  
Ischemic Pain ◽  
Atrial Fibrilation ◽  
Peripheral Arterial

Critical Limb Ischemia (CLI) is a clinical syndrome in the form of ischemic pain, especially at rest or a tissue loss condition, such as an ulcer or gangrene that does not heal, associated with Peripheral Arterial Disease (PAD). Diabetes mellitus (DM) accelerates atherosclerosis and becomes one of the risks of PAD. It is also known to accelerate the worsening of PAD with a 4x greater risk of developing CLI compared to patients without DM. At the other side, 60-95% of patients who are operated on as a result of limb ischemia are diagnosed with atrial fibrillation (AF). This paper is a case report regarding a patient with CLI as a complication of DM and AF.

scholarly journals Cell Therapy in Patients with Critical Limb Ischemia

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Rita Compagna ◽  
Bruno Amato ◽  
Salvatore Massa ◽  
Maurizio Amato ◽  
Raffaele Grande ◽  
...  
Keyword(s):  
Cell Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Tissue Loss ◽  
Systematic Analysis ◽  
Peripheral Arterial Obstructive Disease ◽  
Peripheral Arterial ◽  
Cellular Components

Critical limb ischemia (CLI) represents the most advanced stage of peripheral arterial obstructive disease (PAOD) with a severe obstruction of the arteries which markedly reduces blood flow to the extremities and has progressed to the point of severe rest pain and/or even tissue loss. Recent therapeutic strategies have focused on restoring this balance in favor of tissue survival using exogenous molecular and cellular agents to promote regeneration of the vasculature. These are based on stimulation of angiogenesis by extracellular and cellular components. This review article carries out a systematic analysis of the most recent scientific literature on the application of stem cells in patients with CLI. The results obtained from the detailed analysis of the recent literature data have confirmed the beneficial role of cell therapy in reducing the rate of major amputations in patients with CLI and improving their quality of life.

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

PRILOZI ◽  
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.

scholarly journals Endovascular invasions for femoral-popliteal segment disorders of C andD-type according to TASC-II classification

2018 ◽  
Vol 24 (2) ◽  
pp. 69-76
Author(s):  
O.L. Nikishin ◽  
M.I. Muz ◽  
A.I. Gavretskiy ◽  
I.V. Altman ◽  
S.I. Savoluk
Keyword(s):  
Peripheral Arterial Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Vascular Bed ◽  
Number Of Patients ◽  
Surgical Methods ◽  
Peripheral Arterial ◽  
Surgical Treatments ◽  
Medical Recommendations

Currently, direct re-vascularization for the management of critical limb ischemia (CLI) is effectuated through open and hybrid surgical treatments. At the same time, therapeutic recommendations for one of the methods appear as a subject of lasting discussions. Today TASC II (TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease) adopted in 2007 is the most popular document that provides justifications for endovascular and surgical treatment of peripheral arterial disease. Clinical practice provides evidence that there is a significant number of patients having critical limb ischemia who suffer from vascular bed disorders and are classified as C or D-type according to TASC classification. Meanwhile, there also are cases when these patients have no other alternative than re-vascularization by means of open surgery, which is why endovascular invasion appears as the only method of re-vascularization for them. The article presents some results of comparative studies within endovascular and surgical tools aimed at revascularization in the area of femoral-popliteal segment, including cases where patients are classified as C and D-type. The results of shunting operations are compared to angioplasty and remote endarterectomy, whereas technical methods for re-entry during subintimal angioplasty are regarded apart. Despite the fact that there are medical recommendations for the use of endovascular and surgical methods depending on TASC II classification, today there is no evidence that these tools can be efficient in revascularization of femoral-popliteal segment. In order to identify the efficiency of distinct methods in revascularization of femoral-popliteal segment there a need in a number of extended randomized studies designed to evaluate the role of such factors, as anatomic location of the vascular bed disorder, the extent of a disease, the location of purolo-necrotic areas as well as other pathologies on the results of the study.

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