scholarly journals INCIDENTALLY DISCOVERED PULMONARY NEOPLASIA IN A PATIENT WITH POSTTRAUMATIC AVULSION OF CALCANEAL REGION - A BLESSING IN DISGUISE

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Dan Dumitrescu ◽  
Costel Savlovschi ◽  
Meda Comandasu ◽  
Dragos Serban ◽  
Bogdan Socea ◽  
...  
Keyword(s):  
Cardiovascular Surgery ◽  
Skin Flap ◽  
Local Treatment ◽  
Arterial Disease ◽  
Skin Grafts ◽  
Foot And Ankle ◽  
Pulmonary Tumor ◽  
Traumatic Episode ◽  
Peripheral Arterial ◽  
Pulmonary Neoplasia

In the last century, foot and ankle related traumatic pathology became more and more frequent. A 75 years old male with associated peripheral arterial disease presented himself in ER with an infected, contusive wound at the left foot sole and calcaneum. After local treatment (debridement, hyaluronic acid derivatives and antibiotics), the wound evolution was good. During the extensive clinical and paraclinical investigations preceding cardiovascular surgery for the pre-existing peripheral arteriopathy), a pulmonary tumor in resectable stage was discovered. So, the patient underwent pulmonary bilobectomy and afterward a cutaneous free groin flap reconstruction of the foot. The local wound evolution was good, and the patient could stand and walk after a month. He is currently under oncological supervision. Although skin grafts are recommended in lesions affecting weightbearing zones, in this case, given the arteriopathy, it was preferred a free skin flap.  In this case with complicated, intricated pathology, the traumatic episode played also a beneficial role by helping the early diagnosis of an operable lung cancer.

Level of Agreement Between Systematic Doppler Examination of the Lower Extremity and Diagnostic Angiography in the Setting of Peripheral Arterial Disease

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Timothy Greene ◽  
Todd Hasenstein ◽  
Eric T. Choi ◽  
Andrew J. Meyr
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Arterial Flow ◽  
Peroneal Artery ◽  
Foot And Ankle ◽  
Doppler Examination ◽  
Examination Technique ◽  
Diagnostic Angiography ◽  
Peripheral Arterial ◽  
Level Of Agreement

Background The objective of this investigation was to determine the level of agreement between a systematic clinical Doppler examination of the foot and ankle and diagnostic peripheral angiography. Methods The described Doppler examination technique attempted to determine the patency, quality, and direction of the flow through the dorsalis pedis artery, posterior tibial artery, terminal branches of the peroneal artery, and vascular arch of the foot. These results were then compared with angiographic distal run-off images as interpreted by a blinded vascular surgeon. Results Levels of agreement with respect to artery patency/quality ranged from 64.0% to 84.0%. Sensitivity ranged from 53.8% to 84.2%, and specificity ranged from 64.7% to 91.7%. Agreement with respect to arterial flow direction ranged from 73.3% to 90.5%. Conclusions We interpret these results to indicate that this comprehensive physical examination technique of the arterial flow to the foot and ankle with a Doppler device might serve as a reasonable initial surrogate to diagnostic angiography in some patients with peripheral arterial disease.

scholarly journals Noninvasive management of the diabetic foot with critical limb ischemia: current options and future perspectives

2011 ◽  
Vol 2 (6) ◽  
pp. 247-255 ◽  
Author(s):  
Mathias Weck ◽  
Torsten Slesaczeck ◽  
Hannes Rietzsch ◽  
Dirk Münch ◽  
Thomas Nanning ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Arterial Stenosis ◽  
Amputation Rate ◽  
Foot Ulcers ◽  
Peripheral Arterial

Foot ulcers are a major complication in patients with diabetes mellitus and involve dramatic restrictions to quality of life and also lead to enormous socio-economical loss due to the high amputation rate. The poor and slow wound healing is often aggravated by the frequent comorbidity of foot ulcers with peripheral arterial disease, making the treatment of this condition even more complicated. While the local treatment of foot ulcers is mainly based on mechanical relief and prevention or treatment of infection, improving perfusion of the impaired tissue remains the major challenge in peripheral arterial disease. While focal arterial stenosis is the domain of interventional angioplasty or vascular surgery, patients with critical limb ischemia and lacking options for revascularization have a much worse prognosis, because current treatment options avoiding amputation are scarce. However, based on recent research efforts, there is rising hope for promising and more-effective therapeutic approaches for these patients. Here, we discuss the current improvements of established therapies aimed at an improvement of limb perfusion, as well as the development of novel cutting-edge therapies based on stem-cell technology. The experiences of a ‘high-volume center’ for treatment of diabetic foot syndrome with a current major amputation rate of 4% are discussed.

Management of Peripheral Arterial Disease

2006 ◽  
Vol 39 (3) ◽  
pp. 44
Author(s):  
WILLIAM E. GOLDEN ◽  
ROBERT H. HOPKINS
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Peripheral Arterial

High tolerance of progressive elastic compression in peripheral arterial disease

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 413-417 ◽  
Author(s):  
Serge Couzan ◽  
Jean-François Pouget ◽  
Claire Le Hello ◽  
Céline Chapelle ◽  
Silvy Laporte ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Return Flow ◽  
High Tolerance ◽  
Compression Stockings ◽  
Short Term ◽  
Poor Tolerance ◽  
The Mean ◽  
Peripheral Arterial

Summary. Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6 x 6 plan) evaluating the short-term tolerance of progressive compression stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in patients with PAD (ankle brachial index ABI > 0.60 < 0.75) and chronic venous insufficiency (C1s–C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease > 15 % of ABI on each side, no decrease > 15 % of toe brachial index (TBI) on each side and no decrease > 25 % of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8 %, mean age was 77.3 ± 7.5 years and no patient were diabetic. At inclusion, the mean low ABI was 0.60 ± 0.04 and the mean high ABI was 0.77 ± 0.18. The mean low TBI was 0.32 ± 0.09 and the mean high TBI 0.46 ± 0.15. The mean number of active standing plantar flexions was 33.0 ± 5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7 %, class C2s: 27.8 %, class C3: 44.4 %, class C4: 5.6 % and class C4s: 5.6 %). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in symptomatic PAD.

Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Anouk Grandjean ◽  
Katia Iglesias ◽  
Céline Dubuis ◽  
Sébastien Déglise ◽  
Jean-Marc Corpataux ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Hybrid Approach ◽  
Arterial Disease ◽  
Early Mortality ◽  
Secondary Patency ◽  
Limb Salvage Rate ◽  
Peripheral Arterial ◽  
Salvage Rate

Abstract. Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

Markers of arterial stiffness in peripheral arterial disease

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 341-348 ◽  
Author(s):  
Marc Husmann ◽  
Vincenzo Jacomella ◽  
Christoph Thalhammer ◽  
Beatrice R. Amann-Vesti
Keyword(s):  
Arterial Stiffness ◽  
Peripheral Arterial Disease ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Arterial Disease ◽  
Care Physician ◽  
Additional Information ◽  
Non Invasive ◽  
Assessment Techniques ◽  
Peripheral Arterial

Abstract. Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

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