Continuous Sciatic Block Nerve in the Management of Vascular Pain in Critical Ischemia of Lower Limbs Patients

2020 ◽  
Author(s):  
Keyword(s):  
Lower Limbs ◽  
Critical Ischemia ◽  
Vascular Pain

Use of intravenous alprostadil in patients with severe critical ischemia of the lower limbs

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 318-323
Author(s):  
Jorge Enrique Machado-Alba ◽  
Manuel E Machado-Duque
Keyword(s):  
Critical Limb Ischemia ◽  
Adverse Reactions ◽  
Limb Ischemia ◽  
Cross Sectional Study ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Cross Sectional ◽  
Potential Benefits ◽  
Advanced Stages ◽  
Clinical Records

Objectives To determine the indications for the use, potential benefits, and adverse reactions of alprostadil in a group of Colombian patients. Methods A retrospective cross-sectional study was conducted in patients diagnosed with critical limb ischemia who received alprostadil in five hospitals in Colombia between September 2011 and July 2017. We reviewed the clinical records of each patient to obtain the sociodemographic and pharmacological variables, clinical stages, complications, comorbidities, reported effectiveness and adverse reactions. Results Sixty-one patients treated with alprostadil were evaluated; 50.8% of patients were men, and the average age of 72.5 ± 10.7 years. A total of 86.9% of patients were hypertensive, and 65.6% were diabetic. A total of 77.0% presented ulceration, and this condition was considered as a diabetic foot in 57.4% of patients. A total of 81.9% of patients were classified as Fontaine stage 4; 60.7% received therapy as initially indicated, with an average of 19 days of alprostadil use. Regarding the therapy results, 58.0% of the patients with ulcers or trophic lesions showed improvement, 86.2% showed improvement of pain, and the limb was saved in 72.1% of patients. Conclusions Critical limb ischemia was presented by patients with advanced age and high cardiovascular risk who were treated during severe and advanced stages where therapeutic options are limited. Treatment with alprostadil achieved satisfactory results with improvement in ulcers, pain, and limb salvage rates in this series of patients.

scholarly journals Combined Endovascular Treatment of Acute Coronary Syndrome with Bioresorbable Scaffolds and Angioplasty in Patient with Critical Lower Limb Ischemia – Hybrid Treatment in Multidisciplinary Hospital

2019 ◽  
Vol 14 (6) ◽  
pp. 901-907
Author(s):  
A. I. Zagorulko ◽  
R. V. Kolosov ◽  
A. V. Sidelnikov ◽  
Yu. V. Korzheva ◽  
A. G. Koledinsky
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Arteries ◽  
Lower Limb ◽  
Hybrid Methods ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Critical Ischemia ◽  
Long Term Outcome ◽  
Coronary Syndrome ◽  
Hybrid Treatment

The key to successful treatment in patients with acute coronary syndrome is maximally early revascularization of the coronary arteries. Treatment of multifocal atherosclerosis with lesions of the coronary and peripheral arteries requires coordinated work of the multidisciplinary team of doctors. Critical ischemia of the lower limbs requires urgent revascularization in order to prevent limb amputation. However, it is not always possible to perform revascularization using specialists of the same profile – endovascular or surgical. The use of hybrid methods of treatment (surgical and endovascular) allows to significantly improve the prognosis in saving the limb. The article presents a clinical observation of successful multistep treatment of a patient with acute coronary syndrome in combination with critical ischemia of the lower limb. The first stage was performed by multiple stenting of the coronary arteries with bioabsorptive scaffolds; the second stage was the hybrid treatment – femoral-tibial bypass with simultaneous recanalization and angioplasty of the lower leg arteries with good postoperative and long-term outcome.

Diabetic Critical Ischemia of Lower Limbs: Distal Arterial Revascularisation

2009 ◽  
Vol 109 (3) ◽  
pp. 321-326 ◽  
Author(s):  
A.A. Khalifa ◽  
G. Gueret ◽  
A. Badra ◽  
P. Gouny
Keyword(s):  
Lower Limbs ◽  
Critical Ischemia ◽  
Arterial Revascularisation

scholarly journals Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

2013 ◽  
Vol 12 (4) ◽  
pp. 284-288
Author(s):  
Esdras Marques Lins ◽  
Jose Wellington Barros ◽  
Fernanda Appolonio ◽  
Eduardo Anacleto ◽  
Eduardo Cavalcanti Lima
Keyword(s):  
Myocardial Infarction ◽  
Lower Limb ◽  
Troponin I ◽  
Lower Limbs ◽  
Elevated Blood ◽  
Peripheral Artery ◽  
Conventional Surgery ◽  
Critical Ischemia ◽  
Infrainguinal Bypass ◽  
Peripheral Artery Occlusive Disease

BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

scholarly journals The First Experience of Using Allografts in Surgery of Main Arteries of Lower Limbs

2020 ◽  
Vol 9 (3) ◽  
pp. 442-448
Author(s):  
R. E. Kalinin ◽  
I. A. Suchkov ◽  
V. V. Karpov ◽  
A. S. Pshennikov ◽  
A. A. Egorov
Keyword(s):  
Vascular Surgery ◽  
Postoperative Period ◽  
Unsolved Problem ◽  
Medical Literature ◽  
Infectious Complications ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Main Artery ◽  
The World ◽  
Extensive Necrosis

The article describes the experience of using allografts in surgery of the main arteries of the lower limbs. The urgency of using bioprostheses is briefly shown. The management of patients with infectious complications remains an unsolved problem in vascular surgery. Reconstructive vascular surgery is often repeated. Operations are often performed in the presence of extensive necrosis and trophic ulcers. The autovein is not always available for reconstruction of the main artery , which is why the issue of choosing a material for repeated reconstruction remains relevant. The medical literature has shown the tendency of xenoprostheses to aneurysmal transformation in the postoperative period. There is not a lot of information in the world and domestic sources on the use of arterial allografts. The lack of clear indications and contraindications for use, optimal preservation periods, the choice of the necessary preservatives and a suitable medium do not allow the widespread use of allografts in practical surgery if there is access to the technology of vascular collection, conservation and transplantation. The problem of using allografts requires further study. In this regard, the experience of using allografts in two non­standard clinical situations is presented. It was concluded that it is possible to effectively use freshly prepared arterial allografts from a postmortem donor during reconstruction in patients with critical ischemia of the lower extremities in the absence of a suitable autovein and the impossibility of using a synthetic prosthesis.

scholarly journals Advantages of modern methods of prevention of thrombotic complications in patients with critical ischemia of lower limbs after reconstructive operations

2020 ◽  
Vol 27 (4) ◽  
pp. 487-494
Author(s):  
Ivan I. Katelnitskiy ◽  
Igor I. Katelnitskiy ◽  
Ekaterina S. Livadnyaya
Keyword(s):  
Anticoagulant Therapy ◽  
Statistical Significance ◽  
Diagnostic System ◽  
Heparin Therapy ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Additional Control ◽  
Reconstructive Operations ◽  
Thrombotic Complications ◽  
Selection Of

Aim. To evaluate and improve the results of reconstructive operations in patients with obliterating atherosclerosis with critical ischemia of the lower limbs through reduction of the rate of thrombotic complications by improvement of diagnosis of risk factors for thrombosis on the basis of coagulogram and Thrombodynamics T-2 test data. Materials and Methods. In the I group of patients (n=48) reconstructive operations were performed on the arteries of lower limbs and anticoagulant therapy with unfractionated heparin (UFH) with control of hemostasiogram before the operation, in 6 hours and 6 days after the operation and with additional control of APTT 30 minutes before introduction of UNH. In the II group (n=34) reconstructive operations were performed with selection of anticoagulant therapy using parameters of hemostasiogram and laboratory-diagnostic system Thrombodynamics Recorder T-2 with control before the operation, in 6 hours, 6 days after the operation and with additional control of APTT in 30 minutes before introduction of UFH. Results. Analysis of the data of coagulogram and Thrombodynamics T-2 test showed statistical significance of APTT, fibrinogen, delay and initial speed of clot growth, a combination of which permits a possibility for correction of heparin therapy for prevention of thrombosis. Conclusions. The dynamics of the parameters of Thrombodynamics T-2 test in selection of UFH dose proves high effectiveness of this method for selection of adequate doses of anticoagulant drugs for prevention of postoperative thromboses in patients with critical ischemia of the lower limbs.

scholarly journals Treatment of critical limb ischemia in patients with multilevel arterial lesions

2018 ◽  
Vol 22 (3) ◽  
pp. 474-478
Author(s):  
V. Shaprynskyi ◽  
Y. Gupalo ◽  
O. Shved ◽  
O. Nabolotnyi ◽  
D. Shapovalov
Keyword(s):  
Atherosclerotic Lesion ◽  
Lower Extremities ◽  
Main Group ◽  
Lower Limbs ◽  
Control Group ◽  
Critical Ischemia ◽  
Optimal Method ◽  
Surgical Interventions ◽  
Limb Preservation ◽  
Arterial Lesions

The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.

scholarly journals The treatment of "critical ischemia" of the limbs in endarteritis obliterans by thickening of the tibial bone

2005 ◽  
Vol 52 (2) ◽  
pp. 61-65
Author(s):  
Slavko Tomic ◽  
O. Krajcinovic ◽  
Aleksandar Lesic ◽  
V. Bumbasirevic ◽  
Marko Bumbasirevic
Keyword(s):  
Operative Treatment ◽  
Arterial Occlusion ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Amputation Level ◽  
Ischemia Of The Limbs ◽  
Tibial Bone ◽  
Distraction Osteosynthesis ◽  
Ilizarov Apparatus ◽  
Endarteritis Obliterans

The authors report their experience in the treatment of the "critical ischemia" in 8 patients with arterial occlusion of the lower limbs in endarteritis obliterans. All patients were treated by thickening of the tibia using the Ilizarov apparatus for distraction osteosynthesis. In all cases the operative treatment ensured lowering of the amputation level, forming of the functional stump and long-lasting remission of the illness.

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