scholarly journals COVID-19-ASSOCIATED ACUTE LOWER LIMBS ISCHAEMIA IN ELDERLY AND SENILE PATIENTS: TREATMENT PROSPECTS (PRELIMINARY ANNOUNCEMENT)

2021 ◽  
pp. 11-16
Author(s):  
О. E. Kanikovsky ◽  
S. V. Sander ◽  
О. I. Bondarchuk ◽  
О. P. Fedzhaha ◽  
V. P. Malyarchuk ◽  
...  
Keyword(s):  
Blood Clotting ◽  
Limb Ischemia ◽  
High Amplitude ◽  
Lower Limbs ◽  
Amplitude Curve ◽  
Aim Analysis ◽  
Intraarterial Infusion ◽  
Tibial Arteries ◽  
Thrombotic Complications ◽  
Coronavirus Infection

Summery. The aim — analysis of preliminary experience of treatment of COVID-19-associated acute lower limbs ischemia in elderly and senile patients. Materials and methods. We examined 48 patients (age 60- 84 years). First group — 16 patients with COVID-19-associated acute lower limbs ischemia, second group — 32 patients with chronic limb ischemia without coronavirus infection. . Results and discussion. First group’s patients had extended blood clotting time (more than 13-15 min). Other blood clotting indicators changed slightly. An isoline or a low-amplitude curve was recorded during photoplethysmography. After thrombectomy (6 patients) 3 patients had fatal thrombotic complications (PE, myocardial infarction, stroke), 1 had progressive ischemia. Pharmacotherapy was performed in 10 patients (in 2 patients later than 12 hours from the onset of ischemia). The effectiveness of timely started pharmacotherapy reached 67 %. All patients of group II had arteriosclerosis of the tibial arteries. Blood clotting indicators were normal. A high-amplitude curve was recorded during photoplethysmography. Thus, all elderly and senile patients has arteriosclerosis of the tibial arteries. On this basis, there was a fatal coincidence (coagulopathy, a sharp slowdown in blood flow, endothelial dysfunction) in case of coronavirus infection (COVID-19). Prospects for further developments are the improvement of anticoagulant therapy (for example, the simultaneous use of unfractionated and low molecular weight heparin) and improving of collateral circulation (for example, nerve block and forced intraarterial infusion or lavage). Conclusion. Currently, the effectiveness of thrombectomy in elderly and senile patients with COVID-19-associated acute lower limbs ischemiа is 33 %, the effectiveness of timely started pharmacotherapy Is 67 %.

Complex Endovascular Treatment for Critical Limb Ischemia in Poor Surgical Candidates: A Pilot Study

2002 ◽  
Vol 9 (5) ◽  
pp. 599-604 ◽  
Author(s):  
Bruce H. Gray ◽  
John R. Laird ◽  
Gary M. Ansel ◽  
John W. Shuck
Keyword(s):  
Endovascular Treatment ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Intention To Treat ◽  
Area Reduction ◽  
Tibial Arteries ◽  
Table Analysis ◽  
A Prospective Study

Purpose: To evaluate the effectiveness of complex endovascular treatment for limb salvage in patients with critical limb ischemia. Methods: In a prospective study, 23 patients (13 men; mean age 70 ± 11 years, range 44–87) with ischemic ulceration or gangrene of 25 lower limbs were enrolled at 4 sites to evaluate treatment with excimer laser recanalization followed by balloon angioplasty with optional stenting in the superficial femoral, popliteal, and/or tibial arteries. Results: Multiple lesions (mean 3.1, range 1–8) were treated in most cases. Reduction of stenosis/occlusion to <50% was achieved in 22 (88%) limbs. Individual cases of vessel perforation, inability to cross the lesion, and excessive residual stenosis accounted for the 3 failures. Over a 6-month period, 4 patients died of cardiac comorbidity and 1 was lost to follow-up. Adverse events included 4 minor and 2 below-knee amputations, 4 secondary angioplasties, and 4 femorodistal bypasses. The mean wound area reduction was 70% at 3 months, increasing to 89% at 6 months. According to life table analysis, the limb salvage rate was 90% with bypass and 69% without in the successfully treated patients (corresponding intention-to-treat rates were 79% and 61%). Conclusions: Complex endovascular treatment combining laser debulking and angioplasty/stenting offers an alternative for patients with critical limb ischemia who lack good surgical options.

scholarly journals PROGRESS IN SURGICAL TREATMENT OF CHRONIC LOWER LIMB ISCHEMIA

2018 ◽  
Vol 25 (6) ◽  
pp. 14-18
Author(s):  
O. A. Alukhanyan ◽  
X. G. Маrtyrosya ◽  
I. V. Poluektova ◽  
V. A. Avakimyan
Keyword(s):  
Surgical Treatment ◽  
Pain Syndrome ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Chronic Ischemia ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Bypass Patency ◽  
Thrombotic Complications ◽  
Male Patients

Aim. The study was conducted to expand the variety of ways for surgical treatment of chronic ischemia of lower limbs complicated by the involvement of the femoropopliteal and pedidial arterial segment. Materials and methods. The experience of surgical interventions in 43 male patients aged 52-75 suffering from chronic ischemia of lower limbs complicated by the atherosclerotic involvement of the femoropopliteal and pedidial segment has been summarized. According to the classification by A.V. Pokrovskiy, ischemia of the 3rd stage has been determined in 24 patients (55,8%), while ischemia of the 4th stage complicated by necrosis of the toes (critical ischemia) has been determined in other 19 patients (44,2%). All examined patients have undergone the reconstructive interventions using the prepared lateral subcutaneous vein of the upper extremity as a shunt.Results. During the first day after the operation, the regression of pain syndrome as well as the warming of the lower extremity was indicated in 93% of patients. In 8-12 days after the reconstructive operation, the patients have undergone the 15 necrectomy or toe amputation. In the nearest postoperative period (less than 6 months) no thrombotic complications in the reconstructed segment have been determined. Within the observation period from 6 months to 5 years the bypass patency has been preserved in 71% of patients; ischemia of the 2nd B type has been revealed in all patients with the preserved bypass patency by the clinical examination.Conclusion. Despite the “forced” character of usage of the prepared V. cephalica due to the absence of “traditional” venous shunts as well as the labor intensity of the method, it allows to expand the variety of ways for surgical treatment of patients suffering from chronic ischemia of lower limbs of the 3rd-4th stages complicated by occlusive involvements of the femoropopliteal and pedidial segment.

scholarly journals Experimental Modeling of the Ultra-Necrotic Stage of Critical Ischemia of the Lower Limbs

2021 ◽  
Vol 14 (2) ◽  
pp. 107-111
Author(s):  
Boris Semenovich Sukovatykh ◽  
Elvin Eynulla Feyziev ◽  
Alexander Sergeevich Belous ◽  
Elena Vladimirovna Trubnikova ◽  
Mikhail Borisovich Sukovatykh ◽  
...  
Keyword(s):  
Experimental Model ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Doppler Flowmetry ◽  
The Third ◽  
Posterior Tibial ◽  
Leg Muscles ◽  
Tibial Arteries ◽  
Experimental Group

Objective. So far, no experimental model of the necrotic ulcerative stage of critical limb ischemia has been created. Aim. Development of a method for modeling the necrotic ulcerative stage of critical lower limb ischemia.Materials and methods. The experimental study was carried out on 120 rats - males of the "Wistar" line, divided into 4 groups of 30 animals each. In the first group (intact), the level of microcirculation in the muscles of the hind limb was determined. In the second (sham-operated) group, ischemia was not simulated, but the neurovascular bundle of the thigh was isolated and the wound was sutured. In the third group (comparison), the modeling of chronic ischemia of the leg muscles was performed by removing the femoral, popliteal, anterior and posterior tibial arteries. In the fourth (experimental) group, to simulate chronic critical ischemia of the leg muscles, the femoral, popliteal, anterior and posterior tibial arteries and veins were removed, and the peripheral nerve was damaged.In the postoperative period, the dynamics of symptoms of limb ischemia was monitored. Animals were taken out of the experiment, 10 animals in each group by an overdose of anesthesia on the 10th, 21st and 28th days. Before hatching, the level of microcirculation was determined using laser Doppler flowmetry. To study the morphological picture at the same time in the third and fourth groups, the ischemic gastrocnemius muscle of the leg was excised and a standard histological examination was performed.Results. Trophic disorders in animals of the third group developed in 13.3%, and in the experimental group - in 100%. In the experimental group, the level of microcirculation at all periods was significantly less than in the comparison group: on the 10th and 21st by 1.3 times, on the 28th day by 1.2 times, and the area of ​​muscle necrosis was greater by the same days by 21.2%, by 8.2% and by 6.8%.Conclusion. The developed experimental model corresponds to the necrotic ulcerative stage of critical ischemia in humans.

Pathology of critical limb ischemia; comparison of plaque characteristics between anterior and posterior tibial arteries

2020 ◽  
Vol 315 ◽  
pp. e131
Author(s):  
Y. Koyama ◽  
S. Migita ◽  
S. Yamada ◽  
T. Mukaiyama ◽  
H. Amazaki ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Posterior Tibial ◽  
Tibial Arteries

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 Coexistence of axial spondyloarthritis and thromboangiitis obliterans in a young woman

Reumatismo ◽  
2015 ◽  
Vol 67 (1) ◽  
Author(s):  
G. Lopalco ◽  
F. Iannone ◽  
D. Rigante ◽  
A. Vitale ◽  
M.E. Mancini ◽  
...  
Keyword(s):  
Young Woman ◽  
Axial Spondyloarthritis ◽  
Lower Limbs ◽  
Heavy Smoker ◽  
Thromboangiitis Obliterans ◽  
Left Hand ◽  
Inflammatory Parameters ◽  
Luminal Narrowing ◽  
Tibial Arteries ◽  
Fourth Finger

A peculiar coexistence of axial spondyloarthritis and ischemia of the feet and the fourth finger of the left hand in a young woman, who was a heavy smoker, is discussed in this report. This picture was considered within the context of thromboangiitis obliterans. Positivity of anti-nuclear antibodies and mild elevation of inflammatory parameters were noted. Computed tomography angiograms of upper and lower limbs showed luminal narrowing and occlusion of the left humeral, left anterior/posterior tibial and right anterior tibial arteries. Daily iloprost perfusions were started, and smoking cessation was strongly recommended. Coldness and rest pain in the distal extremities improved within a few weeks. The possibility that spondyloarthritis might precede the clinical picture of thromboangiitis obliterans should be considered in heavy smokers.

scholarly journals A catastrophic seronegative anti-phospholipid syndrome: case and literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Vanda Pinto ◽  
Augusto Ministro ◽  
Nuno Reis Carreira ◽  
Ana Cardoso ◽  
Catarina Sousa Gonçalves ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
High Mortality ◽  
Pulmonary Arteries ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Renal Infarction ◽  
Vascular Events ◽  
Intensive Care Unit Treatment ◽  
Serological Tests ◽  
Hospital Emergency Room

Abstract Background Antiphospholipid Syndrome (APS) is a multisystemic autoimmune disease characterized by arterial and venous thrombosis and / or obstetric morbidity in the presence of at least one circulating anti-phospholipid antibody. The spectrum of vascular events varies from deep venous thrombosis to catastrophic APS, a rare form characterized by acute multiorgan thrombosis and high mortality. Case report We present the case of a 32-week pregnant woman arriving in the hospital emergency room with bilateral acute lower limb ischemia. In the obstetric evaluation, fetal death was declared. Computerized Tomography angiography showed pulmonary embolism of both pulmonary arteries, areas of splenic and right renal infarction and multiple arterial and venous thrombosis. The patient underwent urgent caesarean section and axillary-bifemoral bypass. No events registered. In the postoperative period, in an intensive care unit, treatment with rituximab and plasmapheresis were added to anticoagulant therapy. The laboratorial investigation was negative for thrombophilia and autoimmune diseases. Conclusion Catastrophic APS develops quickly, with multiorgan involvement and high mortality rate. The presented case poses a multidisciplinary challenge, with the surgical approach of extra-anatomical revascularization being less invasive and guaranteeing immediate perfusion of the lower limbs. Although the serological tests were negative for anti-phospholipid antibodies, this case hardly fits into another diagnosis. Therefore, it was treated as a catastrophic APS, having shown a favorable evolution.

scholarly journals A case of severe acute respiratory syndrome coronavirus 2 with acute thrombotic cerebral infarction and generalized thrombosis

2021 ◽  
pp. 405-408
Author(s):  
Sylvia Nikolaeva Genova ◽  
Nikolaeva Genova ◽  
Mina Miroslavova Pencheva ◽  
Alexander Georgiev Ivanov
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Cerebral Infarction ◽  
Viral Pneumonia ◽  
Autopsy Case ◽  
Full Spectrum ◽  
Histological Changes ◽  
Large Size ◽  
Thrombotic Complications ◽  
Coronavirus Infection ◽  
The Brain

The full spectrum of coronavirus disease 2019 (COVID-19) has not been fully described yet. COVID-19 is associated with a high risk of thrombotic complications such as venous thromboembolism and cerebrovascular disease. Here, we report an autopsy case of a 55-year-old woman diagnosed with severe viral pneumonia complicated by acute cerebral infarction and venous and arterial thrombosis in different organs. The patient died due to severe acute respiratory syndrome coronavirus 2. Macroscopically and histologically, in addition to viral pneumonia and diffuse hemorrhages, fibrin clots were found in arteries and venous vessels of medium and large size in the brain, lungs, and pancreas. Propagation of cerebrovascular thrombosis has led to extensive cerebral infarction. The dating of this infarction, according to the macroscopical findings and the histological changes, was between 24 and 48 h before death. This case confirms the hypothesis on the risk of generalized arterial and venous thromboses in coronavirus infection.

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI

2021 ◽  
pp. 20210215
Author(s):  
Nikolaos Galanakis ◽  
Thomas G Maris ◽  
Georgios Kalaitzakis ◽  
Nikolaos Kontopodis ◽  
Nikolas Matthaiou ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Intravoxel Incoherent Motion ◽  
Healthy Individuals ◽  
Imaging Protocol ◽  
Percutaneous Transluminal

Objectives: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. Methods: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. Results: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10−5 mm2/s to 331.51 ± 31 10−5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10−5 mm2/s vs 332.47 ± 22.95 10−5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64–0.93). Conclusions: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. Advances in knowledge: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.

Hemorrhagic complications of а novel coronavirus infection: actual clinical problem.

2021 ◽  
Author(s):  
И.Б. Симарова ◽  
С.Н. Переходов ◽  
А.Ю. Буланов
Keyword(s):  
Case Reports ◽  
Clinical Problem ◽  
Clear Understanding ◽  
The Novel ◽  
Hemorrhagic Events ◽  
Thrombotic Complications ◽  
Predictive Role ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
Therapeutic Doses

Гиперкоагуляционный характер коагулопатии, ассоциированной с новой коронавирусной инфекцией COVID-19, и высокий риск связанных с этим тромботических осложнений — хорошо известный факт на сегодняшний день. Тем не менее в литературе имеются описания и геморрагических событий у больных COVID. В обзоре приведен анализ публикаций, описывающих кровотечения при коронавирусной инфекции; общая частота их в среднем составляет 4–8%. Превалируют желудочно-кишечные кровотечения, существенную часть составляют межмышечные гематомы и кровоизлияния в кожу и слизистые. Показана предиктивная роль применения антикоагулянтов в терапевтических дозах и гипофибриногенемии. Отмечено отсутствие четкого понимания патофизиологических механизмов. Hypercoagulable character of coagulopathy associated with the novel coronavirus infection COVID-19, and the high risk of associated thrombotic complications is a well-known fact. However, there are also case reports of hemorrhagic events in COVID patients in the literature. The review summarizes the publications describing bleedings in coronavirus infection; their overall frequency is on average 4–8%. Gastrointestinal bleeding are prevalent, intermuscular hematomas and hemorrhages in the skin and mucous membranes are frequent. The predictive role of anticoagulants use in therapeutic doses and hypofibrinogenemia is shown. The absence of clear understanding of the pathophysiological mechanisms is noted.

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