Analysis of associated diseases in patients with acute critical lower limb ischemia

Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number of arterial thrombosis demanded more complex ?inflow? and ?outflow? ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Conclusion. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

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Reasons to use cilostazol

Medycyna Faktów ◽

10.24292/01.mf.0321.10 ◽

2021 ◽

Vol 14 (3) ◽

pp. 281-284

Author(s):

Andrzej Wojtak

Keyword(s):

Lower Limb ◽

Collateral Circulation ◽

Progressive Disease ◽

Limb Ischemia ◽

Lower Limbs ◽

Disease Development ◽

Lower Limb Ischemia ◽

Initial Stage ◽

Variable Distance ◽

Male Sex

Occlusive atherosclerosis of the lower limbs in the initial stage is characterized by symptoms of intermittent claudication with a variable distance depending on the severity of its changes. As a progressive disease, it may lead to the obstruction of the arteries of the lower extremities and the formation of a collateral circulation network in the form of natural by-passes of obstructed sections of the arteries. Disease development is accelerated by: older age, male sex, smoking, diabetes, dyslipidemic disorders and arterial hypertension. One of the effective forms of treatment of chronic lower limb ischemia in the course of atherosclerosis is pharmacotherapy with cilostazol.

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Prostaglandin E1 From the Tip of an Intraaortic Balloon Catheter for Lower Limb Ischemia

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(98)00039-3 ◽

1998 ◽

Vol 65 (4) ◽

pp. 1158-1160 ◽

Cited By ~ 2

Author(s):

Toshihide Nakano ◽

Ryuji Tominaga ◽

Kiminori Shiraishi ◽

Hisataka Yasui

Keyword(s):

Lower Limb ◽

Prostaglandin E1 ◽

Balloon Catheter ◽

Limb Ischemia ◽

Intraaortic Balloon ◽

Lower Limb Ischemia

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Acute Thrombosis of an Infrarenal Abdominal Aortic Aneurysm Presenting as Bilateral Critical Lower Limb Ischemia

Vascular and Endovascular Surgery ◽

10.1177/1538574420954297 ◽

2020 ◽

pp. 153857442095429

Author(s):

Hai-Lei Li ◽

Yiu Che Chan ◽

Dong-Zhe Cui ◽

Stephen W. Cheng

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limbs ◽

Neurological Deficits ◽

Leg Pain ◽

Lower Limb Ischemia ◽

Acute Thrombosis ◽

Abdominal Aortic

Background: Intraluminal thrombosis in the aneurysm sac is commonly seen in abdominal aortic aneurysm (AAA). Complete acute thrombosis of an AAA is a rare and catastrophic event. Method: We report a patient with acute AAA thrombosis presenting as bilateral lower limbs critical ischemia. A79-year-old male with a past history of AAA presented with acute onset of bilateral leg pain, coolness, weakness and numbness. His lower extremity pulses including femorals were absent bilaterally on physical examination. Urgent computed tomography angiography showed an infrarenal AAA measuring 45 mm in diameter. The aneurysm sac and bilateral common iliac arteries were completely occluded. Emergency open repair of AAA and bilateral iliac thrombectomy were successfully performed under general anesthesia. Result: Bilateral femoral pulses were present and the neurological deficits were completely resolved after operation. Patient recovered well and was asymptomatic at 3-month follow-up. Conclusion: Acute thrombosis of aortic aneurysm could be an unusual cause of lower limb ischemia, prompt diagnosis followed by surgical revascularization is essential to avoid prolonged ischemia.

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Pathogenesis of ischemia/reperfusion syndrome

Kazan medical journal ◽

10.17816/kmj2018-640 ◽

2018 ◽

Vol 99 (4) ◽

pp. 640-644 ◽

Cited By ~ 4

Author(s):

D E Kutepov ◽

M S Zhigalova ◽

I N Pasechnik

Keyword(s):

Blood Flow ◽

Lower Limb ◽

Ischemia Reperfusion ◽

Vascular Complications ◽

Limb Ischemia ◽

Biologically Active ◽

Lower Limbs ◽

Ion Pump ◽

Critical Ischemia ◽

Lower Limb Ischemia

Ischemia/reperfusion syndrome is a collective concept that combines various pathological conditions developing against the background of the restoration of the main blood flow in the organ or limb segment, which has long been subjected to ischemia or traumatic amputation. Intensive care physicians often see ischemia/reperfusion syndrome after restoration of blood supply in patients with critical ischemia of the lower limb. The rate of critical ischemia of the lower limbs ranges from 400 to 1000 cases per 1 million of the population. The number of lower limb amputations due to critical lower limb ischemia in economically developed countries is 13.7-32.3 cases per 100,000 of the population. The main etiological factors of critical lower limb ischemia are atherosclerosis of peripheral vessels and vascular complications of diabetes. The pathogenesis of ischemia/reperfusion syndrome is based on a complex of pathophysiological changes resulting from the restoration of blood flow in previously ischemic lower limb. Restoration of blood circulation leads to massive flow into the systemic bloodstream of anaerobic metabolism products, free myoglobin, biologically active substances and inflammatory mediators. The main sources of reperfusion damage are activated forms of oxygen, in particular, superoxide radical О2-, nitric oxide, lipid peroxidation products. In the conditions of primary ischemia, and then tissue reperfusion, excessive production of activated oxygen forms leads to damage of biological structures (lipids, proteins, deoxyribonucleic acid), which causes disruption of normal cell functioning or its death due to necrosis or apoptosis, ion pump dysfunction, adhesion of leukocytes and increased vascular permeability.

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Transplantation of cord blood cells as a method for the treatment of patients with distant artery of the lower limbs

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(3)-10 ◽

2018 ◽

Vol 22 (3) ◽

pp. 450-455

Author(s):

D. B. Dombrovsky ◽

V. V. Savin ◽

Yu.R. Pshyborovskaya

Keyword(s):

Cord Blood ◽

General Condition ◽

Lower Limb ◽

Blood Cells ◽

Lower Extremities ◽

Limb Ischemia ◽

Lower Limbs ◽

Lower Limb Ischemia ◽

Reconstructive Operations ◽

Cord Blood Cells

Treatment of patients with distal lesions of the arteries of the lower extremities is a rather urgent problem. The aim is to compare the clinical status of patients with distal arterial disease before treatment and after using cord blood cells. We examined 16 patients with manifestations of chronic lower limb ischemia on the background of obliterating atherosclerosis. The patients were examined, the impossibility of performing reconstructive operations was determined, the cord blood cells were introduced into the ischemia zone. After transplantation, in most cases, positive clinical symptoms were observed. Patients noted improvement in their general condition, gradually decreased, and after 1-3 months and further there was no pain at rest, their working capacity improved, their family relationships were balanced, the degree of ischemia according to Pokrovsky-Fontein was reduced, the distance and the speed of painless walking increased in 1, 3 times after 12 months. Analyzing the value of LDF, an improvement in microcirculation processes was noted in patients with chronic limb ischemia 6–12 months after the transplantation of cord blood cells. The indices of the control radiopaque contrast angiography of the vessels of the lower extremities testified to a significant improvement in the distal blood flow, due to the developed collateral network. A clinical case of patient G., with a lesion of the lower limb arterial bed caused by obliterating atherosclerosis of the lower limb arteries, is presented. After transplantation of cord blood cells and stimulation of angiogenesis, a long-term positive clinical effect was obtained, which manifested itself in the form of an improvement in the general condition, a decrease in the degree of ischemia according to the Pokrovsky-Fontain classification, an increase in the distance and speed of painless walking, and an improvement in microcirculatory parameters. So, it has been clinically proven that the use of the cord blood cell transplantation method to patients who cannot perform direct reconstructive interventions expands the possibilities of successful treatment of patients with chronic lower limb ischemia against the background of obliterating atherosclerosis.

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Ischaemic heart disease in patients with diabetes mellitus and critical lower limb ischemia

Diabetes Mellitus ◽

10.14341/2072-0351-6084 ◽

2012 ◽

Vol 15 (3) ◽

pp. 39-44

Author(s):

Konstantin Vladimirovich Melkozerov ◽

Victor Yur'evich Kalashnikov ◽

Sergey Anatol'evich Terekhin ◽

Olga Nikolaevna Bondarenko

Keyword(s):

Diabetes Mellitus ◽

Heart Disease ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limbs ◽

Lower Limb Ischemia ◽

Color Duplex Ultrasonography ◽

Patients With Diabetes ◽

Contrast Angiography ◽

Coronary Angiograms

Aims. To assess prevalence of ischemic heart disease (IHD) and clinical features of asymptomatic IHD in patients with diabetes mellitus(DM) and critical lower limb ischemia (LLI).Materials and Methods. We examined 118 patients with DM, who underwent hospitalization for critical LLI. Besides routinecardiologic examination, all patients were subject to color duplex ultrasonography of lower limbs and CT contrast angiography. Patientswith proper indications underwent coronary angiography. Statistical data was processed with SPSS v17.0.0. software package. Results. We have found 58.5% of patients with DM and critical LLI to suffer from IHD - and approximately 40% to have myocardialinfarction in their medical history. According to acquired coronary angiograms, 89% of asymptomatic cases were characterized byhemodynamically significant stenosis, while 68.7% of them had either three arteries affected or left main coronary artery lesions. Conclusion. Patients with DM and critical LLI require thorough examination, as subclinical IHD may be masked in them by lowerlimb angiopathy.

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Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽

10.1024/0301-1526.37.4.327 ◽

2008 ◽

Vol 37 (4) ◽

pp. 327-332 ◽

Cited By ~ 1

Author(s):

Koutouzis ◽

Sfyroeras ◽

Moulakakis ◽

Kontaras ◽

Nikolaou ◽

...

Keyword(s):

Upper Limb ◽

Lower Limb ◽

Cardiac Troponin ◽

Cardiac Involvement ◽

Troponin I ◽

Limb Ischemia ◽

Elevated Troponin ◽

Troponin Elevation ◽

Lower Limb Ischemia ◽

Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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