scholarly journals NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

2020 ◽  
Vol 18 (6) ◽  
pp. 710-715
Author(s):  
N. N. Ioskevich ◽  
◽  
L. F. Vasilchuk ◽  
P. E. Vankovich ◽  
S. P. Antonenko ◽  
...  
Keyword(s):  
Lower Limb ◽  
Type I Diabetes ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Type I ◽  
Critical Ischemia ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

scholarly journals A Very Rare Cause of Lower Limb Ischemia in Young People: Popliteal Artery Entrapment

2018 ◽  
Vol 12 (1) ◽  
pp. 18-28 ◽  
Author(s):  
Hasan Baki Altinsoy ◽  
Ozkan Alatas ◽  
Emjed Khalil ◽  
Kenan Abdurrahman Kara ◽  
Candan Cudi Okten ◽  
...  
Keyword(s):  
Young People ◽  
Early Diagnosis ◽  
Popliteal Artery ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Diagnostic Tools ◽  
Type I ◽  
Conventional Angiography ◽  
Lower Limb Ischemia ◽  
Popliteal Artery Entrapment

Background: Popliteal artery entrapment syndrome (PAES) is a very rare pathology that can cause lower extremity ischemia in healthy young people. Anomalous anatomic relationships between the popliteal artery (PA) and the surrounding musculo-tendinous structures cause PAES. We present 31 patients with PAES in 35 limbs that were treated surgically in our clinic within a 12-year period. Patients and Methods: From 2001 to 2015, 31 patients (mean age: 32 ± 7.4 years) underwent surgery for PAES. ; 4 patients presented had bilateral PAES. Doppler ultrasonography (US), magnetic resonance angiography (MRA), and conventional angiography were performed as diagnostic procedures. We detected Type I PAES in 4 limbs and Type II PAES in 12 limbs. In the remaining 19 limbs, we diagnosed Type III or Type IV PAES. Simple release of the PA, PA embolectomy and simple release, and the radial artery (RA) patch angioplasty, with or without thromboendarterectomy (TEA), were performed. In 12 limbs, PA continuity was provided by RA interposition. Results: With the exception of 5 patients, no complications were seen after surgery. Haematoma was detected in 2 patients and local infection in 2 patients. One patient required a revision for recurrent PA thromboembolic event 12 h after surgery. At a median follow- up of 23 months (range: 11-29 months), there were no postoperative complications. Conclusions: PAES can result in lower limb ischemia due to chronic vascular trauma in young healthy patients. The use of diagnostic tools such as US, a non-invasive method, and MRA are effective diagnostic tools for early diagnosis. With their combined approach, exact and early diagnosis can be achieved. PA release, alone or with arterial bypass using RA, is a viable treatment option when intervention is necessary to prevent limb loss in the early stages of the disease.

Is initial success of thrombolytic therapy with rt-PA in patients with lower limb ischemia durable? A long-term follow-up series

VASA ◽  
2007 ◽  
Vol 36 (2) ◽  
pp. 114-120 ◽  
Author(s):  
Geier ◽  
Mumme ◽  
Köster ◽  
Marpe ◽  
Hummel ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Success Rate ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Long Term Results ◽  
Bleeding Complications ◽  
Acute Ischemia ◽  
Lower Limb Ischemia

Background: Catheter-directed intraarterial thrombolytic therapy with rt-PA has been established as an alternative to surgery in selected patients with lower limb ischemia. The purpose of this study is to evaluate its long-term results and to try to identify patient variables influencing outcome. Patients and methods: The results of thrombolytic treatment for acute or subacute lower limb ischemia in 82 patients (51 male, 31 female) were retrospectively analysed. Clinical data (time of symptoms onset, clinical stage, type of affected vessel, anatomical localisation) as well as comorbidities were recorded. The success rate of thrombolysis as well as the incidence of adverse events was evaluated. Patients with initial success were followed up after a median of 52,5 months. Results: Thrombolytic therapy was successful in 67 cases (82%). An additional endovascular or surgical procedure was necessary in 39 of these patients (48%). The overall bleeding rate was 18% and the mortality and major amputation rate was 1%. 42 patients with early clinical success were available for follow-up. 34 of them (81%) were free of ischemic symptoms and the overall limb salvage rate was 96%. We could not identify factors significantly influencing early or long-term results, although there was a trend towards better results in patients with acute ischemia and in patients with occluded native arteries. Conclusions: Intraarterial local thrombolytic therapy has a relatively high initial success rate in selected patients with lower limb ischemia, but is associated with a significant number of bleeding complications. Furthermore, additional procedures are required in almost half the patients. Initial success is durable at the long-term in the majority of cases. Better selection of patients and refinements of the thrombolytic therapy might help to further improve results and lower the bleeding complications.

Primary retrograde distal access for endovascular interventions in patients with lower limb ischemia

2021 ◽  
pp. 54
Author(s):  
S.A. Platonov ◽  
V.V. Zavatsky ◽  
V.N. Zhigalo ◽  
M.A. Kiselev ◽  
K.Sh. Isaev ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Endovascular Interventions

scholarly journals Treatment of critical lower limb ischemia using a hybrid technique

2014 ◽  
Vol 13 (3) ◽  
pp. 257-261
Author(s):  
Ricardo Wagner da Costa Moreira ◽  
Pedro Victor Alcântara da Costa ◽  
David Domingos Rosado Carrilho
Keyword(s):  
Effective Treatment ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Treatment Method ◽  
Major Amputation ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Endovascular Techniques ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Critical ischemia of a lower limb is a condition that threatens its viability and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method and is performed using surgical or endovascular techniques. For patients with thoracoabdominal aortic aneurysms, combining these two approaches into a "hybrid technique" makes it possible to treat patients who could not be adequately treated by either technique in isolation. We report on a case of lower limb critical ischemia treated using a combination of surgery and endovascular techniques, in an application of the hybrid technique in a different arterial bed.

Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis

2020 ◽  
Vol 25 (5) ◽  
pp. 460-467
Author(s):  
Matteo Pozzi ◽  
Augustin Metge ◽  
Anthony Martelin ◽  
Caroline Giroudon ◽  
Justine Lanier Demma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Good Neurological Outcome ◽  
Lower Limb Ischemia ◽  
Hospital Survival

High-risk pulmonary embolism (PE) requires hemodynamic and respiratory support along with reperfusion strategies. Recently updated European guidelines assign a low class of recommendation to extracorporeal membrane oxygenation (ECMO) for high-risk PE. This systematic review assessed clinical outcomes after ECMO in high-risk PE. We searched electronic databases including PubMed, Embase and Web of Science from January 2000 to April 2020. Efficacy outcomes included in-hospital survival with good neurological outcome and survival at follow-up. Safety outcomes included lower limb ischemia and hemorrhagic and ischemic stroke. Where possible (absence of high heterogeneity), meta-analyses of outcomes were undertaken using a random-effects model. We included 16 uncontrolled case-series (533 participants). In-hospital survival with good neurological outcome ranged between 50% and 95% while overall survival at follow-up ranged from 35% to 95%, both with a major degree of heterogeneity (I2 > 70%). The prevalence of lower limb ischemia was 8% (95% CI 3% to 15%). The prevalence of stroke (either hemorrhagic or ischemic) was 11% (95% CI 3% to 23%), with notable heterogeneity (I² = 63.35%). Based on currently available literature, it is not possible to draw definite conclusions on the usefulness of ECMO for high-risk PE. Prospective, multicenter, large-scale studies or nationwide registries are needed to best define the role of ECMO for high-risk PE. PROSPERO registration ID: CRD42019136282.

Chronic critical lower-limb ischemia: prospective trial of angioplasty with 1-36 months follow-up.

Radiology ◽  
1993 ◽  
Vol 188 (2) ◽  
pp. 381-387 ◽  
Author(s):  
P J Matsi ◽  
H I Manninen ◽  
M T Suhonen ◽  
A E Pirinen ◽  
S Soimakallio
Keyword(s):  
Lower Limb ◽  
Prospective Trial ◽  
Limb Ischemia ◽  
Lower Limb Ischemia

Long-Term Follow-Up of Intraarterial Infusion of Streptokinase in Acute Lower Limb Ischemia

1987 ◽  
Vol 21 (5) ◽  
pp. 339-343
Author(s):  
C. Delcour ◽  
B. Bellens ◽  
G. Vandenbosch ◽  
J.P. Dereume ◽  
J. Struyven
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Intraarterial Infusion ◽  
Lower Limb Ischemia ◽  
Long Term Follow Up

scholarly journals Endovascular treatment of chronic lower limb ischemia - the first experience of consecutive patients in the Kyrgyz Republic

2019 ◽  
Vol 3 (Issue 4) ◽  
pp. 188
Author(s):  
S.D. Chevgun ◽  
I.Z. Abdyldaev ◽  
A.S. Imankulova ◽  
I.H. Bebezov ◽  
D. Ch. Cholponbaev ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Lower Limb ◽  
Ad Hoc ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Regenerative Process ◽  
Modern World ◽  
Kyrgyz Republic ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Objective: Pure atherosclerosis and diabetes mellitus are often responsible for the lesion of lower limb arteries. As a result, critical ischemia may develop. Endovascular treatment of lower extremities chronic ischemia in the modern world one of the most effective methods of limbs salvage. This report is an analysis of the first experience of endovascular treatment in consecutive patients with chronic lower limb ischemia in the Kyrgyz Republic. Methods: In 2016-2018, there were 31 patients with chronic lower limb ischemia in IIb-IV Fontaine's stages who underwent endovascular treatment. The primary endpoint was 6-month painlessness or reduction of the Fontaine stage; freedom from amputation up to six months; active regenerative process or full recovery of ulcers/wounds up to six months. The secondary endpoints included 6-month all-cause mortality and reintervention rate. Results: Overall,  27 (87.1%) patients reached painless form (stage I according to Fontaine (ABI ≥0.9)), with complete regeneration or active reparative process observed in 20 (64. 5%) patients. In general, major amputation was avoided in 29 (93.5%) patients (two patients underwent amputation by E. Burgess). Minor amputations were performed below the level of foot dorsum (Sharp) in 35.5% (11 patients). Simultaneous percutaneous coronary interventions and peripheral interventions were performed in 6 (19. 4%) cases. In total, within 6 months one death was registered (3.2%). Conclusion:  The first endovascular treatment of consecutive patients showed encouraging 6-month results. Simultaneous («Ad-hoc») or stepwise (at the current hospitalization) procedures on coronary and peripheral arteries ensure safety and can provide more chances of  patient`s survival.

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