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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rest pain, ulceration, and gangrene are often considered together in studies describing outcomes in patients with critical limb ischemia. A retrospective analysis of prospectively collected data of 152 infrainguinal bypass grafts performed on 128 patients with chronic critical limb ischemia over a 6-year period was carried out. Grafts were classified according to the mode of presentation and were followed up by regular clinical and duplex examinations. Mean follow-up period was 29 months (range 12 to 60 months). Patients' demographics, risk factors, and graft characteristics were not statistically different between the groups. The 5-year cumulative primary patency rates were 33%, 52%, and 51% for gangrene, ulceration, and rest pain, respectively (p = 0.04). The 5-year cumulative primary assisted patency rates were 46%, 70%, and 72% for gangrene, ulceration, and rest pain, respectively (p = 0.01). The 5-year cumulative secondary patency rates were 48%, 76%, and 75% for gangrene, ulceration, and rest pain, respectively (p = 0.003). The 5-year cumulative limb salvage rates were 59%, 87%, and 83%, for gangrene, ulceration, and rest pain, respectively (p = 0.01). Gangrene is a distinct subcategory of critical limb ischemia with a worse prognosis than ulceration and rest pain and should be classified as such when reporting results of infrainguinal bypass grafts.
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PMID:Infrainguinal bypass graft patency and limb salvage rates in critical limb ischemia: influence of the mode of presentation. 1261 60

A 61-year-old woman presented with symptoms and signs of severe ischemia in the left leg. Rest pain was present, and the leg was pulseless. The patient reported a complicated history of repeated strokes. Complete evaluation revealed mitral valve disease, atrial fibrillation, and occlusion of the distal aorta and left iliac and femoral arteries. Corrective surgery consisted of mitral valve replacement and concomitant ascending aorta to left common femoral and femoral graft to right femoral artery bypass. Recovery was uneventful. The cardiac and vascular prostheses functioned well and provided complete relief of ischemia.
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PMID:Ascending aorta to common femoral artery bypass: An unusual but successful method for revascularization of the lower extremity: Report of case. 1521 84

Rest pain, tissue loss, and gangrene are manifestations of critical limb ischemia caused by peripheral arterial disease and define a patient subgroup at highest risk for major limb amputation. Patients with nonhealing lower extremity wounds should be screened for the risk factors for peripheral arterial disease and offered noninvasive vascular testing. The diagnosis of critical limb ischemia mandates prompt institution of medical and surgical management to achieve the best chance of limb salvage. Surgical intervention has evolved from primary amputation to open bypass to the present era of endovascular therapy. The goals of surgical bypass and endovascular therapy are to improve perfusion sufficiently to permit healing. Despite poorer patency rates and the more frequent need for reintervention, endovascular therapy has been shown in multiple retrospective studies to achieve limb salvage similar to open bypass. Only one large, prospective, randomized controlled trial exists comparing open bypass with endovascular therapy: The Bypass versus Angioplasty in Severe Limb Ischemia of the Leg (BASIL) trial. Close clinical surveillance and serial monitoring of limb perfusion by means of noninvasive arterial studies are needed to determine the need for further vascular intervention. Limb salvage patients suffer from multiple comorbidities and benefit from a multidisciplinary, team approach to care.
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PMID:Critical evaluation of endovascular surgery for limb salvage. 2120 Feb 88

With the ageing population and increasing incidence of diabetes, arterial occlusive disease will become more common as cause of lower limb pain. In the diagnosis of limb pain of arterial origin it is essential to distinguish rest pain from intermittent claudication. Rest pain is associated with high risk of amputation and is therefore an indication for examinations within specialized care. First-line treatment of intermittent claudication instead consists of the management of risk factors and guided exercise. Specialized care consultation is required only in case of intermittent claudication which is refractory to conservative treatment and threatening the ability to work and function. Acute lower limb ischemia is always an indication for emergency assessment.
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PMID:[Lower limb pain of arterial origin]. 2415 14

Critical limb ischemia (CLI) in high surgical risk patients with chronic liver diseases has a grave prognosis with a one-year mortality rate of 20% and a one-year amputation rate of 25% after the initial diagnosis. According to Trans-Atlantic Inter-Society Consensus (TASC)-II Guidelines, revascularization (surgical & endovascular) is the treatment of choice for patients with critical limb ischemia (CLI). The primary goal of revascularization is to relieve ischemic rest pain, heal ulcers, prevent amputation, improve patient's quality of life (limb salvage) and secondary goal was the periprocedural complications. Endovascular techniques include balloon angioplasty, stents, stent-grafts, and plaque debulking procedures. Surgical options, identification of patients at risk of postoperative complications could have an impact on the indications for a procedure as well as permitting modifications of treatment to reduce the surgical risk This study evaluated the treatment out comas after limb salvage angioplasty for patients who otherwise would be candidates for primary amputation due to poor co-morbid conditions as chronic liver disease and diabetes. The clinical evaluation, laboratory investigations and abdominal ultrasonography were performed to all patients to evaluate their liver status. Patients were classified according to Child-pugh classification into child A, B & C. All patients were subjected to either detailed arterial duplex or C.T. angiography to assess their arterial lesions from January 2008- January 2010. 95 patients with critical limb ischemia (Rutherford categories 4, 5, 6) were treated by primary percutaneous transluminal angioplasty (PTA). No patient was excluded on the basis of the extent of arterial occlusive disease. The primary end points were immediate technical success, clinical improvement and limb salvages rates. Secondary end points were periprocedural complications and mortality. Most of the patients were male (54.7%) with mean age 62 (48-70 years). Underlying cirrhosis due to HCV was (82.2%), HBV (5.4%), while mixed viral infections was (12.4%). 54% were categorized as Child B, 32% as child A and 14% as child C. Associated diabetes mellitus was present in 96% of the cases, hypertension in 64.2%, ischemic heart disease in 74% and hyperlipedemia in 32%. Rest pain, tissue loss, or both, were the presenting symptoms in 83% while infection and ulcer were present in the other 17% of patients. The total numbers of interventions were 154; the treated lesions were 89 in the tibial arteries, 12 in the popliteal artery, 44 in the superficial femoral artery, 3 in the common femoral artery and 6 in the iliac arteries with initial technical success rate of 93.6% and periprocedural complications of 12.6%. All patients were in Rutherford clinical category 4, 5, 6 none of these patients had a previous bypass operation. Mean follow-up was 15 months. The limb-salvage rate was 87.4%. Eighty patients (84.2%) of toe amputation sites healed primarily. three patients with rest pain had resolution of their symptoms after angioplasty. All technical failures were due to inability to cross the lesions. Of the 6 technical failures, 4 required amputation, and 2 refused any further therapy.
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PMID:Limb-salvage angioplasty in poor surgical chronic liver disease and diabetic patients. 2426 Aug 26


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