scholarly journals Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

2017 ◽  
Vol 3 (4) ◽  
pp. 160-171
Author(s):  
Theodora Benedek ◽  
István Kovács ◽  
Imre Benedek
Keyword(s):  
Surgical Treatment ◽  
Limb Salvage ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Therapeutic Angiogenesis ◽  
Lower Limbs ◽  
Current Status ◽  
High Morbidity ◽  
Acute Limb Ischemia ◽  
Promising Alternative

Abstract Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.

Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

2021 ◽  
pp. 028418512110069
Author(s):  
Talha Butt ◽  
Leena Lehti ◽  
Jan Apelqvist ◽  
Anders Gottsäter ◽  
Stefan Acosta
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Intraclass Correlation ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Acute Limb Ischemia ◽  
Below The Knee

Background Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results Patients with (n = 23) and without (n = 85) DM had lower ( P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

scholarly journals Safety of transfer, type of procedure, and factors predictive of limb salvage in a modern series of acute limb ischemia

2019 ◽  
Vol 69 (4) ◽  
pp. 1174-1179 ◽  
Author(s):  
Jake Hemingway ◽  
Davidson Emanuels ◽  
Shahram Aarabi ◽  
Elina Quiroga ◽  
Nam Tran ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Limb Ischemia ◽  
Acute Limb Ischemia

scholarly journals FT17. Factors Predicting Limb Salvage in Acute Limb Ischemia Treated at a Tertiary Referral Center

2017 ◽  
Vol 65 (6) ◽  
pp. 22S-23S
Author(s):  
Shahram Aarabi ◽  
David Emanuels ◽  
Elina Quiroga ◽  
Nam Tran ◽  
Benjamin W. Starnes ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center

scholarly journals Outcome in Patients with Acute Limb Ischemia Post Hybrid Procedure Compared to Surgical Thrombectomy

2020 ◽  
Vol 1 (2) ◽  
pp. 55-60
Author(s):  
Nyityasmono Nugroho ◽  
Nyityasmono Tri Nugroho ◽  
Dedy Pratama
Keyword(s):  
Critical Review ◽  
Literature Search ◽  
Limb Ischemia ◽  
Hybrid Procedure ◽  
P Value ◽  
High Morbidity ◽  
Acute Limb Ischemia ◽  
Research Database ◽  
Best Management ◽  
Surgical Thrombectomy

Introduction: Acute limb ischemia (ALI) is characterized by decreased perfusion to extremities in the form of acute ischemia and the presence of acute thrombus which may endanger the viability of the extremities. Therapeutic modalities are various including intraarterial thrombolysis with or without the help of ultrasonography and the use of thrombectomy instruments. However, due to the high morbidity and mortality rate, a new technique called the hybrid procedure is introduced. This procedure is a combination between endovascular management to correct the abnormalities with the help of angiography as well as thrombectomy surgical management, in the same time. Therefore, it is necessary to conduct a literature search related to the case we are reporting, to determine whether hybrid procedure or thrombectomy only is the best management for ALI. This study aims to determine the best management for the case being reported according to literature search and critical reviews collected from medical research database. Method: From the data collected, there was one interesting case, which is a case about acute limb ischemia, and the following operative management. Afterwards, a literature search was conducted to obtain articles related to the case, and critical review was made regarding the selected article. Results: At the end of the literature search, we found two articles which showed better outcome on hybrid procedure compared to surgical thrombectomy. Compared to the group who underwent thrombectomy, there was decreased 30-days mortality in the group who underwent the hybrid procedure (3.3% vs 4.4%, p-value 0.05), decreased incidence of amputations after 30 days (6.49% vs 13.5%, p-value 0.023), increased limb salvage (91.9% vs 82.3%, p-value 0.03, 95% CI), and decreased two-years mortality (18.7% vs 40.5%; p– value <0.001). Conclusion: Critical review on articles obtained from literature search in online database showed that the outcome hybrid procedure was better than surgical thrombectomy only. Keywords: acute limb ischemia; hybrid procedure; thrombectomy; outcome

scholarly journals Endovascular Revascularization Strategies Using Catheter-Based Thrombectomy Versus Conventional Catheter-Directed Thrombolysis for Acute Limb Ischemia

2021 ◽  
Author(s):  
Maofeng Gong ◽  
Xu He ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
Jianping Gu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Clinical Success ◽  
Limb Ischemia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Clinical Event ◽  
Comparable Efficacy ◽  
Acute Limb Ischemia ◽  
Technical Success Rate ◽  
Catheter Directed Thrombolysis

Abstract Background Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). Methods A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to August 2018 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. Results More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P < .001). Patients who underwent primary CBT achieved a higher technical success rate than those who underwent primary CDT in a shorter procedure time (P < .001), whereas 42.1% of patients who underwent CBT did not need adjunctive CDT. The duration and dosage of adjunctive CDT in the CBT group were significantly decreased compared with those in the primary CDT group (both P < .001), and the CBT group achieved a shorter in-hospital length of stay (P < .001). Subgroup analysis revealed that patients treated with AngioJet and Rotarex catheters achieved slightly lower dosages, shorter CDT durations and shorter in-hospital stay lengths than those treated with large-bore catheters (P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent primary CBT had slightly fewer complications than those who underwent primary CDT (P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.5%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. Conclusions Endovascular treatment of ALI with the use of catheter-based therapies is a safe and effective modality with similar safety and clinical outcome to conventional CDT alone, and this treatment modality overcomes the common shortcomings of CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

scholarly journals Bleeding complications at the access sites during catheter directed thrombolysis for acute limb ischaemia: Mini review

2021 ◽  
Vol 5 (1) ◽  
pp. 001-003
Author(s):  
Noory Elias ◽  
Böhme Tanja ◽  
Beschorner Ulrich ◽  
Zeller Thomas
Keyword(s):  
Treatment Options ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Bleeding Complications ◽  
Limb Ischaemia ◽  
Acute Limb Ischemia ◽  
Access Site ◽  
Catheter Directed Thrombolysis ◽  
Acute Limb Ischaemia ◽  
Surgical Bypass

Acute and subacute ischemia of the lower limbs represents a major emergency with a high in-hospital mortality, complication, and leg amputation rates. Treatment options for acute limb ischemia include systemic anticoagulation, followed by various catheter based options including infusion of fibrinolytic agents (pharmacological thrombolysis), pharmacomechanical thrombolysis, catheter-mediated thrombus aspiration, mechanical thrombectomy, and any combination of the above or open surgical intervention (thromboembolectomy or surgical bypass). Minor and major bleeding complication during catheter directed thrombolysis (CDT) especially at access site are frequent. Bleeding complications require often an interruption or termination of CDT affecting clinical outcome of the patients. Recently we examined a new access site bleeding protection device during CDT.

scholarly journals COVID-19 Complicated with Arterial Thrombosis Resulting Acute Limb Ischemia: A Case Report from Bangladesh

2020 ◽  
pp. S50-S56
Author(s):  
Md Reaz Uddin Chowdhury ◽  
Kazi Shanzida Akter ◽  
Sahedul Islam Bhuiyan ◽  
Bimal Chandra Das ◽  
Mohammad Moksedul Moula ◽  
...  
Keyword(s):  
Arterial Thrombosis ◽  
Virus Disease ◽  
Rare Complication ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Rare Presentation ◽  
Need To Evaluate ◽  
Huge Impact ◽  
Few Data

COVID-19(Corona virus disease 2019), which starts from Wuhan, China on December, 2019 spread rapidly to different countries of the world including Bangladesh. It affects huge impact on health care system. It’s a new disease with multisystem involvement. Physicians are experiencing new presentation of different cases and rare complication including arterial thrombosis. Few data is available regarding arterial thrombosis in SARS-CoV-2 infected patients. We are currently fighting with a 60 year old lady suffering from COVID-19 pneumonia with other co-morbidities developed severe arterial occlusion of right leg despite of taking anti platelet for long time for another cause. Patient developed irreversible right lower limb ischemia not improving with continuous infusion of unfractionated heparin followed by severe pulmonary embolism. So further study and recommendations will need to evaluate the cases and treatment in COVID-19 Patients with rare presentation. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S50-S56

scholarly journals Prediction of Limb Salvage after Therapeutic Angiogenesis by Autologous Bone Marrow Cell Implantation in Patients with Critical Limb Ischemia

2011 ◽  
Vol 4 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Shuhei Tara ◽  
Masaaki Miyamoto ◽  
Gen Takagi ◽  
Yoshimitsu Fukushima ◽  
Sonoko Kirinoki-Ichikawa ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Limb Salvage ◽  
Bone Marrow Cell ◽  
Critical Limb Ischemia ◽  
Marrow Cell ◽  
Autologous Bone Marrow ◽  
Limb Ischemia ◽  
Therapeutic Angiogenesis ◽  
Autologous Bone ◽  
Cell Implantation

“Silent” thrombosis of an abdominal aortic aneurysm not producing acute limb ischemia

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 265-267 ◽  
Author(s):  
Moulakakis ◽  
Maras ◽  
Bountouris ◽  
Pomoni ◽  
Georgakis ◽  
...  
Keyword(s):  
Blood Flow ◽  
Abdominal Aortic Aneurysm ◽  
Mortality Rate ◽  
Aortic Aneurysm ◽  
Acute Pain ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Acute Limb Ischemia ◽  
Abdominal Aortic ◽  
Flow Through

Thrombosis of an abdominal aortic aneurysm is a rare devastating complication with an estimated mortality rate of 50%. Simultaneous acute pain, pallor and coldness of the lower limbs, mottling from the level of iliac crests or umbilicus, paraplegia and absence of femoral pulses are all manifestations of a sudden and acute interruption of blood flow through the aneurysmatic aorta. We report a case of an occlusion of an abdominal aortic aneurysm during hospitalization which was not manifested with symptoms of limb ischemia. In this case we feature the rare and unusually “silent” presentation of the event.

Sign in / Sign up

Export Citation Format

Share Document