Lower limb arterial intervention or autologous platelet-rich gel treatment of diabetic lower extremity arterial disease patients with foot ulcers

Introduction: Peripheral arterial disease is a condition due to partial or complete occlusion of arteries excluding that of heart and brain. Lower extremity arterial disease is specific to lower limbs. Some of the patients are asymptomatic while a majority present with claudication, rest pain, ulceration or even gangrene. Methods: We took all admitted cases of lower extremity arterial disease from January, 2015 to December 2018. ABI was used as the first clinical tool for the diagnosis of PAD in patients with history or physical examination findings suggestive of PAD as per AHA guidelines. Outpatient arterial Doppler ultrasonography complemented by lower limb CT angiogram was used as a confirmatory tool for the diagnosis and also to assess anatomical location and severity of stenosis. Results: Total of 54 cases of lower extremity arterial diseases were identified with a mean age of 59.2 years (S.D. 11.4). Right lower limb was involved in 35(50%). Mean age was 58 years(SD 13.1). Mean duration of symptom was 3.4 years (SD 3.3). Claudication was present in all the patients. 32(45.7%) had ulcers. Toe(44.3%) was most commonly involved. Decreased local temperature(91.4%) and color change(87.1%) were major symptoms. 35(50%) of the patients had gangrene. Mean peak systolic velocity was lowest in the peroneal artery. 16.6% patients got additional peripheral bypass surgery. Conclusion: Claudication, decreased local temperature and color change were very common findings of lower extremity arterial disease. Gangrene was present in half of the patients.

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Retraction Note: Association of severity of coronary artery disease by SYNTAX score (SS) and lower extremity arterial disease by duplex ultrasound (DUS) study—an Indian perspective

The Egyptian Heart Journal ◽

10.1186/s43044-020-00130-9 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Saumen Nandi ◽

Anindya Mukherjee ◽

Dibbendhu Khanra ◽

Kaushik Biswas

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Lower Extremity ◽

Duplex Ultrasound ◽

Arterial Disease ◽

Syntax Score ◽

Lower Extremity Arterial Disease ◽

Retraction Notice ◽

Artery Disease ◽

Indian Perspective

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s43044-020-00091-z.

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Omega-3 Polyunsaturated Fatty Acid Supplementation in Patients with Lower Extremity Arterial Disease

Journal of the American College of Nutrition ◽

10.1080/07315724.2021.1891155 ◽

2021 ◽

pp. 1-9

Author(s):

Min-I Su ◽

Ying-Chih Cheng ◽

Yu-Chen Huang ◽

Cheng-Wei Liu

Keyword(s):

Fatty Acid ◽

Lower Extremity ◽

Polyunsaturated Fatty Acid ◽

Arterial Disease ◽

Omega 3 ◽

Lower Extremity Arterial Disease ◽

Fatty Acid Supplementation ◽

Acid Supplementation

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An update on vessel preparation in lower limb arterial intervention

CVIR Endovascular ◽

10.1186/s42155-020-00175-6 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

William Ormiston ◽

Shelagh Dyer-Hartnett ◽

Rukshan Fernando ◽

Andrew Holden

Keyword(s):

Lower Limb ◽

Vessel Wall ◽

Arterial Intervention ◽

Arterial Disease ◽

Long Term Outcomes ◽

Pulsatile Pressure ◽

Short And Long Term ◽

Late Restenosis ◽

Vessel Preparation

Abstract Background Plain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes. We aim to give an overview of some of the devices currently available, or under investigation, for vessel preparation in the lower limb. Main text Vessel preparation devices include those that remove plaque (atherectomy devices) and those that modify plaque. The four groups of plaque removing atherectomy devices are defined by their plaque removal method: Directional, rotational orbital and excimer laser are categories of devices investigated for plaque modification. Intravascular lithotripsy devices generate sonic pulsatile pressure waves that pass into the vessel wall cracking calcified plaques whilst sparing soft tissue. This enables dilatation of calcified lesions at low pressure by conventional balloons and enables full stent expansion. Other balloon based vessel preparation devices were designed to modify plaque and produce more controlled, lower pressure luminal expansion without major dissections and potentially with less recoil than conventional angioplasty balloons. Scoring balloons have a helical nitinol element attached to the balloon that scores plaque facilitating uniform luminal enlargement. Further specialty balloons have been developed in recent years, including the Chocolate, Phoenix and Serranator balloons. Finally, the temporary Spur self-expanding retrievable nitinol stent has a series of radially aligned spurs that are driven into the vessel wall by post-dilatation, potentially improving drug delivery. Conclusion Lesion specific vessel preparation aims to improve both short and long term outcomes through improved penetration of anti-proliferative drug, maximising luminal gain, reducing the need for stent placement and minimising intimal injury. Some forms of vessel preparation appear to improve short term outcomes; long-term outcomes remain uncertain. An overview of some of the multiple devices available for vessel preparation is presented.

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Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

The Surgery Journal ◽

10.1055/s-0041-1731444 ◽

2021 ◽

Vol 07 (03) ◽

pp. e132-e137

Author(s):

Mohammed Alagha ◽

Thomas M. Aherne ◽

Ahmed Hassanin ◽

Adeel S. Zafar ◽

Doireann P. Joyce ◽

...

Keyword(s):

Lower Extremity ◽

Sensitivity And Specificity ◽

False Negative ◽

Arterial Disease ◽

Initial Assessment ◽

Reference Standard ◽

Lower Extremity Arterial Disease ◽

Negative Results ◽

Positive Results ◽

Arterial Imaging

Abstract Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark. Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard. Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively. Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.

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