Peripheral Rearterialization for Critical Limb Ischaemia and Antiseptic Resin or Honey Salve in Postoperative Ulcer Care Results in Healing Rate Of Leg Ulcers in Three Quarters of Cases. A Prospective Clinical Follow-up of 35 Patients with Preoperati

2020 ◽  
Keyword(s):  
Healing Rate ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Leg Ulcers

scholarly journals Skin grafting in the treatment of hard-to-heal leg ulcers

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Giovanni Mosti ◽  
Vincenzo Mattaliano ◽  
Pietro Picerni ◽  
Costantino Christou
Keyword(s):  
Ulcer Healing ◽  
Healing Rate ◽  
Skin Grafting ◽  
Leg Ulcers ◽  
Clinical Routine ◽  
Ulcer Size ◽  
Donor Skin ◽  
Post Traumatic ◽  
Chronic Leg Ulcers

Some risk factors or comorbidities may make Chronic Leg Ulcers (CLU) very difficult to heal. These ulcers are usually defined refractory ulcers and may require an in-hospital intensive care to increase the healing rate. Aim of this retrospective study was to assess if our clinical routine in hospitalized patients, made up with surgical debridement followed by donor skin grafting (allografts), may favor the ulcer healing. The records of 120 patients (55 males and 65 females; mean age 73.9±11.3 years) with ulcers greater than 100 cm2 and lasting for more than 1 year were analyzed. The median ulcer size was 165 cm2 (IQR 130-250 cm2; range 100-1000 cm2). The median ulcer duration was 24 months (IQR 16-32 months; range 12-300 months). The ulcer pathophysiology was venous in 74 patients, arterial in 21, mixed in 12, vasculitis in 5 and post-traumatic in 8 patients. After debridement the patients were submitted to allograft procedures (single or multiple) up to the ulcer healing. When allograft was able to create an effective granulation tissue and reduce the ulcer size an autograft was performed to get the ulcer closure. 109 patients healed and 11 were lost at follow-up. 65 patients healed just with one allograft in 16 weeks (IQR 13-21 weeks). 42 patients healed with 2 procedures in 20 weeks (IQR 18-23 weeks). 31 of them received a final autograft while 11 healed with two allografts. 2 patients with an ulcer surface of 200 cm2, both affected by CLI, healed with 3 allografts procedures in 40 and 33 weeks, respectively. Pain and exudate amount were significantly decreased and even disappeared after the first allograft. Allografts alone or followed by an autograft are able to get the ulcer healing also in case of extensive and long lasting ulcers refractory to all previous treatments.

scholarly journals An observational study into the management of arteriomegaly: a call for a revised classification system

2012 ◽  
Vol 94 (4) ◽  
pp. 250-255 ◽  
Author(s):  
JV Barandiaran ◽  
TC Hall ◽  
I Glaves ◽  
N El-Barghouti ◽  
EP Perry
Keyword(s):  
Observational Study ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Cerebrovascular Events ◽  
Progression Of Disease ◽  
Artery Disease

INTRODUCTION Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution. METHODS Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed. RESULTS Arteriomegaly was identified in 1.3% of patients (n=69) undergoing lower limb angiography in the study period. Of these, the majority (n=67) were men. The mean age was 74 years (range: 60–89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Fortynine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hoi lier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6–146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up. CONCLUSIONS This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier’s classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity.

Outcomes of covered expandable stents for the treatment of TASC D aorto-iliac occlusive lesions

Vascular ◽  
2015 ◽  
Vol 23 (6) ◽  
pp. 630-636 ◽  
Author(s):  
Robert Tewksbury ◽  
Lupe Taumoepeau ◽  
Andrew Cartmill ◽  
Anna Butcher ◽  
Toby Cohen
Keyword(s):  
Large Diameter ◽  
Clinical Signs ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Critical Limb Ischaemia ◽  
Secondary Patency ◽  
Limb Ischaemia ◽  
Vascular Insufficiency ◽  
Good Patency

Introduction Aortoiliac arterial occlusive disease is frequently encountered in the management of lower limb vascular insufficiency. We report our experience with covered balloon-expandable stents for treatment of TASC D lesions of the abdominal aorta and common iliac arteries. Methods A retrospective study of 30 patients who underwent aortoiliac stenting with the Atrium Advanta V12 from March 2010 to September 2012 was conducted. Patient demographic data, clinical signs and symptoms and procedural details were recorded. Outcomes assessed were primary patency, secondary patency, technical success, complications, limb salvage and survival. Results Median age was 67 years (range 48–84) and 40% of patients underwent treatment for critical limb ischaemia. Median follow-up was 13 months (range 3–38 months). Stent configuration comprised of long iliac stents in 20 patients, a large diameter aortic stent with iliac stenting in six patients, and aortic stent alone in four patients. Radiological success was achieved in 100% and the complication rate was 6%. Primary patency at 6, 12 and 24 months was 97%, 90% and 79%, respectively. Four cases of in-stent stenosis were reported, with three of these undergoing re-interventions resulting in a secondary patency rate of 97% at the end of follow-up. One patient death occurred within the follow-up period. Discussion This case series demonstrates that treatment of complex aortoiliac occlusive disease with covered balloon-expandable stents can have acceptable results with good patency and good clinical outcome. Secondary patency rates are comparable to open surgical revascularisation, with lower morbidity.

scholarly journals A 5.5 years observational follow-up study of patients with critical limb ischaemia treated efficiently by endovascular approach

2020 ◽  
Vol 30 (2) ◽  
pp. 236-240
Author(s):  
Dan F. Filip ◽  
Gabriela Kozma ◽  
Calin F. Pop
Keyword(s):  
Endovascular Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Artery ◽  
Arterial Segment ◽  
Final Treatment ◽  
Endovascular Approach ◽  
The Mean ◽  
Peripheral Artery Diseases

Objectives – The aim of this study was to describe our experience with endovascular treatment in critical limb ischaemia and to bring new follow-up data about these patients with initial successfully revascularization. Methods – A retrospective study of 181 patients with critical limb ischaemia, with successful endovascular treatment in our institution was performed. We followed death, reintervention and amputation rates during a mean period of 55.1 ± 8.2 months. Results – The mean age of the patients was 65.2±11.6 years. Of these patients, 66.3% were males, 38.1% diabetics, 51.4% active smokers, 21% with chronic kidney disease, 32.6% with other clinical forms of peripheral artery diseases. The final treatment was stenting in 31.5% of cases and balloon angioplasty alone in the rest of the cases. Treated arteries were in the femoral-popliteal segment – 55.6%, aorto-iliac segment – 31.4% and infrapopliteal segment – 13%. 27.6% of the patients underwent procedures on more than one arterial segment. During follow up 11 deaths occurred (6.1%), 27 patients (14.9%) underwent reinterventions for revascularization (endovascular or surgical) and 31 patients (17.1%) suffered further amputations. Conclusions – Despite a certain rate of death, amputation and reintervention, our results suggest that endovascular approach in critical limb ischaemia can be an effi cient and feasible treatment option if its results are optimal at the time of implementation.

Surveillance after Distal Revascularization for Critical Limb Ischaemia

2012 ◽  
Vol 101 (2) ◽  
pp. 119-124 ◽  
Author(s):  
E. Arvela ◽  
F. Dick
Keyword(s):  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Compelling Evidence ◽  
Surgical Revascularization ◽  
Duplex Scan ◽  
European Guidelines ◽  
Distal Perfusion ◽  
Available Information

Patients with critical limb ischaemia (CLI) are usually elderly and suffer from several co-morbidities. The goal of surveillance after both endovascular and surgical revascularization for CLI is not only the protection of re-established distal perfusion and sustained ambulation but also the reduction of systemic atherothrombotic risk and mortality by ensuring continued best medical care. However, preferred format and rhythm of structured follow-up programs have remained controversial, mainly because of lack of compelling evidence. This review aims to summarize and to appraise available information critically. Thereby, it underlines the importance of systematic surveillance after both surgical and endovascular revascularization for CLI. Recent European guidelines are considered and areas of uncertainty are highlighted and discussed. According to currently available literature and recent guidelines, the early duplex scan is justified in all patients undergoing endovascular or surgical distal revascularization for CLI. There is no best level evidence supporting continued long term duplex surveillance of revascularizations with normal findings at early duplex scan, whereas those patients with abnormal early duplex scan or high risk revacularization are likely to benefit from continued duplex surveillance. Regular clinical follow-up is suggested and clinical deterioration should trigger duplex scanning to ensure revascularization patency.

scholarly journals Efficacy of routine diabetic foot treatments at an outpatient clinic: a cohort study

2014 ◽  
Vol 17 (3) ◽  
pp. 107-112 ◽  
Author(s):  
Oleg Viktorovich Udovichenko ◽  
Eugenia Alexandrovna Berseneva
Keyword(s):  
Diabetes Mellitus ◽  
Outpatient Clinic ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Healing Time ◽  
Treatment Modalities ◽  
Leg Ulcers ◽  
Outpatient Services ◽  
National Guidelines

Reliable data on the efficacy of treatment for diabetic foot (DF) ulcers (DFUs) is essential for planning outpatient services, comparison of several DF clinics, pharmacoeconomic studies and prognosis of healing time. However, no reports based on Russian DF cases have been published to date.Aim. The aim of our study was to analyse of the outcomes of routine DFU treatments at one DF outpatient clinic (DFOC).Materials and methods. We analysed the medical records of all patients admitted to one DFOC for foot/leg ulcers in 2012 (72 patients, 77 episodes of treatment, 124 ulcers in total). The median age of the patients was 66 years (range: 45?90 years), 51% patients were females and 49% were males. Three (4%) patients had type 1 diabetes mellitus, whereas the rest had type 2 diabetes mellitus. The median duration of ulcer prior to the initiation of treatment was 31 days (range: 1?392 days). A total of 106 (85%) cases involved DFUs, whereas 18 (15%) involved leg ulcers in patients with diabetes. One patient had a combination of foot and leg ulcers. Examination and treatment of all patients were conducted by a single experienced doctor according to international and national guidelines. The follow-up time ranged from 8?20 months.Results. Lower extremity ischemia was observed in 39% cases. The healing rate for all ulcers at 3, 6 and 12 months was 34%, 51% and 65%, respectively. At follow-up time, ulcers remained unhealed in 16% patients and 9% survived amputations [1 (1%), below knee; 6 (8%), minor)]. Furthermore, 4% patients died on account of cardiovascular events. The results of the present study were comparable to those reported in other countries. Modern and effective treatment modalities (such as contact casting and revascularisation) were not used extensively; therefore, their active utilisation is necessary to improve treatment outcomes.Conclusions. The healing rate for ulcers in our cohort was 34%, 51% and 65% at 3, 6 and 12 months, respectively. Treatment efficacy should be improved by increasing the use of total contact casting and revascularisation. Person-related measures (i.e. healing of all ulcers in a patient) are optimal for most cases, although ulcer-related measures can be significant in cases where several ulcers are detected in a patient. Our studied cohort is typical for a DFOC; therefore, our data can be used for planning outpatient services, evaluation of other DFOCs and pharmacoeconomic studies.

scholarly journals EP.WE.690PPI Prescribing in Vascular Discharges

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amy Hooper ◽  
Fang Yi Cheung ◽  
Anna Murray
Keyword(s):  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Significant Morbidity ◽  
Diabetic Foot Infection ◽  
Nice Guideline ◽  
Period 2 ◽  
Anti Platelet Agent ◽  
Increased Risk ◽  
Upper Gastrointestinal

Abstract Aims Aspirin and clopidogrel are ubiquitously seen in prescriptions of most attendees to hospitals, especially those being admitted to a vascular unit. Most, if not all, are on at least one anti-platelet agent, and some are on dual antiplatelets (DAPA) or an anticoagulant. These increase the risk for upper gastrointestinal (UGI) bleeds, which lead to significant morbidity and mortality. In order to prevent this, proton pump inhibitors (PPIs) are recommended to be prescribed for patients with increased risk of UGI bleeds. Our aim for this audit was to evaluate the prescription of PPIs in vascular patients discharged from a major vascular hub. Methods Data was collected from a prospectively maintained database of consecutive primary vascular discharges between 01/09/2020 and 31/09/2020. Results 87 patients discharged in this period (71% Male, Median age 72 (22-92) yrs). 26% of admissions accounted for Diabetic foot infection management, 25% for Critical Limb Ischaemia management and 20% for Thoracic or Aortic Aneurysm management. 70% of patients were discharged with either a single or DAPA. 94% of patients met the NICE guideline for requirement for a PPI. 49% of those patients were not discharged with a PPI. Of the patients who should have been prescribed a PPI on discharge, 5% suffered UGI bleeds in the follow up period (2/42). Conclusions PPIs are often not prescribed when discharging vascular patients, most of whom are high risk for having UGI bleeds. We will re-audit this after education and protocols have been implemented.

Pyrophosphate Treatment in Pseudoxanthoma Elasticum (PXE)-Preventing ReOcclusion After Surgery for Critical Limb Ischaemia

2019 ◽  
pp. 1-3
Author(s):  
Suvi Väärämäk ◽  
Hannu Uusitalo ◽  
Natália Tőkési ◽  
Saku Pelttari ◽  
András Váradi ◽  
...  
Keyword(s):  
Limb Ischemia ◽  
Pseudoxanthoma Elasticum ◽  
Skin Lesions ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Tissue Calcification ◽  
Artery Disease ◽  
One Year ◽  
The One

Pseudoxanthoma elasticum (PXE) is a rare metabolic disease characterized by reduced plasma pyrophosphate (PPi) concentration, causing progressive soft tissue calcification represented by skin lesions, central vision lost and peripheral artery disease. PXE is currently incurable. Previous reports have shown early high failure after revascularization by unknown mechanism. Reports of oral PPi administration have shown to decrease tissue calcification in a murine model of PXE. We report the outcome of one patient treated with oral PPi and further operated for critical limb ischemia. During the one-year follow-up the operated area has not re-occluded and there have been no significant side effects.

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