scholarly journals Return To Work After Cell Transplantation in Patients With Angiitis-Induced Critical Limb Ischemia and Factors Related

2021 ◽  
Author(s):  
Hao Liu ◽  
Yifan Liu ◽  
Tianyue Pan ◽  
Yuan Fang ◽  
Gang Fang ◽  
...  
Keyword(s):  
Return To Work ◽  
Cell Transplantation ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Perioperative Period ◽  
Well Being ◽  
Cumulative Rate ◽  
Returning To Work ◽  
Independent Risk Factors

Abstract Backgrounds: Angiitis-induced critical limb ischemia (AICLI) patients, who are usually with young age and high amputation rate, always lose their labor force. Return to work (RTW), not only mean patients’ physical health for they could undertake the work but also demonstrate their psychological well-being. While cell transplantation showed satisfactory efficacy for AICLI patients, few studies in terms of AICLI patients’ returning to work after transplantation were reported. Methods From May 2009 to May 2021, AICLI patients who underwent cell transplantation and completed a no less than 12-month follow-up were retrospectively enrolled. Primary endpoint was RTW. Patients’ demographic characteristics, characteristics of ischemic limb, etc. were reviewed to analyze independent risk factors in terms of RTW. Results 171 AICLI patients (170 males) were enrolled with a mean age of 41.9 ± 9.6 years (range, 20–57 years). The 12-month and 24-month RTW cumulative rates were 69.4% (95% confidence interval [CI] 61.6%-75.6%) and 70.1% (95% CI 62.3%-76.2%), respectively. Age < 40 years (OR 2.659, 95% CI 1.138–6.719), and preoperative job as mental workers (OR 8.930, 95% CI 2.665–42.847) were identified as independent protective factors for RTW, perioperative limb infection of patients with ulcer or gangrene (OR 0.250, 95% CI 0.075–0.779) was identified as independent risk factor. Conclusion AICLI patients who underwent cell transplantation were with a satisfactory mid-term RTW cumulative rate. AICLI patients < 40 years old with preoperative occupation as mental workers were more likely to return to work. Prevention of limb infection during the perioperative period is of great significance to RTW.

scholarly journals Autologous Peripheral Blood Mononuclear Cells for Limb Salvage in Diabetic Foot Patients with No-Option Critical Limb Ischemia

2021 ◽  
Vol 10 (10) ◽  
pp. 2213
Author(s):  
Alessia Scatena ◽  
Pasquale Petruzzi ◽  
Filippo Maioli ◽  
Francesca Lucaroni ◽  
Cristina Ambrosone ◽  
...  
Keyword(s):  
Peripheral Blood Mononuclear Cells ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Limb Ischemia ◽  
Control Group ◽  
Peripheral Blood Mononuclear ◽  
Blood Mononuclear Cells

Peripheral blood mononuclear cells (PBMNCs) are reported to prevent major amputation and healing in no-option critical limb ischemia (NO-CLI). The aim of this study is to evaluate PBMNC treatment in comparison to standard treatment in NO-CLI patients with diabetic foot ulcers (DFUs). The study included 76 NO-CLI patients admitted to our centers because of CLI with DFUs. All patients were treated with the same standard care (control group), but 38 patients were also treated with autologous PBMNC implants. Major amputations, overall mortality, and number of healed patients were evaluated as the primary endpoint. Only 4 out 38 amputations (10.5%) were observed in the PBMNC group, while 15 out of 38 amputations (39.5%) were recorded in the control group (p = 0.0037). The Kaplan–Meier curves and the log-rank test results showed a significantly lower amputation rate in the PBMNCs group vs. the control group (p = 0.000). At two years follow-up, nearly 80% of the PBMNCs group was still alive vs. only 20% of the control group (p = 0.000). In the PBMNC group, 33 patients healed (86.6%) while only one patient healed in the control group (p = 0.000). PBMNCs showed a positive clinical outcome at two years follow-up in patients with DFUs and NO-CLI, significantly reducing the amputation rate and improving survival and wound healing. According to our study results, intramuscular and peri-lesional injection of autologous PBMNCs could prevent amputations in NO-CLI diabetic patients.

Significance of patient-reported outcomes for occupational resumption and quality of life after cardiac rehabilitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Salzwedel ◽  
I Koran ◽  
E Langheim ◽  
A Schlitt ◽  
J Nothroff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Performance ◽  
Well Being ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Funding Source ◽  
Patient Reported ◽  
Returning To Work

Abstract Introduction Comprehensive cardiac rehabilitation (CR) programs based on the bio-psycho-social approach of the international classification of functioning and disease are carried out to achieve improved prognosis, superior health-related quality of life (HRQL) and social integration. We aimed to identify predictors of returning to work (RTW) and HRQL among cardiovascular risk factors and physical performance as well as patient-reported outcome measures (PROMs) modifiable during CR. Methods We designed a prospective observational multi-center study and enrolled 1,586 patients (2017/18) in 12 German rehabilitation centers regardless of their primary allocation diagnoses (e.g. acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), coronary artery disease (CAD), valvular disease). Besides general data (e.g. age, gender, diagnoses), parameters of risk factor management (e.g. smoking, lipid profile, hypertension, lifestyle change motivation), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance), and PROMs (e.g. depression, heart-focused anxiety, HRQL, subjective well-being, somatic and mental health, pain, general self-efficacy, pension desire as well as self-assessment of occupational prognosis using several questionnaires) were documented at CR admission and discharge. 6 months after discharge, status of RTW and HRQL (SF-12) were captured by a follow-up (FU) survey and analyzed in multivariable regression models with multiple imputation of missing values. Results Out of the study participants, 1,262 patients (54±7 years, 77% men) responded to the follow-up survey and could be analyzed regarding the outcome parameters. Most of them were assigned to CR primarily due to AMI (40%) or CAD without myocardial infarction (18%), followed by heart valve diseases in 12% of patients and CABG (8%). 864 patients (69%) returned to work within the follow-up period. Pension desire, negative self-assessed occupational prognosis, heart-focussed anxiety, major life events, smoking and heart failure were negatively associated with RTW, while higher endurance training load, HRQL and work stress were positively associated (Figure 1). HRQL after 6 months was determined more by PROMs (e.g. pension desire, heart-focused anxiety, physical/mental HRQL in SF-12, physical/mental health in indicators of rehab-status questionnaire (IRES-24), stress, well-being in the World Health Organization well-being index and self-efficacy expectations) than by clinical parameters or physical performance. Conclusions Patient-reported outcome measures predominantly influenced RTW and HRQL in heart-disease patients, whereas patients' pension desire and heart-focussed anxiety had a dominant impact on all investigated endpoints. Therefore, the multi-component CR approach focussing on psychosocial support is crucial for subjective health prognosis and occupational resumption. Figure 1. Predictors of returning to work Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German pension insurance

Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Vascular ◽  
2021 ◽  
pp. 170853812110298
Author(s):  
Görkem Yiğit
Keyword(s):  
Critical Limb Ischemia ◽  
Bypass Graft ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Rotational Atherectomy ◽  
Total Occlusion ◽  
The Mean ◽  
Knee Pathology ◽  
Drug Coated Balloon

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.

scholarly journals Theoretical perspectives upon the return to work of cancer patients: The difficult path of integration in the organization

2015 ◽  
Vol 13 (2) ◽  
pp. 113-135 ◽  
Author(s):  
Radu-Ioan Popa
Keyword(s):  
Return To Work ◽  
Cancer Patients ◽  
General Framework ◽  
Well Being ◽  
Point Of View ◽  
Organizational Life ◽  
Theoretical Perspectives ◽  
Depth Analysis ◽  
Returning To Work

Abstract The present article follows an in-depth analysis of several relevant articles and major findings concerning the return to work of cancer patients, in various situations, from a manager and patient point of view, putting into discussion the effects and consequences of different factors that may influence the well-being of the patient at work and impact the organizational life. The concepts of returning to work and integration are scarcely analysed throughout the scholarly literature in the case of employees diagnosed with cancer, due to several reasons presented in the paper: from the complex topic of investigation that many studies fail to approach in terms of confidentiality, technical, ethical and moral grounds to the specific and difficult apparatus for research in the case of an even more complex, multiple instances and personalized manifestation long-term illness. In conclusion, the general framework solicits for a more integrated model of research and future multi-facet schemes for interventions, considering that there is a general consensus focusing on the need for connecting the health services with the employee and employer level, alongside stakeholders’ active participation.

scholarly journals SIMULTANEOUS REVASCULARIZATION OF AORTOFEMORAL AND FEMOROPOPLITEAL ARTERIAL SEGMENTS BY SEMICLOSED LOOP ENDARTERECTOMY

2017 ◽  
Vol 176 (2) ◽  
pp. 28-32
Author(s):  
V. V. Shlomin ◽  
A. V. Gusinskiy ◽  
M. L. Gordeev ◽  
I. V. Mikhailov ◽  
D. N. Maistrenko ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Occlusive Disease ◽  
Long Term Results ◽  
Single Level ◽  
Individual Approach ◽  
Chronic Limb Ischemia

OBJECTIVE. The authors would like to consider the possibility and feasibility of simultaneous revascularization of two arterial segments in patients with lower extremity arterial occlusive disease by method of semiclosed loop endarterectomy. MATERIALS AND METHODS. The research included 143 patients. Revascularization of aortofemoral segment was performed on 67 patients. The simultaneous revascularization of aortofemoral and femoropopliteal segments was carried out for 76 patients. The follow-up period was 5 years. RESULTS. There was revealed that the long-term results of multilevel reconstruction were worse that single-level reconstruction. This method requires an individual approach. The best results of simultaneous interventions were obtained in patients aged 60 and older with the III stage of chronic limb ischemia and 2 or 3 working shin arteries. The worst results were observed in patients younger than 50 year old with IV stage of critical limb ischemia and significant lesions of shin arteries.

Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Grant W Reed ◽  
Negar Salehi ◽  
Pejman Raeisi-Giglou ◽  
Umair Malik ◽  
Rami Kafa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Proportional Hazards ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Kaplan Meier

Introduction: There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy. Methods: In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis. Results: A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005). Conclusions: A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.

P942Impact of left ventricular ejection fraction in patients with critical limb ischemia: from I-PAD registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Fujimori ◽  
A Nagae ◽  
T Miura ◽  
T Katoh ◽  
M Hirabayashi ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
End Point

Abstract Introduction In patients with critical limb ischemia (CLI) it is known that malnutrition, low BMI, inflammation and so on are prognostic factors. But, it is unclear whether left ventricular ejection fraction (LVEF) affects prognosis of CLI patients. So we investigated that LVEF affects prognosis of CLI patients. Methods From July 2015 to July 2016, 371 consecutive peripheral artery disease patients who performed endovascular treatment (EVT) were enrolled in I-PAD registry. 179 of them were patients with CLI. We could conduct follow up survey about 126 (age 75.5±11.1, men 63.5%) and divided two groups according to their LVEF (group with LVEF≤40%, n=13, group without LVEF≤40%, n=113). The primary end point was major adverse limb events (MALE: TLR, TVR, major amputations) and secondary end point was all-cause death. Results The median follow-up period was 11.5±6.7 months. The 18 months MALE rate was significant higher in the group with low LVEF than group without low LVEF (76.9% vs 37.2% p<0.05). The 18months all-cause death tended to be higher in the group with low LVEF, however there was not statistical significance in the two groups (53.8% vs 24.8% p=0.09). Conclusion LVEF was associated with MALE in patients with CLI.

Therapeutic Angiogenesis in Critical Limb Ischemia by Implantation of Autologous Hematopoietic Cells.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4222-4222
Author(s):  
Juan Besalduch ◽  
Raul Lara ◽  
Antonia Sampol ◽  
Antonio Gutierrez ◽  
Pacual Lozano ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Blood Cells ◽  
Gastrocnemius Muscle ◽  
Hematopoietic Cells ◽  
Limb Ischemia ◽  
Therapeutic Angiogenesis ◽  
Peripheral Mononuclear Blood ◽  
Pain At Rest ◽  
Walking Time

Abstract Patients with critical limb ischemia in whom surgical repair is not possible because bad distal vasculature, have an ominous prognosis. This study describes a technique for treatment of patients with critical limb ischemia with implantation of autologous peripheral mobilized hematopoietic cells, with the aim to stimulate angiogenesis. Twelve patients (9M, 3F), with a median age of 58 years (22–78) with critical limb ischemia were treated by injections of peripheral mobilized blood cells in the gastrocnemius muscle of the affected limb. The inclusion criteria were patients with chronic limb ischemia grade III-IV by Doppler examination, plethismography and angiography, with failure to respond to non-surgical treatment and some with previous surgery, and that were no candidates for surgical revascularization. The patients were treated by G-CSF (Neupogen, Amgen) 5μ /kg weight/d during 5 days. At day fifth and sixth we obtained peripheral mononuclear blood cells by means of a CS-3000 Plus (Baxter) blood cell separator. The unmanipulated cells were injected in the affected limb in 2 ml aliquots into the gastrocnemius muscle. Each product of a single apheresis (volume 50 ml) were injected in a sole limb. Six patients received injections only in one limb. Each patient were evaluated regularly for rest pain, amount of required analgesia, healing of the ulcers, peak walking time and, Doppler, plethismographic and angiographic findings. The mean number of injected CD34+ cells in each limb was 0.77 x 106/kg. There were no secondary effects for the mobilization and injection of cells in the 12 studied patients. Moreover, in 7 patients studied with a median follow-up of 1 year, 5 showed an improvement of all parameters, specially pain at rest, peak walking time and skin throphic lesions. Two patients suffered early amputation of the affected extremity because obstruction of an old by-pass. Despite the short follow-up and small patient series, this technique is expected to achieve relief of pain and decrease in major amputations in this critical population. However, comparative studies with longer follow-up should be done to confirm the benefits of this technique.

Peripheral endothelial progenitor cells (CD133+) for therapeutic vasculogenesis in a patient with critical limb ischemia. One year follow-up

Cytotherapy ◽  
2007 ◽  
Vol 9 (1) ◽  
pp. 99-102 ◽  
Author(s):  
M.C. Cañizo ◽  
F. Lozano ◽  
J.R. González-Porras ◽  
M. Barros ◽  
N. López-Holgado ◽  
...  
Keyword(s):  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Endothelial Progenitor ◽  
One Year
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