Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia

The frequency of diabetic complications remains high despite the development of improved therapeutic modalities. Macroangiopathy continues to bethe predominant complication while coronary heart disease is the main cause of mortality.This paper considers clinical features of diabetic patientswith coronary heart disease and critical limb ischemia; various aspects of optimal drug therapy, preoperative examination and diagnostics precedingvascular non-cardiac surgery; preoperative risk assessment; indications for coronary angiography and myocardial revascularization. The authors emphasizethe importance of development of algorithms for the treatment of patients with diabetes, critical limb ischemia, and coronary heart disease.

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Cell therapy of critical limb ischemia in diabetic patients – State of art

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2017.02.028 ◽

2017 ◽

Vol 126 ◽

pp. 263-271 ◽

Cited By ~ 4

Author(s):

Michal Dubský ◽

Alexandra Jirkovská ◽

Robert Bem ◽

Andrea Nemcová ◽

Vladimira Fejfarová ◽

...

Keyword(s):

Cell Therapy ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

State Of Art

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Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

The American Surgeon ◽

10.1177/000313480507100605 ◽

2005 ◽

Vol 71 (6) ◽

pp. 474-480 ◽

Cited By ~ 10

Author(s):

Susan M. Trocciola ◽

Rabih Chaer ◽

Rajeev Dayal ◽

Stephanie C. Lin ◽

Naveen Kumar ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Clinical Success ◽

Ankle Brachial Index ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Arterial Disease ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Endovascular Interventions

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.

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Long-Term Outcomes of Direct and Indirect Below-The-Knee Open Revascularization Based on the Angiosome Concept in Diabetic Patients with Critical Limb Ischemia

Annals of Vascular Surgery ◽

10.1016/j.avsg.2013.08.026 ◽

2014 ◽

Vol 28 (4) ◽

pp. 983-989 ◽

Cited By ~ 36

Author(s):

Anne Lejay ◽

Yannick Georg ◽

Elvira Tartaglia ◽

Sébastien Gaertner ◽

Bernard Geny ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Long Term Outcomes ◽

Below The Knee

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The Prostacyclin Analogue Iloprost as an Early Predictor of Successful Revascularization in Diabetic Patients Affected by Critical Limb Ischemia and Foot Ulcers

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2018.08.021 ◽

2019 ◽

Vol 20 (7) ◽

pp. 594-597

Author(s):

Valentina Izzo ◽

Marco Meloni ◽

Laura Giurato ◽

Luigi Uccioli

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Foot Ulcers ◽

Diabetic Patients ◽

Prostacyclin Analogue ◽

Early Predictor

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Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

Vascular Medicine ◽

10.1177/1358863x16676901 ◽

2016 ◽

Vol 22 (1) ◽

pp. 28-34 ◽

Cited By ~ 10

Author(s):

Caitlin W Hicks ◽

Alireza Najafian ◽

Alik Farber ◽

Matthew T Menard ◽

Mahmoud B Malas ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Multivariable Analysis ◽

Limb Ischemia ◽

Major Amputation ◽

Primary Patency ◽

Tissue Loss ◽

Vascular Intervention ◽

Below The Knee ◽

Endovascular Interventions ◽

One Year

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

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