scholarly journals The treatment of "critical ischemia" of the limbs in endarteritis obliterans by thickening of the tibial bone

2005 ◽  
Vol 52 (2) ◽  
pp. 61-65
Author(s):  
Slavko Tomic ◽  
O. Krajcinovic ◽  
Aleksandar Lesic ◽  
V. Bumbasirevic ◽  
Marko Bumbasirevic
Keyword(s):  
Operative Treatment ◽  
Arterial Occlusion ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Amputation Level ◽  
Ischemia Of The Limbs ◽  
Tibial Bone ◽  
Distraction Osteosynthesis ◽  
Ilizarov Apparatus ◽  
Endarteritis Obliterans

The authors report their experience in the treatment of the "critical ischemia" in 8 patients with arterial occlusion of the lower limbs in endarteritis obliterans. All patients were treated by thickening of the tibia using the Ilizarov apparatus for distraction osteosynthesis. In all cases the operative treatment ensured lowering of the amputation level, forming of the functional stump and long-lasting remission of the illness.

scholarly journals What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review

2021 ◽  
Vol 10 (7) ◽  
pp. 1413
Author(s):  
Judith Catella ◽  
Anne Long ◽  
Lucia Mazzolai
Keyword(s):  
Arterial Disease ◽  
Major Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Quality Of Data ◽  
Amputation Level ◽  
Increased Risk ◽  
Transcutaneous Oximetry ◽  
Peripheral Arterial

Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.

Use of intravenous alprostadil in patients with severe critical ischemia of the lower limbs

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 318-323
Author(s):  
Jorge Enrique Machado-Alba ◽  
Manuel E Machado-Duque
Keyword(s):  
Critical Limb Ischemia ◽  
Adverse Reactions ◽  
Limb Ischemia ◽  
Cross Sectional Study ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Cross Sectional ◽  
Potential Benefits ◽  
Advanced Stages ◽  
Clinical Records

Objectives To determine the indications for the use, potential benefits, and adverse reactions of alprostadil in a group of Colombian patients. Methods A retrospective cross-sectional study was conducted in patients diagnosed with critical limb ischemia who received alprostadil in five hospitals in Colombia between September 2011 and July 2017. We reviewed the clinical records of each patient to obtain the sociodemographic and pharmacological variables, clinical stages, complications, comorbidities, reported effectiveness and adverse reactions. Results Sixty-one patients treated with alprostadil were evaluated; 50.8% of patients were men, and the average age of 72.5 ± 10.7 years. A total of 86.9% of patients were hypertensive, and 65.6% were diabetic. A total of 77.0% presented ulceration, and this condition was considered as a diabetic foot in 57.4% of patients. A total of 81.9% of patients were classified as Fontaine stage 4; 60.7% received therapy as initially indicated, with an average of 19 days of alprostadil use. Regarding the therapy results, 58.0% of the patients with ulcers or trophic lesions showed improvement, 86.2% showed improvement of pain, and the limb was saved in 72.1% of patients. Conclusions Critical limb ischemia was presented by patients with advanced age and high cardiovascular risk who were treated during severe and advanced stages where therapeutic options are limited. Treatment with alprostadil achieved satisfactory results with improvement in ulcers, pain, and limb salvage rates in this series of patients.

scholarly journals Targeting HIF-1α to Prevent Renal Ischemia-Reperfusion Injury: Does It Work?

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Kapil Sethi ◽  
Kenny Rao ◽  
Damien Bolton ◽  
Oneel Patel ◽  
Joseph Ischia
Keyword(s):  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Tissue Injury ◽  
Ischemia Reperfusion ◽  
Arterial Occlusion ◽  
Small Animal ◽  
Kidney Injury ◽  
Renal Ischemia ◽  
Metabolic Adaptation ◽  
Critical Ischemia

Partial nephrectomy (open or minimally invasive) usually requires temporary renal arterial occlusion to limit intraoperative bleeding and improve access to intrarenal structures. This is a time-critical step due to the critical ischemia period of renal tissue. Prolonged renal ischemia may lead to irreversible nephron damage in the remaining tissue and, ultimately, chronic kidney disease. This is potentiated by the incompletely understood ischemia-reperfusion injury (IRI). A key mechanism in IRI prevention appears to be the upregulation of an intracellular transcription protein, Hypoxia-Inducible Factor (HIF). HIF mediates metabolic adaptation, angiogenesis, erythropoiesis, cell growth, survival, and apoptosis. Upregulating HIF-1α via ischemic preconditioning (IPC) or drugs that simulate hypoxia (hypoxia-mimetics) has been investigated as a method to reduce IRI. While many promising chemical agents have been trialed for the prevention of IRI in small animal studies, all have failed in human trials. The aim of this review is to highlight the techniques and drugs that target HIF-1α and ameliorate IRI associated with renal ischemia. Developing a technique or drug that could reduce the risk of acute kidney injury associated with renal IRI would have an immediate worldwide impact on multisystem surgeries that would otherwise risk ischemic tissue injury.

scholarly journals Combined Endovascular Treatment of Acute Coronary Syndrome with Bioresorbable Scaffolds and Angioplasty in Patient with Critical Lower Limb Ischemia – Hybrid Treatment in Multidisciplinary Hospital

2019 ◽  
Vol 14 (6) ◽  
pp. 901-907
Author(s):  
A. I. Zagorulko ◽  
R. V. Kolosov ◽  
A. V. Sidelnikov ◽  
Yu. V. Korzheva ◽  
A. G. Koledinsky
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Arteries ◽  
Lower Limb ◽  
Hybrid Methods ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Critical Ischemia ◽  
Long Term Outcome ◽  
Coronary Syndrome ◽  
Hybrid Treatment

The key to successful treatment in patients with acute coronary syndrome is maximally early revascularization of the coronary arteries. Treatment of multifocal atherosclerosis with lesions of the coronary and peripheral arteries requires coordinated work of the multidisciplinary team of doctors. Critical ischemia of the lower limbs requires urgent revascularization in order to prevent limb amputation. However, it is not always possible to perform revascularization using specialists of the same profile – endovascular or surgical. The use of hybrid methods of treatment (surgical and endovascular) allows to significantly improve the prognosis in saving the limb. The article presents a clinical observation of successful multistep treatment of a patient with acute coronary syndrome in combination with critical ischemia of the lower limb. The first stage was performed by multiple stenting of the coronary arteries with bioabsorptive scaffolds; the second stage was the hybrid treatment – femoral-tibial bypass with simultaneous recanalization and angioplasty of the lower leg arteries with good postoperative and long-term outcome.

Lower Limb Replantation: A report of nine cases

Foot & Ankle ◽  
1983 ◽  
Vol 3 (4) ◽  
pp. 197-202 ◽  
Author(s):  
Joseph E. Kutz ◽  
Jesse B. Jupiter ◽  
Tsu-Min Tsai
Keyword(s):  
Lower Limb ◽  
Lower Limbs ◽  
Bony Union ◽  
Amputation Level ◽  
Knee Amputation ◽  
Successful Case ◽  
Functional Gait

An analysis of nine replantations of completely amputated lower limbs is presented in this paper. Four cases were successful, including two at the level of the distal third of the tibia, one through the midfoot, and one at the proximal third of the tibia. The latter case involved the replantation of the shortened limb followed by a Syme's amputation of the foot to preserve a functional below-knee amputation level. In each successful case protective sensibility, bony union, and a stable stance and functional gait has been achieved, thereby eliminating a prosthetic requirement.

Diabetic Critical Ischemia of Lower Limbs: Distal Arterial Revascularisation

2009 ◽  
Vol 109 (3) ◽  
pp. 321-326 ◽  
Author(s):  
A.A. Khalifa ◽  
G. Gueret ◽  
A. Badra ◽  
P. Gouny
Keyword(s):  
Lower Limbs ◽  
Critical Ischemia ◽  
Arterial Revascularisation

scholarly journals Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

2013 ◽  
Vol 12 (4) ◽  
pp. 284-288
Author(s):  
Esdras Marques Lins ◽  
Jose Wellington Barros ◽  
Fernanda Appolonio ◽  
Eduardo Anacleto ◽  
Eduardo Cavalcanti Lima
Keyword(s):  
Myocardial Infarction ◽  
Lower Limb ◽  
Troponin I ◽  
Lower Limbs ◽  
Elevated Blood ◽  
Peripheral Artery ◽  
Conventional Surgery ◽  
Critical Ischemia ◽  
Infrainguinal Bypass ◽  
Peripheral Artery Occlusive Disease

BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

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