A RCT comparing the outcome of standard wound care and standard wound care combined with longitudinal distractive osteogenesis in chronic non-healing wounds of foot and ankle secondary to chronic limb ischemia

Revascularization is accomplished in 90–95% of CLI patients, according to current data. These findings indicate the increasing involvement of endovascular options (tibial angioplasty) in the last 5 years, indicated in the phrase "endovascular first" and often used in relativized indication. How long this more rigorous under-the-knee treatment will endure in a group of vascular patients with diabetes is uncertain. There is no reliable long-term evidence on how often and/or how quickly these patients need to be hospitalized to have their limbs amputated or CLI treatment. "10-30% of CLI patients can not be revascularized," most sources say.Vascular doctors require precise tools to analyze results to manage treatment for patients with limb-threatening ischemia. Historically, bypass-patency rates, amputation of larger limbs, and death were the most often used endpoints for measuring therapeutic efficacy. Because they're easy to recognize and document, they're important in clinical research. While more difficult to define and track, quality of life and functional status are more probable predictors of success.Amputation is not always necessary when standard revascularization is no longer an option for the patient, based on this paper's findings. Not every CLI patient is the same, and the effects of careful wound care alone in selected high-risk patients should not be overlooked. Also, some of the procedures/therapies discussed in this article may be appropriate for certain individuals. These techniques can be employed in patients with resting pain or non-healing wounds who have extensive minor artery disease, and no distal artery targets for standard open or endovascular revascularization, according to a literature review. As a reason, they are considered a last resort treatment when amputation seems to be the only plausible alternative decision. The hardest component of a vascular medicine specialist's work is to decide whether treatment is suitable for a given patient.

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Lower limb ischemia, the cause arising from difficult healing wounds – a case report

Leczenie Ran ◽

10.15374/lr2015008 ◽

2015 ◽

Vol 12 (2) ◽

pp. 59-67

Author(s):

Paulina Mościcka ◽

Maria T. Szewczyk ◽

Elżbieta Hancke ◽

Justyna Cwajda-Białasik ◽

Paweł Wierzchowski ◽

...

Keyword(s):

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Healing Wounds

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ANALYZING THE EFFECT OF RENAL FUNCTION IN PATIENTS WITH CHRONIC LIMB ISCHEMIA UNDERGOING ENDOVASCULAR TREATMENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02363-9 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1004

Author(s):

Aakash Sheth ◽

Harsh Patel ◽

Kirtenkumar Patel ◽

Samarthkumar Thakkar ◽

Devina Adalja ◽

...

Keyword(s):

Renal Function ◽

Endovascular Treatment ◽

Limb Ischemia ◽

Chronic Limb Ischemia

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Third-Party Reimbursement for Lower-Extremity Wound Care

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-92-1-54 ◽

2002 ◽

Vol 92 (1) ◽

pp. 54-58

Author(s):

Harry Goldsmith ◽

Matthew G. Garoufalis

Keyword(s):

Lower Extremity ◽

Wound Care ◽

Standard Of Care ◽

Third Party ◽

Foot And Ankle ◽

Lower Extremity Wound ◽

Third Party Reimbursement

This article describes the treatment of lower-extremity wounds, specifically foot and ankle ulcerations, in the context of reimbursement for treatments rendered. Therefore, such issues as standard of care, documentation, classification of foot wounds, coding, and reimbursement are discussed. (J Am Podiatr Med Assoc 92(1): 54-58, 2002)

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Abstract 239: Stem Cell Therapy Improves Critical Limb Ischemia

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a239 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Alaa Marzouk

Keyword(s):

Stem Cells ◽

Bone Marrow ◽

Stem Cell ◽

Peripheral Blood ◽

Mononuclear Cells ◽

Embryonic Stem ◽

Limb Ischemia ◽

Control Group ◽

Chronic Limb Ischemia

Introduction: The journey from single cell to complex being is attributable to stem cells role. Adult stem cells originate during ontogeny & persist in specialized niches within organs. Asymmetric division of each stem cell during differentiation produces : one daughter stem cell & one daughter transit amplifying/intermediate cell having migratory properties. Forced migration of hematopoietic stem/progenitor cells (HSPC) from bone marrow into peripheral blood is called mobilization. Accumulating evidence suggests that attenuation of the chemokine stromal derived factor-1(SDF-1)-CXCR4 axis that plays a pivotal role in retention of HSPC in bone marrow (BM) results in the release of these cells from the BM into peripheral blood. Recently, adult cells have been genetically reprogrammed to an embryonic stem cell like state. Induced pluripotent stem cells (IPSCs) were similar to human embryonic stem cells in morphology, proliferative capacity, expression of cell surface antigens, & gene expression. Treatment of ischemic vascular disease of lower limbs remains a significant challenge. Unfortunately, if medical & surgical salvage procedures fail, amputation is an unavoidable result for those patients. Aim of Work: (Hypothesis) To assess the application of implantation of autologous stem/progenitor cell in the treatment of chronic limb ischemia & to evaluate the safety, efficacy & feasibility of this novel therapeutic approach. Methods: A total of 24 patients with chronic limb ischemia not eligible for arterial reconstruction or endovascular procedures were enrolled & randomized (1:1) to either the implanted group or the control group. Control group: Conventional medical therapy in the form of anti platelet therapy & vasodilators. Implanted group: Subcutaneous injection of 300μ g/day of recombinant human granulocyte colony stimulating factor (G-CSF) for 5 days to mobilize stem/progenitor cells from BM. Total leucocytic count is measured daily to follow up successful mobilization of bone marrow mononuclear cells (BMMNCs). Stem cell Harvesting After 5 days peripheral blood mononuclear cells (PBMNCs) were harvested using a cell separator. Samples from apheresis products are subjected to TLC measurement & immunophenotypic characterization of CD34+ cells by flow cytometry. The collected PBMNCs were implanted by multiple intramuscular injections into ischemic limbs. Results: There was significant increase in pain free walking distance & ankle/brachial index (ABI) & significant decreased rest pain. Effectiveness was documented by : reduced number of amputation, increase ABI & improvement of the quality of life in therapeutic group compared to control group. Conclusion: The novel therapeutic approach of PBMNCs implantation in patients with chronic limb ischemia is safe, feasible & effective in decreasing co-morbidity & rate of amputation. Safety was manifested by absence of complications during G-CSF therapy or during harvesting & injection of the stem cells. Recommendations: 1- Future studies on larger number of patients & longer follow up. 2- Controlled studies using different methods & different cell population (PBMNCs, BMMNCs or MSCs) to compare the outcome of each. 3-Studing the role of endothelial progenitor cell dysfunction in different ischemic diseases to develop successful gene therapy.

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

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-2-28-32 ◽

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.

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Assessment of Frailty In Elderly Patients Attending A Multidisciplinary Wound Care Center: A Cohort Study.

10.21203/rs.3.rs-764391/v1 ◽

2021 ◽

Author(s):

Mariona Espaulella-Ferrer ◽

Joan Espaulella-Panicot ◽

Rosa Noell-Boix ◽

Marta Casals-Zorita ◽

Marta Ferrer-Sola ◽

...

Keyword(s):

Wound Healing ◽

Elderly Patients ◽

Healing Rate ◽

Wound Care ◽

Frailty Index ◽

Healing Time ◽

Venous Ulcers ◽

Healing Wounds ◽

Wound Healing Time ◽

The Relationship

Abstract Background: The incidence of frailty and chronic wounds increases with patients’ age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. Methods: The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centers (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at six months or upon wound healing. Wounds were followed up every two weeks. To analyze the relationship between two variables was used the Chi-square test and Student’s or the ANOVA model. The t-test for paired data was used to analyze the evolution of the frailty index during follow-up.Results: A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at six months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p=0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p=0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p=0.637). Wound healing rate is statically significantly higher in non-frail patients (3,26% wound reduction/day, P25-P75 0.8-8.8%/day) in comparison with frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day; p=0.044). Conclusion: Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

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GW26-e2286 MRI tissue perfusion evaluation in patients with chronic limb ischemia compared with healthy subjects.

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.06.952 ◽

2015 ◽

Vol 66 (16) ◽

pp. C245-C246

Author(s):

Nadezda Sinkevich ◽

E. Butorova ◽

M. Maslennikov ◽

O. Stukalova ◽

O. Bulkina ◽

...

Keyword(s):

Healthy Subjects ◽

Limb Ischemia ◽

Tissue Perfusion ◽

Chronic Limb Ischemia

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Pathophysiology of chronic limb ischemia

Gefässchirurgie ◽

10.1007/s00772-018-0380-1 ◽

2018 ◽

Vol 23 (S1) ◽

pp. 13-18 ◽

Cited By ~ 9

Author(s):

F. Simon ◽

A. Oberhuber ◽

N. Floros ◽

P. Düppers ◽

H. Schelzig ◽

...

Keyword(s):

Limb Ischemia ◽

Chronic Limb Ischemia

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Multidisciplinary Care for Critical Limb Ischemia: Current Gaps and Opportunities for Improvement

Journal of Endovascular Therapy ◽

10.1177/1526602819826593 ◽

2019 ◽

Vol 26 (2) ◽

pp. 199-212 ◽

Cited By ~ 11

Author(s):

Ehrin J. Armstrong ◽

Syed Alam ◽

Steve Henao ◽

Arthur C. Lee ◽

Brian G. DeRubertis ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Patient Population ◽

Wound Care ◽

Multidisciplinary Care ◽

Limb Ischemia ◽

Medical Specialty ◽

Complex Patient ◽

Arterial Insufficiency ◽

Artery Disease ◽

Improve Patient

Critical limb ischemia (CLI), defined as ischemic rest pain or nonhealing ulceration due to arterial insufficiency, represents the most severe and limb-threatening manifestation of peripheral artery disease. A major challenge in the optimal treatment of CLI is that multiple specialties participate in the care of this complex patient population. As a result, the care of patients with CLI is often fragmented, and multidisciplinary societal guidelines have not focused specifically on the care of patients with CLI. Furthermore, multidisciplinary care has the potential to improve patient outcomes, as no single medical specialty addresses all the facets of care necessary to reduce cardiovascular and limb-related morbidity in this complex patient population. This review identifies current gaps in the multidisciplinary care of patients with CLI, with a goal toward increasing disease recognition and timely referral, defining important components of CLI treatment teams, establishing options for revascularization strategies, and identifying best practices for wound care post-revascularization.

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