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This review is intended to help clinicians and patients understand the present state of peripheral artery disease, appreciate the progression and presentation of critical limb ischemia/chronic limb-threatening ischemia, and make informed decisions regarding inflow and outflow endovascular revascularization and surgical treatment options within the...
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Background
Spinal cord stimulation (SCS) is a therapeutic option for patients with a peripheral arterial disease with critical limb ischemia (CLI) and consequent ischemic rest pain. Neuromodulation is chosen when vascular reconstruction is not possible or failed. Data about the effect of SCS over limb salvage rates are dissonant.
Method
We report...
Purpose: To report the 12-month safety and efficacy outcomes of the investigational device exemption trial evaluating an implantable below-the-knee (BTK) dissection repair device. Materials and Methods: The prospective, multicenter, single-arm Tack-Optimized Balloon Angioplasty (TOBA) II BTK study ( ClinicalTrials.gov identifier NCT02942966) evalua...
Purpose of Review
Peripheral artery disease is a widespread condition that can cause functional impairment and emergent complications, including limb-threatening ischemia. Revascularization of ischemic extremities is achievable with surgical bypass and endovascular techniques, but patients with diffuse or extensive disease are not candidates as the...
Background and aims
The increasing prevalence of diabetes mellitus is causing a massive growth of peripheral artery disease incidences, a disabling complication of diabetic atherosclerosis, which leads often to the amputation of the affected limb. Critical limb ischemia is the terminal disease stage, which requires a prompt intervention to relieve...
Objective
To compare the mortality rates of patients with claudication and de novo femoropopliteal lesions treated with and without paclitaxel coated devices (PCD).
Background
A recent meta-analysis, mostly including patients with claudication and de novo femoropopliteal lesions but also with recurrent stenoses and critical limb ischemia, has show...
Citations
... A subgroup of patients may evolve to more severe symptoms such as rest pain, nonhealing skin ulcerations or gangrene indicating chronic critical limb ischemia (CLI). This condition is associated with a 25% one-year mortality rate and 25% one-year amputation rate [2]. ...
The most common cause of peripheral arterial disease (PAD) is atherosclerosis. PAD can be considered a global pandemic, as it affected a quarter billion people worldwide in 2013 [1]. The prevalence and complexity of the disease is increasing due to aging populations and the rise in risk factors including diabetes and kidney disease.
... Surgical treatment of PAD is indicated in patients with persistent claudication (even when optimal medical treatment has been followed), in patients with limb-threatening ischemia (to restore pulsatile flow to the foot), and in patients with acute limb ischemia. The latter are treated using a comprehensive approach, taking into account the location and extent of the lesion, the general health status, and the patient's life expectancy (3)(4)(5). ...
... 3 The incident rates of peripheral artery disease (PAD) and critical limb ischaemia (CLI) are on the rise worldwide. 9 Treatments for PAD include risk control, optimal medical therapy, revascularisation (endovascular or surgical) and limb amputation (major or minor). These treatments aim to reduce pain, prevent tissue loss, ischaemic ulcers or infection, as well as improve the quality of life. ...
Objectives
We aimed to investigate the regional variations in the number of interventions and surgeries for peripheral artery disease (PAD) and explore the major determinants of the variations.
Design
Cross-sectional study.
Setting
The Japanese Ministry of Health, Labour and Welfare National Database and Diagnostic Procedure Combination database in 2018.
Data
The rates of endovascular treatment (EVT), bypass surgery per 100 000 individuals in the population were calculated for all 47 prefectures in Japan. The total annual changes in the rates of EVT and bypass surgery in Japan from 2012 to 2019 were calculated.
Analysis
A linear regression model was developed with rates of EVT and bypass surgery as dependent variables and regional medical supply in each prefecture as explanatory variables. These regional factors included the rate of percutaneous coronary intervention (PCI) for angina, the numbers of cardiovascular specialists, specialists in cardiac surgery, interventional radiology (IVR) training facilities and cardiovascular surgery training facilities, per 100 000, respectively.
Results
There was a 5.7-fold difference (143 and 25 per 100 000 individuals aged ≥40 years) in the highest and lowest EVT rates. The highest and lowest rates of bypass surgery were 34 and <10 per 100 000 individuals aged ≥40 years in a prefecture, respectively. The rate of PCI contributed most significantly positive to the rate of EVT (p<0.001). However, the numbers of IVR and cardiovascular surgery training facilities had significant positive and negative relationships, respectively, with the rate of EVT. The numbers of specialists in cardiac surgery and cardiovascular specialists had significant positive (p=0.01) and negative (p=0.01) correlations, respectively, with the rate of bypass surgery.
Conclusions
Considerable regional variations in the rates of revascularisation for PAD were found. Unbalanced presence of medical resources, preference of suppliers and the training system had larger effects on the regional variation in Japan.
... Review of the literature indicates that endovascular revascularization is an effective therapy for peripheral artery disease (6). Myocardial revascularization with coronary bypass surgery or angioplasty remains the conventional treatment for ischemic heart disease, and the use of arterial grafts and drugeluting stents have improved clinical outcomes. ...
For the adult population the frequency of peripheral arterial disease is 3% - 4%. Cardiovascular and cerebrovascular event rates, both fatal and non-fatal, are increased in patients with PAD and DM relative to nondiabetic patients with PAD.
It is the clinical case of a 62-year-old patient, diagnosed with type 2 diabetes with chronic obliterative arteriopathy stage IV of the lower limbs.
Postoperative evolution was favorable, as there was no need for amputation of the left hallux or debridement of necrotic tissues, due to the decision to perform the timely iliofemoral bypass that restored arterial flow to the femoral and iliac arteries through the prosthetic graft.
Continued treatment to normalize lipid metabolism, hypertension, repeated vasodilator therapy, diet and exercise are absolutely necessary and must be included in the long-term therapeutic plan of patients who have undergone restorative surgery, with timely referral to specialist medical services.
... By analyzing the literature, only a few cases describe a delayed manifestation of obliterating arteriopathy of the lower limbs in SARS-CoV-2 [23]. The endovascular approach is first recommended by various vascular societies when invasive revascularization procedures are required [24]. A recent analysis reveals that during the pandemic in Madrid 44% of revascularizations were performed by full endovascular methods, while 39% of them were performed by full open revascularization [25]. ...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can engender multi-system inflammatory syndrome. Its main symptoms are cardiovascular and thromboembolic problems that can develop into severe complications. The present case is about a 55-year-old patient who was admitted for critical ischemia of the right lower limb and necrosis of the right forefoot. The patient was infected with coronavirus disease 2019 (COVID-19) one month before her admission. The patient also has cardiovascular risks including type 2 diabetes and hypertension. The performance of ultrasounds revealed a thrombus in the right atrium and the pulmonary artery, and arteriography detected an occlusion of the right popliteal joint for which she had an endovascular recanalization and amputation of the right forefoot. This case highlights that SARS-CoV-2 infection could be considered a serious cardiovascular disease requiring cardiovascular explorations to initiate hospital management and avoid severe complications.
... Peripheral arterial disease (PAD), with its prevalence of 5.9% in the population aged ≥ 40 years, contains a significant proportion of patients whose main pathology is located in the infragenicular arteries; these changes are causal for up to 19.1% of PAD patients [1,2]. Treatment of these patients, like in any disease, should be based on a risk-benefits analysis [3]. ...
... Comparing the two-week and six-month follow-ups, a positive trend regarding clinical symptoms becomes apparent, while the mean ABI values remain constant. This finding may emphasize the importance of the clinical symptoms as outcome parameters instead of purely focusing on patency rates when evaluating a successful treatment, which can be found in comparable studies [19,20]. With just one short-term complication and no longterm complications, the intervention seems feasible to accomplish in comparison to similar procedures, when routinely performed by a specialized team [21]. ...
Background and Objectives: Peripheral arterial disease (PAD) contains a significant proportion of patients whose main pathology is located in the infragenicular arteries. The treatment of these patients requires a deliberate consideration due to the threat of possible complications of an intervention. In this retrospective study, the feasibility of a below-the-knee atherectomy (BTKA) via a 1.5 mm Phoenix atherectomy catheter and the patient outcome over the course of 6 months are investigated. Materials and Methods: The data of patients suffering from PAD with an infragenicular pathology treated via 1.5 mm Phoenix™ atherectomy catheter between March 2021 and February 2022 were retrospectively analyzed. Prior to the intervention, after 2 weeks and 6 months, the PAD stages were graded and ankle-brachial-indeces (ABI) were measured. Results: The study shows a significant improvement of ABI, both after 2 weeks and 6 months. Additionally, the number of PAD stage IV patients decreased by 15.2% over the course of 6 months, and 18.2% of the patients improved to PAD stage IIa. Only one bleeding complication on the puncture side occurred over the whole study, and no other complications were observed. Conclusions: Phoenix™ atherectomy usage in the BTKA area seems to be feasible and related to a favorable outcome in this retrospective study.
... Historically, an open surgical bypass was considered standard therapy for CLI, but additional evidence indicated that endovascular revascularization is an effective and safe therapy for CLI 33,34) . In a previous study of patients with chronic HD with CLI, no significant differences were found in clinical outcomes, such as overall survival, major amputation, and major adverse limb events, between surgical bypass and endovascular therapy 35) . ...
Aim: The aim of this study was to investigate the effects of continuous cilostazol use on emergency department (ED) visits, hospitalizations, and vascular outcomes in patients with hemodialysis (HD) with peripheral artery disease (PAD).
Methods: This retrospective cohort study recruited 558 adult patients, who had received chronic HD for at least 90 days between January 1, 2008 and December 31, 2012, from the National Health Insurance Research Database. Eligible patients were divided into two groups based on continuing or discontinuing cilostazol treatment. Outcome measures were ED visits, hospitalizations, mortality, and vascular outcomes such as percutaneous transluminal angioplasty, surgical bypass, lower leg amputation, ischemic stroke, hemorrhagic stroke, and cardiovascular events.
Results: Patients with continuous cilostazol use had significantly higher prevalence of stroke, cancer, vintage, and the use of angiotensin receptor blocker and β-blocker, but significantly lower incidence of ischemic stroke and cardiovascular events, as well as lower mortality, than those without continuous cilostazol use (all p＜.05). Continuous cilostazol use was independently associated with lower risk of ED visits, hemorrhagic stroke, and cardiovascular events (adjusted hazard ratios: 0.79, 0.29, and 0.67; 95% confidence intervals: 0.62-0.98, 0.10-0.84,and 0.48-0.96, respectively; all p＜.05). Continuous cilostazol use was significantly associated with higher ED visit-free and cardiovascular event-free rates (log-rank test; p＜.05).
Conclusion: Continuous treatment of cilostazol in patients with HD with PAD significantly decreases the risk of ED visits, hemorrhagic stroke, and cardiovascular events and improves ED visit-free and cardiovascular event-free rates during long-term follow-up.
... 6,[15][16][17][18][19] The current standard of care is managing the comorbidities, addressing the metabolic abnormalities, and supportive care through frequent dressing changes and offloading techniques, and revascularisation via endovascular or surgical approaches to restore blood flow but with limited success because of poor target vessels, poor wound healing, and chronic renal failure limiting the contrast load. 20 Treatment aimed at blocking pathw33ays contributing to poor wound healing in diabetics could be therapeutically very beneficial. Receptor for Advanced Glycation Endproducts (RAGE) expression in diabetes underlies several of the molecular pathways contributing to poor wound healing. ...
Receptor for Advanced Glycated End‐products (RAGE) is highly expressed in diabetes and impairs wound healing. We proposed that administering an antibody that blocks RAGE will hasten the healing of dorsal wounds in diabetic pigs compared with a non‐immune IgG. Two purpose‐bred diabetic (D) Yucatan minipigs (Sinclair, Auxvasse MO) each underwent 12 2 × 2 cm full thickness dorsal wounds: four wounds received decellularized porcine skin patches (Xylyx Bio, Bklyn NY): four anti‐RAGE Ab (CR‐3) infused patches, four saline infused patches and four wounds were left open. One pig received anti‐RAGE Ab (CR‐3) 1 mg/kg IM q 10 days and other received non‐immune IgG. Wounds were measured at 2 and 4 weeks followed by euthanasia and wound harvesting. At 2 weeks few of the patches appeared to be incorporated into the wound. By 4 weeks all patches in pigs treated systemically with CR‐3 were detached and the wounds almost healed. For all 24 wounds for both pigs regardless of presence of patch or type of patch, the average IgG treated pig wound size at 4 weeks was 69.2 ± 14.6% of initial size and the average CR‐3 treated pig wound size was 40.9 ± 11.3% of initial size (P = 0.0002). Quantitative immunohistology showed greater staining for collagen in the CR‐3 treated wounds compared with IgG treated. Staining was positive for RAGE, Mac, and IL‐6 in the IgG treated wounds and negative in the CR‐3 treated wounds. From these pilot experiments, we conclude that a RAGE blocking antibody given parenterally improved wound healing in a diabetic pig while patches were not effective.
... The use of the hybrid technique in lower extremity arterial disease is to achieve complete revascularization (37)(38)(39)(40). Patients with multifocal disease involving the ilio-femoral and femoro-popliteal systems can be treated in a hybrid fashion with endovascular stenting of the iliac artery followed by surgical bypass or endarterectomy to the femoro-popliteal lesion. ...
Gümünüzde kardiyologlar ve kardiyovasküler cerrahlar birden çok komorbiditeye ve kardiyovasküler hastalığa sahip hasta grubuyla daha sık karşılaşmakta. Perkutan ve cerrahi teknikler bu hastalarda tek başına başarı sağlayamamakta veya yüksek riskli olmakta. İki yöntemin güçlü yönlerini hibrid bir şekilde kullanarak bu hastalarda düşük riskli prosedürler gerçekleştirilebilmektedir. Gelişen teknoloji ile birlikte miyokardiyal revaskülarizasyon, kalp kapak hastalıkları, aort ve periferik damar hastalıkları için yeni hibrid prosedürler oluşturulabilmektedir.
... It is clinically important to focus on the microvasculature and nonvascular tissue such as skeletal muscle and skin as well as re-establishing macrovascular blood flow in the management of CLI [18][19][20]. Degradation of skeletal muscle, skin and other tissue is associated with degradation of the vascular network. The use of microvascular regeneration strategies through direct tissue stimulation during the critical phase of the threatened limb together with optimized medical care would enable avoidance of major amputation in the long term. ...
Various therapeutic strategies for angiogenesis are performed to improve symptoms in patients with critical limb ischemia (CLI). Pre-clinical studies have shown that low-intensity pulsed ultrasound (LIPUS) exposure induces angiogenesis. LIPUS may be a new stratergy for treatment of CLI. The purpose of this pilot trial was to evaluate outcomes in patients with CLI who were treated with LIPUS. Fourteen patients with CLI, who were not candidates for angioplasty or surgical revascularization, were enrolled in this study. Historical control data were obtained from the Hiroshima University PAD database. The primary endpoints were major amputation and death. The outcomes were compared in 16 lower limbs of the 14 patients with CLI who were treated with LIPUS and in 14 lower limbs of 14 patients with CLI as historical controls. All patients were followed for after 5 years after treatment with LIPUS. The mean duration of LIPUS exposure in the LIPUS group was 381± 283 days. During the 5-year follow-up periods, there were 3 major amputations and 7 deaths in the LIPUS group and there were 14 major amputations and 7 deaths in the historical control group. The overall amputation-free survival rate was significantly higher in patients who were treated with LIPUS than in historical controls. There was no significant difference between overall mortality-free survival rates in the LIPUS group and historical control group. LIPUS is a noninvasive option for therapeutic angiogenesis with the potential to reduce the incidence of major amputations in patients with CLI.
