Primary retrograde distal access for endovascular interventions in patients with lower limb ischemia

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

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Role of Hybrid Interventions in Management of Critical Lower Limb Ischemia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2430772 ◽

2020 ◽

pp. 229-237

Author(s):

Samy R. Zekilah ◽

Adel H. Kamhawy ◽

Hassan A. Hassan ◽

Mohamed A. El-heniedy ◽

Ahmed M. Ismael

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

University Hospital ◽

Tissue Loss ◽

Hybrid Technique ◽

Lower Limb Ischemia ◽

Endovascular Interventions ◽

Ischemic Ulcer ◽

Work Up

Aims: To evaluate safety and efficacy of the hybrid technique in revascularization of multilevel lower limb arterial occlusive disease in patients with critical lower limb ischemia. Study Design: A prospective non comparative interventional study. Place and Duration of Study: It was conducted between February 2017 and June 2019 in the Department of Vascular Surgery, Tanta University hospital. Methodology: The study included 23 patients were treated with hybrid intervention techniques, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up like duplex scanning with or without CT angiography. All patients were undergone hybrid interventions in an operating room with imaging facilities (mobile c-arm device) where both surgical and endovascular interventions were done simultaneously. Results: Twenty three patients were treated for unilateral critical lower limb ischemia using single session elective hybrid intervention. The patients age ranged from 46 to 76 (mean 62.6) with 19 males. 8 patients (34.8%) presented with ischemic rest pain and the remainder (65.2%) presented with tissue loss (ischemic ulcer or gangrene). most common inflow procedure was femoro-popliteal supragenicular bypass, and the commonest outflow procedure was tibial angioplasty. Technical success was achieved in 22 patients. Mean ABI was improved from 0.49 preoperatively to 0.84 in early post-operative measurements. Out of 23 limbs treated there were 20 limbs saved from amputation (87% limb salvage rate). We had three mortalities from other co-morbidities and four minor complications treated conservatively and resolved. Conclusion: Hybrid interventions were proved to be reasonable, effective and safe option for treatment of critical lower limb ischemia.

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CLINICAL OUTCOMES OF ENDOVASCULAR INTERVENTIONS IN DIABETIC PATIENTS WITH CRITICAL LOWER LIMB ISCHEMIA

Atherothrombosis Journal ◽

10.21518/2307-1109-2019-1-25-35 ◽

2019 ◽

pp. 25-35

Author(s):

I. A. Bondar

Keyword(s):

Clinical Outcomes ◽

Lower Limb ◽

Vascular Diseases ◽

Limb Ischemia ◽

Diabetic Patients ◽

Lower Limb Ischemia ◽

Endovascular Interventions ◽

Patients With Diabetes ◽

Limb Vessel ◽

Percutaneous Transluminal

The article describes the features of lower limb vessel lesions in patients with diabetes, modern methods for diagnosing critical lower limb ischemia (CLLI), indications for endovascular interventions, and reviews the clinical outcomes of percutaneous transluminal balloon angioplasty in patients with diabetes. The authors emphasized high efficacy of endovascular operations in CLI in patients with diabetes. The issues of the prevention of CLLI and the treatment of the lower limb vascular diseases in diabetes are discussed.

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Erosive and ulcerative lesions of the gastrointestinal tract and bleeding in patients with critical lower limb ischemia and diabetes mellitus underwent endovascular interventions

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2021-180-1-65-72 ◽

2021 ◽

Vol 180 (1) ◽

pp. 65-72

Author(s):

A. A. Poliantsev ◽

D. V. Frolov ◽

A. M. Linchenko ◽

S. N. Karpenko ◽

A. A. Chernovolenko ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Endovascular Interventions ◽

Ulcerative Lesions ◽

The Relationship

The objective was to study the prevalence of erosive and ulcerative gastroduodenal lesions, bleedings of this localization and the relationship with factors predisposing to them in patients with critical lower limb ischemia and type 2 diabetes mellitus who underwent endovascular intervention for limb revascularization.Methods and materials. The study included 81 patients aged 67.5±6.8 years, hospitalized in the department of vascular surgery with critical lower limb ischemia of atherosclerotic genesis and type 2 diabetes mellitus to perform revascularization by means of transluminal balloon angioplasty with stenting when indicated. In the preoperative period, all patients underwent fibrogastroduodenoscopy, according to the results of which a scoring assessment of the lesion of the gastric mucosa and duodenum was presented.Results. All patients participating in the study were diagnosed with pathology of the gastroduodenal zone: in 95.1 % of the inflammatory nature, in 4.9 % of the ulcer. The relationship between the duration of rest pain, the fact of damage to the mucous membrane of the upper gastrointestinal tract and its severity was not revealed, but the relationship of erosive and ulcerative lesions of the stomach and duodenum with the number of taken pain pills was determined. In patients with repeated endovascular intervention and / or amputation, gastrointestinal bleedings were more often recorded compared with study participants who underwent a single revascularization – 11.1 and 1.6 % of patients, respectively.Conclusion. Erosive and ulcerative lesions of varying severity are present in all patients with critical lower limb ischemia on the background of diabetes mellitus. At the same time, patients with repeated endovascular interventions and / or amputations are more susceptible to bleeding. For the prevention of pathology of the stomach and duodenum, an in-depth diagnosis and a differentiated approach are required.

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Results of endovascular interventions in acute lower limb ischemia

UMJ Heart & Vessels ◽

10.30978/hv2019-2-52 ◽

2019 ◽

Vol 0 (2) ◽

pp. 52-55

Author(s):

A. B. Babynkin ◽

V. V. Boyko ◽

O. I. Pityk

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Endovascular Interventions

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Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽

10.1024/0301-1526.37.4.327 ◽

2008 ◽

Vol 37 (4) ◽

pp. 327-332 ◽

Cited By ~ 1

Author(s):

Koutouzis ◽

Sfyroeras ◽

Moulakakis ◽

Kontaras ◽

Nikolaou ◽

...

Keyword(s):

Upper Limb ◽

Lower Limb ◽

Cardiac Troponin ◽

Cardiac Involvement ◽

Troponin I ◽

Limb Ischemia ◽

Elevated Troponin ◽

Troponin Elevation ◽

Lower Limb Ischemia ◽

Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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