scholarly journals Using cell indirect revascularization for chronic limb ishemia

2014 ◽  
Vol 18 (1 (69)) ◽  
Author(s):  
R. V. Saliutin
Keyword(s):  
Progenitor Cells ◽  
Lower Limb ◽  
Human Liver ◽  
Fetal Liver ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Recovery Processes ◽  
Vascular Bed ◽  
Indirect Revascularization ◽  
Peripheral Arterial

The problem of treating patients with no reconstruction of peripheral arterial bed is relevant and it still remans open. The results of the pilot study with a simulated limb ischemia, demonstrated the feasibility and efficacy of fetal liver progenitor cells in activating regenerative and recovery processes as well as angiogenesis.The aim of the research was to investigate the clinical efficacy of cell "indirect" revascularization method in the complrehensive treatment of patients with chronic limb ischemia.The developed method of fetal human liver progenitor cells application in treatment of lower limb ischemia is an effective and affordable method of indirect revascularization. This method is indicated for use in patients whose vascular bed can not be reconstructed, and in elderly patients with severe concomitant pathologies.

Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia

2019 ◽  
Vol 15 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Hesham Ebrahim Ahmed Al-rudaini ◽  
Ping Han ◽  
Huimin Liang
Keyword(s):  
Digital Subtraction Angiography ◽  
Ct Angiography ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Definitive Treatment ◽  
Digital Subtraction ◽  
Arterial Tree ◽  
Lower Limb Ischemia ◽  
Significant Difference ◽  
Peripheral Arterial

Background:CT Angiography (CTA) of aortoiliac and lower extremity arteries is a relatively recent innovation of CT imaging that has changed after the introduction of multi-detector row scanners.Objective:The study aimed to evaluate the diagnostic accuracy of Multidetector Computed Tomographic Angiography (MDCTA) in the assessment of arterial tree in patients with Peripheral Arterial Occlusive Disease (PAOD), as compared to Digital Subtraction Angiography (DSA).Methods:A single-center nonrandomized prospective study was conducted on 50 patients complaining of peripheral arterial disease (chronic stage) from February 2017 to October 2017. All the patients were exposed to DSA and CTA prior to definitive treatment. The images were then analyzed using maximum intensity projection, volume-rendered, and curved multiplane reformation techniques.Results:All the patients involved in this study were susceptible according to their clinical presentation. The statistical analysis exposed a highly significant difference between CTA and DSA in the assessment of stenosis at the level of Femoropopliteal segment (P<0.01), while for infrapopliteal segment, there was no statistically significant difference between CTA and DSA having 8% versus 14% insignificant stenosis and 62% versus 47% significant stenosis in CTA and DSA, respectively. The overall accuracy of CT angiography in the femoropopliteal segments was 95.20% while in the infrapopliteal segment it was 94.5%.Conclusion:Multidetector CT angiography was found to be a reliable alternative mean for pathoanatomical description of the arterial lesions in critical lower limb ischemia and its subsequent management in comparison to digital subtraction angiography.

scholarly journals Hyperfibrinogenemia in Peripheral Arterial Disease: Coexistent and Independent Risk Factor (A Report of Two Cases and Review of Literature)

PRILOZI ◽  
2018 ◽  
Vol 39 (2-3) ◽  
pp. 93-96
Author(s):  
Marijan Bosevski ◽  
Gorjan Krstevski ◽  
Irena Mitevska ◽  
Emilija Antova ◽  
Golubinka Bosevska
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Lower Limb ◽  
Case Reports ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Lower Limb Ischemia ◽  
Left Limb ◽  
Peripheral Arterial

Abstract These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2. We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.

scholarly journals Genetics of Vascular Inflammation in Lower Limb Ischemia: The TNF-α Hypothesis in Peripheral Arterial Disease

2021 ◽  
Author(s):  
Diego Caicedo ◽  
Clara V. Álvarez ◽  
Sihara Pérez ◽  
Jesús Devesa
Keyword(s):  
Peripheral Arterial Disease ◽  
Mrna Expression ◽  
Lower Limb ◽  
Vascular Inflammation ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Lower Limb Ischemia ◽  
Hs Crp ◽  
Peripheral Arterial

Background: Vascular inflammation plays a crucial role in peripheral arterial disease (PAD), although the role of the mediators involved has not yet been properly defined. The aim of this work is to investigate gene expression and plasma biomarkers in chronic limb-threating ischemia (CLTI). Methods: Using patients from the GHAS trial, both blood and ischemic muscle samples were obtained to analyze plasma markers and mRNA expression, respectively. Statistical analy-sis was performed by using univariate (Spearman, t-Student, X2) and multivariate (multiple lo-gistic regression) tests. Results: 35 patients were available at baseline (29 for mRNA expression). Baseline characteristics (mean): Age:71.4&plusmn;12.4 (79.4% male); TNF-&alpha;:10.7&plusmn;4.9; hs-CRP:1.6&plusmn;2.2; Neutrophil-to-lymphocyte ratio (NLR):3.5&plusmn;2.8. Plasma TNF-&alpha; was found elevated (&ge;8.1) in 68.6% of patients, while high hs-CRP (&ge;0.5) in 60.5%. Diabetic patients with high level of inflammation showed significantly higher levels of NOX4 expression at baseline (p=0.0346). Plasma TNF-&alpha; had a negative correlation with eNOS expression (-0.5, p=0.015) and hs-CRP with VEGF-A (-0.63, p=0.005). The expression of NOX4 was parallel to that of plasma TNF-&alpha; (0.305, p=0.037), especial-ly in DM. Cumulative mortality at 12-month was related to NLR &ge;3 (p=0.019) and TNF-&alpha; &ge;8.1 (p=0.048). The best cut-off point for NLR to predict mortality was 3.4. Conclusions: NOX4 and TNF-&alpha; are crucial for the development and complications of lower limb ischemia, especially in DM. hs-CRP could have a negative influence on angiogenesis too. NLR and TNF-&alpha; represent suita-ble markers of mortality in CLTI. These results are novel because they connect muscle gene expres-sion and plasma information in patients with advanced PAD, deepening the search of new and ac-curate targets for this condition.

scholarly journals Comparison of Color Doppler and computed tomography angiography (CTA) in arterial disease in patients with lower limb ischemia.

2021 ◽  
Vol 28 (10) ◽  
pp. 1381-1391
Author(s):  
Muhammad Zakir ◽  
Anjum Tazeen ◽  
Faisal Nadeem Khan ◽  
Mehreen Fatima ◽  
Javed Tauqir ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Peripheral Arterial Disease ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
Color Doppler ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Cross Sectional ◽  
Lower Limb Ischemia ◽  
Peripheral Arterial

Objective: To compare the diagnostic accuracy of color Doppler ultrasound with computed tomography angiography in patients with lower limb ischemia and to assess the severity of stenosis. Study Design: Cross Sectional Analytical study. Setting: Shalamar Hospital, Lahore. Period: May 2020 to October 2020. Material & Methods: Data were collected according to the Age, Height, Weight, BMI, Duration of diabetes, Total Cholesterol, LDL, HDL, Triglyceride, Gender, Socioeconomic status, Diabetes, Hypertension, Stenosis, Collateral, calcification. Sample size of46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%).Data entry and analysis will be done by using SPSS version-23. Results: Total numbers of 46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%). According to the result analysis 34 patients had shown peripheral arterial disease at color Doppler and 12 patients had not shown peripheral arterial disease at color doppler. 38 patients had shown peripheral arterial disease at CTA and 8 patients had not shown peripheral arterial disease at CTA. Conclusion: This study concludes that computed tomography angiography for detection of peripheral arterial disease as the gold standard, MDCT angiography shows higher sensitivity (82.6%) than color-coded Doppler ultrasonography (73.9%) in the assessment of peripheral arterial disease.

scholarly journals The use of both internal thoracic arteries for coronary revascularization increases the estimate of post-operative lower limb ischemia in patients with peripheral artery disease

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Linda Renata Micali ◽  
Massimo Bonacchi ◽  
Daniel Weigel ◽  
Rosie Howe ◽  
Orlando Parise ◽  
...  
Keyword(s):  
Lower Limb ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Lower Limb Ischemia ◽  
Acute Kidney Disease ◽  
History Of ◽  
Artery Disease ◽  
Peripheral Arterial

Abstract Background Patients with a history of peripheral arterial disease (PAD) undergoing coronary artery bypass grafting (CABG) exhibit higher rates of complications. There are conflicting data on the survival benefits for bilateral thoracic artery (BITA) grafting compared with left internal thoracic artery (LITA) CABG in patients with PAD. The aim of the study was to explore the influence of the use of BITA grafts vs. LITA for CABG on post-operative acute lower limb ischemia (ALLI) and main post-operative complications in patients with concomitant PAD. Methods We used a propensity-score (PS) based analysis to compare outcomes between the two surgical procedures, BITA and LITA. The inverse probability of treatment weighting PS technique was applied to adjust for pre- and intra-operative confounders, and to get optimal balancing of the pre-operative data. The primary outcome was the estimate of postoperative ALLI. Secondary outcomes included overall death and death of cardiac causes within 30 days of surgery, stroke and acute kidney disease (AKD). Results The study population consisted of 1961 patients. The LITA procedure was performed in 1768 patients whereas 193 patients underwent a BITA technique. The estimate of ALLI was 14% higher in the BITA compared to the LITA (p < 0.001) group. Thirty-day mortality, cardiac death, occurrence of stroke and AKI did not differ significantly between the groups. Conclusions The use of both ITAs led to a significant increase in ALLI. This result was most likely caused by the complete disruption of the ITA collateral providing additional blood supply to the lower extremities. Based on our data, BITA should be used with extreme caution in PAD patients. Further research on this topic is necessary to confirm our findings.

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