scholarly journals Efficiency of the Endovascular Correction of Clinically Evident Degrees of Chronic Obliterating Lower Limb Diseases in Multisegment Lesions

2020 ◽  
pp. 14-20
Author(s):  
S. Yu. Gorokhovsky ◽  
A. A. Lyzikov ◽  
M. L. Kaplan ◽  
V. E. Tihmanovich
Keyword(s):  
Lower Limb ◽  
Surgical Intervention ◽  
Ankle Brachial Index ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Treatment Results ◽  
Arterial Lesion ◽  
Arterial Lesions ◽  
Arterial Insufficiency

Objective: to evaluate the efficiency and extent of endovascular revascularization in patients with multisegment lesions in chronic obliterating diseases of the lower limb arteries.Material and methods. The outcomes of the endovascular correction of multisegment lesions of the lower limb arteries were analyzed in 10 patients. Results. After the treatment the patients revealed a statistically significant change (increase of the value) of the ankle-brachial index (ABI) (p = 0.001). The ABI value after the surgical intervention amounted to 0.81 (0.71; 0.87), which was connected with a favourable prognosis for such patients. Аccording to the established criteria, the outcomes of the interventions comprised the decrease of the degree of chronic arterial insufficiency (p < 0.01), all the patients were discharged having no clinical manifestations of critical lower limb ischemia or decreased evidence of intermittent claudication.Conclusion. The majority of patients with clinically evident ischemia of the lower limbs suffer from multisegment arterial lesion (the number of the segments exceeds 2), which entails the need of multiple corrections in one patient. Meanwhile, the evaluation of the treatment results is possible only in the postoperative period according to the indirect criteria. Therefore, during the operation there arises the need to develop a method of the objective intraoperative evaluation of the extent and efficiency of the performed correction of arterial lesions on each segment.

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.

scholarly journals P853 Bilateral lower limb ischemia in a healthy young man what if the heart was hiding the etiology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Mouadili ◽  
A Tamdy ◽  
B El Fatmi ◽  
S Elkarimi
Keyword(s):  
Popliteal Artery ◽  
Lower Limb ◽  
Cardiac Myxoma ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Atrial Myxoma ◽  
Surgical Removal ◽  
Left Atrial Myxoma ◽  
Tibial Arteries ◽  
The Right

Abstract Cardiac myxoma is the most common benign cardiac tumor with diverse nonspecific clinical manifestations; moreover, atrial myxoma embolization to the peripheral vessels is rare. A 24-year-old man presented tothe emergency departement complaining ofpain and coldness of his two lower extremities. The right femoral pulse was normally felt while the pulses of the left lower limb from the femoral down to the posterior and anterior tibial arteries were not felt. Bilateral thrombectomy was performed on emergency basisand a fatty-like mass from the left femoral artery was removed. The histological examination of this mass was suggestive of myxoma.So, transthoracic echocardiography was done and confirmed the diagnosis of myxoma that was seen in the left atrium and measuring about 10X6 cm in its maximal dimensions. Surgical removal of the myxoma was done later and the patient recovered uneventfully. Conclusion Although myxomas are rare, they should be considered in the differential diagnosis of peripheral embolic disease, especially when an embolic event occurs in a young adult without evidence of endocarditis or arrhythmia. Echocardiography is the modality of choice for diagnosis and follow-up of this type of tumors. FIGURE 1: CTA (computed tomography angiography) showing Occlusion of the left popliteal artery and occlusion of the distal part of the right popliteal artery FIGURE 2: macroscopic view of gelatinous left atrial myxoma

scholarly journals Analysis of associated diseases in patients with acute critical lower limb ischemia

2013 ◽  
Vol 66 (1-2) ◽  
pp. 41-45 ◽  
Author(s):  
Vladimir Manojlovic ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Djordje Milosevic ◽  
Janko Pasternak ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Lower Limb ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Metabolic Decompensation ◽  
Arterial Embolism ◽  
Lower Limb Ischemia ◽  
Associated Diseases ◽  
Arterial Blood

Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number of arterial thrombosis demanded more complex ?inflow? and ?outflow? ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Conclusion. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

scholarly journals Acute Lower Limb Ischemia Secondary to COVID-19: A Case Report

2021 ◽  
Vol 11 (6) ◽  
pp. 161-163
Author(s):  
Komal Gharsangi ◽  
Rajesh Bhawani ◽  
Nitesh Kumar
Keyword(s):  
Lower Limb ◽  
Distress Syndrome ◽  
Multiorgan Failure ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Respiratory Illness ◽  
Acute Limb Ischemia ◽  
Poor Clinical Outcome ◽  
Rare Manifestation ◽  
Thrombotic Complications

COVID -19 is not just a respiratory illness; it is a great masquerader with clinical manifestations from pneumonia, acute respiratory distress syndrome to endothelial dysfunction, hypercoagulability and multiorgan failure. Thrombotic complications due to Covid related coagulopathy is of concern as it further leads to poor clinical outcome in severe cases of Covid 19. Acute limb ischemia (ALI) is a rare manifestation of Covid related coagulopathy. Key words: COVID, coagulopathy, acute limb ischemia (ALI).

scholarly journals Lower Limb Varicose Veins's Clinical Profile and Management

2020 ◽  
pp. 1-5
Author(s):  
C. Z. Perdeshi ◽  
Kustub A. Kulkani ◽  
Revendra N. Yadav ◽  
Mayur Nagwakar ◽  
Niten H. Patil
Keyword(s):  
Varicose Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Clinical Manifestations ◽  
Clinical Profile ◽  
Lower Limbs ◽  
Study Results ◽  
Common Technique ◽  
Age Range ◽  
Made In

The lower limbs’ venous system has the pressure of posture, and blood has to be pushed against gravity into the heart cavity. This issue is generally approached either by a cautious approach or by surgical interference, all of which are constrained. Attempts to study different clinical manifestations of varicose veins are being made in the present study. The overall number of 50 varicose vein patients was analysed and the study results were reported. Varicosity veins of the lower limb is a fairly normal pathological entity. In the 20-50 age range, the condition is more common. The main modality of the procedure is surgery. The most common technique performed is Saphenofemoral flush ligation with stripping. 

scholarly journals The use of oscillometric higly accurate blood pressure monitor for the determination of the ankle-brachial index in examination of patients at suspicion on lower limbs arteries atherosclerosis

2016 ◽  
Vol 19 (1) ◽  
pp. 40-45
Author(s):  
A. A Karlov ◽  
Nataliya A. Karlova ◽  
E. A Zolozova ◽  
N. A Mazur ◽  
E. V Sayutina ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Ankle Brachial Index ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Blood Pressure Monitor ◽  
Comprehensive Therapy ◽  
Cardiovascular Morbidity And Mortality ◽  
Blood Pressure Monitors

Atherosclerotic involvement of lower limbs arteries is a common disorder associated with a high risk of cardiovascular morbidity and mortality, requiring an early start of the comprehensive therapy. Typical clinical manifestations of this disease are found only in some patients that encumbers to make timely diagnosis. Determination of ankle-brachial index (ABI) is a reliable approach of the assessment of the state of blood flow in the lower extremities, but the classical technique requires the participation of specially trained personnel and expensive equipment. In the article there is discussed the use of widely available oscillometric blood pressure monitors for the determination of ABI. In a group of 39 patients with high risk of the development of atherosclerosis there was performed a comparison of the results of the determination of ABI with the help of oscillographic blood pressure monitors and ABI evaluated by the method of volumetric sphygmography. There was shown the sufficient accuracy of the determination of ABI with the aid of oscillographic blood pressure monitors and the interrelationship of this index with the risk of detection ofsignificant atherosclerotic involvement of lower limbs arteries according to Doppler ultrasound data. There was demonstrated that this method can be used at the stage of outpatient examination of patients with a high risk for atherosclerotic involvement of lower limbs arteries.

scholarly journals Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

2019 ◽  
Vol 46 (2) ◽  
pp. 130-132
Author(s):  
Kazuhiro Kurisu ◽  
Satoshi Kimura ◽  
Hiroshi Mitsuo ◽  
Yasutaka Ueno
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Reperfusion Injury ◽  
Lower Limb ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Kidney Injury ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Aortic Repair

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.

scholarly journals CHRONIC LIMB ISCHEMIA

2018 ◽  
Vol 25 (02) ◽  
pp. 201-204
Author(s):  
Fawad Farooq ◽  
Shams Uddin Shaikh ◽  
Shahbaz Shaikh ◽  
Tariq Ashraf
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Study Results ◽  
Significant Difference ◽  
Chronic Limb Ischemia

Background: The Ankle brachial index (ABI) measurements are commonlyused inscreening and management of Peripheral Vascular Disease. In recent studies, Anklebrachial index (ABI) is utilized as a predictor of future atherosclerotic vascular disease andall-cause mortality. Purpose: The purpose of this study was to investigate utility of pre andpost peripheral vascular intervention ankle-brachial index (ABI) assessmentinpatientswith thechronic limb ischemia. Study Design: Quasi experimental study. Setting: National Instituteof Cardio-Vascular Disease (NICVD), Karachi, Pakistan. Period: January 2013 to June 2014.Methodology: The study included 23 patients hospitalized. According to study inclusion/exclusion criteria, patients of chronic limb ischemia on clinical ground and the vascular lesionsof lower limb according toTrans-Atlantic Inter-Society Consensus (TASC scoreclassification II)were evaluated and recruited. The lesions were further classified into three types, Aortoilliac,Femoropopliteal andTibioperoneal. Ankle brachial index (ABI) was classified according toAmerican Diabetic Association. The study was approved by the ethical committee of NICVD.Data was analyzed using SPSS 20. Inc. Results: The mean age of the enrolled patients was57.86±6.56 years. Majority of the patients were male 18(78.3%). The commonly found peripherallesion was femoropopliteal in 9(39%), TASC grade A was commonwith 8 (62%) of cases. ABIscore done pre and post procedure showed a significant difference with a (p-value<0.05) andthere was an improvement of ABI scores in all the lesions after peripheral vascular intervention.Conclusion: The study results concluded that there was animprovement in ABI score afterintervention of peripheral vascular surgery for lower limb segment and recommended its utilityfor the assessment in Peripheral Vascular Disease intervention.

scholarly journals Outcome of Early Surgical Intervention in Acute Lower Limb Ischemia due to Thromboembolism

2014 ◽  
Vol 7 (1) ◽  
pp. 38-43
Author(s):  
QA Azad ◽  
NAK Ahsan ◽  
AM Asif Rahim ◽  
SAN Alam ◽  
M Rahman
Keyword(s):  
Lower Limb ◽  
Surgical Intervention ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Arterial Embolism ◽  
Vascular Flow ◽  
Femoral Artery Occlusion ◽  
Group A ◽  
Group B ◽  
Early Surgical Intervention

Background: Acute lower extremity ischemia is a common vascular disease and considered limb- and life- threatening. The present study evaluated and compared the outcome of early and late surgical intervention in acute lower limb ischemia due to thromboembolism. Methodology: This non randomized comparative parallel study was conducted at the Department of Cardiovascular Surgery, NICVD, Dhaka, Bangladesh from January 2007 to December 2008 for duration of two year. Total 80 patients were enrolled in this study. The patients were divided into equal two groups, Group A, for early surgical intervention (with in 24 hours) and Group B, late surgical intervention (more than 24 hours). Results: Mean (±SD) age of both Group A and Group B was 51.93 (±11.73) and 47.00 (± 11.01) years. Male and female ratio of the total study population was 1.76:1 Pain and absence of pulse distal to occlusion was common for all. Cold extremity, sensory deficit, motor deficit, diminish vascular flow was the commonest findings of both group. In Group A, 57.5% had superficial femoral artery occlusion, 22.5% had iliac artery and 20.0% popliteal artery occlusion. In Group B, 42.5% had superficial femoral artery occlusion, 32.5% had popliteal artery occlusion and 25.0% had iliac artery occlusion. Fasciotomy was performed in 15.0% patients of Group A and in 22.0% patients of Group B. After Fogarty embolectomy in group A and group B had warm extremity (80.0% vs. 65.0%), pulsation distal to occlusion (90.0% vs. 75.0%), intact sensory function (82.5% vs. 67.5%), intact motor function (80.0% vs. 65.0%), and normal vascular flow by Doppler US (80.0% vs. 65.0%). During postoperative period history of bleeding, infection, reperfusion injury, muscle necrosis and limb amputation were 12.5% vs. 10.0%, 5.0% and 7.5%, 17.5% vs. 35.0%, 15.0% vs. 12.5% and 37.5% vs. 32.5% respectively. Conclusion: Duration of embolism may be the significant factor determining the outcomes of the management of acute arterial embolism in the lower extremities. The 24- hour duration of arterial embolism is a crucial factor influencing the surgical the management and early diagnosis and shifting of patients to specified centre as early as possible to save limb as well as life. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20799 Cardiovasc. j. 2014; 7(1): 38-43

Sign in / Sign up

Export Citation Format

Share Document