Critical limb ischemia potential gene therapy strategies

2021 ◽  
Author(s):  
Moataz Dowaidar
Keyword(s):  
Wound Care ◽  
Limb Ischemia ◽  
Current Data ◽  
Vascular Medicine ◽  
Bypass Patency ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Healing Wounds ◽  
Artery Disease ◽  
Therapy Strategies

Revascularization is accomplished in 90–95% of CLI patients, according to current data. These findings indicate the increasing involvement of endovascular options (tibial angioplasty) in the last 5 years, indicated in the phrase "endovascular first" and often used in relativized indication. How long this more rigorous under-the-knee treatment will endure in a group of vascular patients with diabetes is uncertain. There is no reliable long-term evidence on how often and/or how quickly these patients need to be hospitalized to have their limbs amputated or CLI treatment. "10-30% of CLI patients can not be revascularized," most sources say.Vascular doctors require precise tools to analyze results to manage treatment for patients with limb-threatening ischemia. Historically, bypass-patency rates, amputation of larger limbs, and death were the most often used endpoints for measuring therapeutic efficacy. Because they're easy to recognize and document, they're important in clinical research. While more difficult to define and track, quality of life and functional status are more probable predictors of success.Amputation is not always necessary when standard revascularization is no longer an option for the patient, based on this paper's findings. Not every CLI patient is the same, and the effects of careful wound care alone in selected high-risk patients should not be overlooked. Also, some of the procedures/therapies discussed in this article may be appropriate for certain individuals. These techniques can be employed in patients with resting pain or non-healing wounds who have extensive minor artery disease, and no distal artery targets for standard open or endovascular revascularization, according to a literature review. As a reason, they are considered a last resort treatment when amputation seems to be the only plausible alternative decision. The hardest component of a vascular medicine specialist's work is to decide whether treatment is suitable for a given patient.

Management of the Asymptomatic Diabetic Patient with Evidence of Ischaemia

2010 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Dimitrios Bliagos ◽  
Ajay J Kirtane ◽  
Jeffrey W Moses ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Medical Therapy ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Ageing Population ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Asymptomatic Diabetic Patient ◽  
Artery Disease

In the US, a total of 23.6 million people have diabetes, representing 7.8% of the population, and the prevalence of diabetes is on the rise due to an increasingly sedentary lifestyle, increasing obesity and an ageing population. Coronary artery disease is the leading cause of death in patients with diabetes, despite a reduction in cardiovascular events over the last 50 years, due in part to better medical therapy. Asymptomatic diabetic patients with evidence of ischaemia on stress testing have higher cardiac mortality; increasing amounts of ischaemia are associated with higher mortality rates. Revascularisation of high-risk patients, or those with significant ischaemia, has the potential to improve outcomes in this patient population. The choice of which revascularisation strategy to choose – either percutaneous coronary intervention (PCI) or coronary artery bypass grafting – should be carefully individualised, and must always be implemented against the background of optimal medical therapy.

scholarly journals The role of Nicorandil in non-healing surgical wounds

2010 ◽  
Vol 92 (6) ◽  
pp. e16-e18 ◽  
Author(s):  
AD Riddell ◽  
U Minhas ◽  
GL Williams ◽  
KJ Harding
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aetiological Factor ◽  
Severe Coronary Artery Disease ◽  
Surgical Wounds ◽  
Severe Coronary Artery ◽  
Risk Patients ◽  
Healing Wounds ◽  
Artery Disease

We report two patients with non-healing surgical wounds, which healed after the withdrawal of Nicorandil therapy. Nicorandil should be recognised as an aetiological factor for non-healing wounds or ulcers once other inflammatory and malignant causes have been excluded. This may avoid surgery for high-risk patients and may also reduce complications for patients who undergo surgery for non-healing wounds. As Nicorandil is used in patients with severe coronary artery disease, it is recommended that the advice of a cardiologist is sought prior to cessation or adjustment to its dose.

Cardiovascular risk assessment in diabetes and pre-diabetes

ESC CardioMed ◽  
2018 ◽  
pp. 923-924
Author(s):  
Nikolaus Marx
Keyword(s):  
Risk Assessment ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Target Organ Damage ◽  
Risk Scores ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High

Patients with diabetes exhibit an increased propensity to develop cardiovascular disease with an increased mortality. Early risk assessment, especially for coronary artery disease, is important to initiate therapeutic strategies to reduce cardiovascular risk. This chapter reviews the current literature on risk scores in patients with type 1 and type 2 diabetes and summarizes the role of risk assessment based on biomarkers and different imaging strategies. Current guidelines recommend that patients with diabetes are characterized as high-risk or very high-risk patients. In the presence of target organ damage or other risk factors such as smoking, marked hypercholesterolaemia, or hypertension, patients with diabetes are classified as very high-risk patients while most other people with diabetes are categorized as high-risk patients.

Multidisciplinary Care for Critical Limb Ischemia: Current Gaps and Opportunities for Improvement

2019 ◽  
Vol 26 (2) ◽  
pp. 199-212 ◽  
Author(s):  
Ehrin J. Armstrong ◽  
Syed Alam ◽  
Steve Henao ◽  
Arthur C. Lee ◽  
Brian G. DeRubertis ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Patient Population ◽  
Wound Care ◽  
Multidisciplinary Care ◽  
Limb Ischemia ◽  
Medical Specialty ◽  
Complex Patient ◽  
Arterial Insufficiency ◽  
Artery Disease ◽  
Improve Patient

Critical limb ischemia (CLI), defined as ischemic rest pain or nonhealing ulceration due to arterial insufficiency, represents the most severe and limb-threatening manifestation of peripheral artery disease. A major challenge in the optimal treatment of CLI is that multiple specialties participate in the care of this complex patient population. As a result, the care of patients with CLI is often fragmented, and multidisciplinary societal guidelines have not focused specifically on the care of patients with CLI. Furthermore, multidisciplinary care has the potential to improve patient outcomes, as no single medical specialty addresses all the facets of care necessary to reduce cardiovascular and limb-related morbidity in this complex patient population. This review identifies current gaps in the multidisciplinary care of patients with CLI, with a goal toward increasing disease recognition and timely referral, defining important components of CLI treatment teams, establishing options for revascularization strategies, and identifying best practices for wound care post-revascularization.

scholarly journals Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High-Risk Patients With Diabetes

JAMA ◽  
2014 ◽  
Vol 312 (21) ◽  
pp. 2234 ◽  
Author(s):  
Joseph B. Muhlestein ◽  
Donald L. Lappé ◽  
Joao A. C. Lima ◽  
Boaz D. Rosen ◽  
Heidi T. May ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Ct Angiography ◽  
Cardiac Events ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Artery Disease

Detecting Vascular Problems in Patients With Diabetes Treated With an Intra-Aortic Balloon Pump

1997 ◽  
Vol 23 (6) ◽  
pp. 656-663 ◽  
Author(s):  
Prasama Sangkachand ◽  
Marjorie Funk ◽  
Dorothy L. Sexton ◽  
Kimberly O. Lacey
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Insertion Site ◽  
Signs And Symptoms ◽  
Limb Ischemia ◽  
Intra Aortic Balloon Pump ◽  
Cardiac Assist Device ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Artery Disease

Individuals with diabetes are at increased risk for both peripheral vascular disease and coronary artery disease. In patients with severe coronary artery disease, a cardiac assist device called an intra-aortic balloon pump (IABP) often is used to aid the failing heart and prevent further cardiac ischemia. Because this device is inserted via the femoral artery, patients are at risk of limb ischemia distal to the insertion site. Patients with diabetes are particularly prone to this complication. Detecting the early signs and symptoms of ischemia is crucial to preventing serious sequelae. Standard vascular examination techniques, in addition to being subjective and not easily reproducible, may be misleading in patients with diabetes. This article provides a review of the signs and symptoms of lower limb ischemia and noninvasive vascular tests that clinicians can use to evaluate lower extremity circulation. Also included are protocols for patient care during and after hospitalization, and two case studies of cardiac patients with diabetes who were treated with an IABP.

scholarly journals Perawatan Luka Diabetes Mellitus Menggunakan Teknik Modern Dressing

2020 ◽  
Vol 9 (2) ◽  
pp. 160-172
Author(s):  
Alberikus Dimantika ◽  
Sugiyarto Sugiyarto ◽  
Yuyun Setyorini
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Wound Healing ◽  
Type 2 Diabetes Mellitus ◽  
Wound Care ◽  
Meta Analysis ◽  
Acellular Matrix ◽  
Patients With Diabetes ◽  
Artery Disease

Background: The most common complication in patients with diabetes mellitus tippe 2 (DM) is diabetic ulcers, where the tissue deformity occurs either partially (Partial Thickness) or completely (Full Thickness). If not handled properly and appropriately, ulcers can become infected. Where leg ulcers, infection, neuroarthropathy and peripheral artery disease are the causes of gangrene and lower limb amputations. The aim of this study  is to determine the effectiveness of wound healing in the treatment of diabetes mellitus wounds using modern dressing techniques. Methods: the literature review (LR) method uses meta-analysis where the data used is a database of searches using MEDLINE (PubMed), Google Scholar, Science Direct, Surgery Science and Sci-Hub. Reports published from 2010-2020 that focused on modern wound care dressings for wound healing of type 2 diabetes mellitus were identified. Results: Based on the analysis of the journal, there are nursing implications that have been compared from 10 journals, it was found that the treatment of type two diabetes mellitus wounds using modern dressing techniques is more effective in wound healing, by accelerating granulation and healing of the various types of dressings used, each of which has advantages. in terms of wound healing type 2 diabetes mellitus. Conclusion: The use of modern dressing techniques is effective in wound healing in the treatment of type 2 diabetes mellitus wounds. Researchers suggest that they be able to conduct research related to modern wound care dressings such as the use of alginate dressings, foam dressings, hydrogel dressings, moisture dressings, silver dressings, hydrophilic polyurethane foam dressings, acellular matrix dressings, and others related to wound care using modern dressing techniques. . Further research needs to be done by paying attention to the latest evidence-based practice journals to enrich knowledge about wound care with modern dressing techniques for diabetes mellitus wounds.

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