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Liu X, Ding Q, Liu W, Zhang S, Wang N, Chai G, Wang Y, Sun S, Zheng R, Zhao Y, Ding C. A Poloxamer 407/chitosan-based thermosensitive hydrogel dressing for diabetic wound healing via oxygen production and dihydromyricetin release. Int J Biol Macromol 2024; 263:130256. [PMID: 38368995 DOI: 10.1016/j.ijbiomac.2024.130256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
The current clinical treatment of diabetic wounds is still based on oxygen therapy, and the slow healing of skin wounds due to hypoxia has always been a key problem in the repair of chronic skin injuries. To overcome this problem, the oxygen-producing matrix CaO2NPS based on the temperature-sensitive dihydromyricetin-loaded hydrogel was prepared. In vitro activity showed that the dihydromyricetin (DHM) oxygen-releasing temperature-sensitive hydrogel composite (DHM-OTH) not only provided a suitable oxygen environment for cells around the wound to survive but also had good biocompatibility and various biological activities. By constructing a T2D wound model, we further investigated the repairing effect of DHM-OTH on chronic diabetic skin wounds and the mechanisms involved. DHM-OTH was able to reduce inflammatory cells and collagen deposition and promote angiogenesis and cell proliferation for diabetic wound healing. These in vitro and in vivo data suggest that DHM-OTH accelerates diabetic wound repair as a novel method to efficiently deliver oxygen to wound tissue, providing a promising strategy to improve diabetic wound healing.
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Affiliation(s)
- Xinglong Liu
- School of Chinese Medicine, Jilin Agricultural Science and Technology University, Jilin 132101, China
| | - Qiteng Ding
- Jilin Agricultural University, Changchun 130118, China
| | - Wencong Liu
- School of Food and Pharmaceutical Engineering, Wuzhou University, Wuzhou 543002, China
| | - Shuai Zhang
- Jilin Agricultural University, Changchun 130118, China
| | - Ning Wang
- Jilin Agricultural University, Changchun 130118, China
| | - Guodong Chai
- Jilin Agricultural University, Changchun 130118, China
| | - Yue Wang
- Jilin Agricultural University, Changchun 130118, China
| | - Shuwen Sun
- Jilin Agricultural University, Changchun 130118, China
| | - Runxiao Zheng
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China
| | - Yingchun Zhao
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China.
| | - Chuanbo Ding
- School of Chinese Medicine, Jilin Agricultural Science and Technology University, Jilin 132101, China.
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Meloni M, Andreadi A, Bellizzi E, Giurato L, Ruotolo V, Romano M, Bellia A, Uccioli L, Lauro D. A multidisciplinary team reduces in-hospital clinical complications and mortality in patients with diabetic foot ulcers. Diabetes Metab Res Rev 2023; 39:e3690. [PMID: 37422897 DOI: 10.1002/dmrr.3690] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/28/2023] [Indexed: 07/11/2023]
Abstract
AIMS The current study aims to evaluate the effectiveness of a multidisciplinary diabetic foot team (MDFT) in the management of in-patients affected by diabetic foot problems. MATERIALS AND METHODS The study was a retrospective observational study. Consecutive patients with a diabetic foot problem requiring hospitalisation were included. All patients were managed by a MDFT led by diabetologists according to the guidance. The rate of in-hospital complications (IHCs), major amputation, and survival were recorded at the end of patient's hospitalisation. IHC was defined as any new infection different from wound infection, cardiovascular events, acute renal injury, severe anaemia requiring blood transfusion, and any other clinical problem not present at the assessment. RESULTS Overall, 350 patients were included. The mean age was 67.9 ± 12.6 years, 254 (72.6%) were males, 323 (92, 3%) showed Type 2 diabetes with a mean duration of 20.2 ± 9.6 years; 224 (64%) had ischaemic diabetic foot ulcers (DFUs) and 299 (85.4%) had infected DFUs. IHCs were recorded in 30/350 (8.6%) patients. The main reasons for IHCs were anaemia requiring blood transfusion (2.8%), pneumonia (1.7%), acute kidney failure (1.1%). Patients with IHCs showed a higher rate of major amputation (13.3 vs. 3.1%, p = 0.02) and mortality (16.7 vs. 0.6%, p < 0.0001) in comparison to those without. Ischaemic heart disease (IHD) and wound duration at the assessment (>1 month) were independent predictors of IHC, whereas IHCs, heart failure, and dialysis were independent predictors of in-hospital mortality. CONCLUSIONS The multidisciplinary management of diabetic foot problems leads to an IHC rate of 8%. The risk of IHCs is higher in patients with IHD and long wound duration.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Ermanno Bellizzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Laura Giurato
- CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Valeria Ruotolo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Maria Romano
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Luigi Uccioli
- CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
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Stavroulakis K, Tsilimparis N, Saratzis A, Rantner B, Stana J, Dayama A, Davies MG, Gouveia E Melo R. Acute Kidney Injury Following Revascularization in Patients With Chronic Limb-Threatening Ischemia and Non-Dialysis-Dependent Chronic Kidney Disease: Insights From the NSQIP Database at 30-Day Follow-Up. J Endovasc Ther 2023:15266028231173297. [PMID: 37191239 DOI: 10.1177/15266028231173297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Patients with chronic limb-threatening ischemia (CLTI) and chronic kidney disease (CKD) are at risk of developing renal injury following revascularization. We aimed to compare the risk of adverse renal events following endovascular revascularization (ER) or open surgery (OS) in patients with CLTI and CKD. METHODS A retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) databases (2011-2017) was performed including patients with CLTI and non-dialysis-dependent CKD, comparing ER to OS. The primary outcome was a composite of postprocedural kidney injury or failure within 30 days. Thirty-day mortality, major adverse cardiac and cerebrovascular events (MACCE), amputation, readmission or target lesion revascularization (TLR) were compared using multivariate logistic regression and propensity-score matched analysis. RESULTS A total of 5009 patients were included (ER: 2361; OS: 3409). The risk for the composite primary outcome was comparable between groups (odds ratio [OR]: 0.78, 95% confidence interval (CI): 0.53-1.17) as for kidney injury (n=54, OR: 0.97, 95% CI: 0.39-1.19) or failure (n=55, OR: 0.68, 95% CI: 0.39-1.19). In the adjusted regression, a significant benefit was observed with ER for the primary outcome (OR: 0.60, p=0.018) and renal failure (OR: 0.50, p=0.025), but not for renal injury (OR: 0.76, p=0.34). Lower rates of MACCE, TLR, and readmissions were observed after ER. Thirty-day mortality and major amputation rates did not differ. In the propensity score analysis, revascularization strategy was not associated with renal injury or failure. CONCLUSIONS In this cohort, the incidence of renal events within 30 days of revascularization in CLTI was low and comparable between ER and OR. CLINICAL IMPACT In a cohort of 5009 patients with chronic limb-threatening ischemia and non-end-stage chronic kidney disease (CKD), postprocedural kidney injury or failure within 30 days was comparable between patients submitted to open or endovascular revascularization (ER). Lower rates of major adverse cardiac and cerebrovascular events, target lesion revascularization, and readmissions were observed after endovascular revascularization. Based on these findings, ER should not be avoided due to fear of worsening renal function in CKD patients with chronic limb-threatening ischemia. In fact, these patients benefit more from ER regarding cardiovascular outcomes with no increased risk of kidney injury.
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Affiliation(s)
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Barbara Rantner
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Jan Stana
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Anand Dayama
- Division of Vascular and Endovascular Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Gouveia E Melo
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
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Zaman N, Rundback J. Deep Venous Arterialization: Background, Patient Selection, Technique, Outcomes and Follow-up, and Future Implementation. Semin Intervent Radiol 2023; 40:183-192. [PMID: 37333738 PMCID: PMC10275674 DOI: 10.1055/s-0043-57264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Critical limb-threatening ischemia (CLTI) is a severe manifestation of peripheral arterial disease with a highly increased risk for morbidity and mortality that has limited and suboptimal opportunities for treatment, ultimately resulting in major amputation for patients. Deep venous arterialization (DVA) provides a suitable limb salvage option for "no-option" patients facing amputation by introducing an artificial anastomosis between a site of proximal arterial inflow and retrograde venous outflow to deliver tissue perfusion to lower extremity wounds. Because DVAs are employed as a last-resort effort in CLTI patients, it is important to provide updated information on indications for usage, strategies in creating DVA conduits, and discussion of outcomes and expectations for patients undergoing this procedure. Additionally, variations in method, including use of various techniques and devices, are explored. The authors provide an up-to-date review of the literature and discuss pertinent procedural and technical considerations for utilizing DVAs in CLTI patients.
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Affiliation(s)
- Naveed Zaman
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - John Rundback
- Advanced Interventional and Vascular Services, LLP, Teaneck, New Jersey
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Stavroulakis K, Gkremoutis A, Borowski M, Torsello G, Böckler D, Zeller T, Steinbauer M, Tsilimparis N, Bisdas T, Adili F, Balzer K, Billing A, Brixner D, Debus SE, Florek HJ, Grundmann R, Hupp T, Keck T, Gerß J, Wojciech K, Lang W, May B, Meyer A, Mühling B, Oberhuber A, Reinecke H, Reinhold C, Ritter RG, Schelzig H, Schlensack C, Schmitz-Rixen T, Schulte KL, Spohn M, Storck M, Trede M, Uhl C, Weis-Müller B, Wenk H, Zhorzel S, Zimmermann A. Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry). J Endovasc Ther 2020; 27:599-607. [DOI: 10.1177/1526602820938465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of all available treatment options in 1200 consecutive CLTI patients. For the purposes of this analysis, only the 337 patients with non-dialysis-dependent CKD treated by either BG (n=86; median 78 years, 48 men) or EVT (n=251; median age 80 years, 135 men) were analyzed. The primary composite outcome was amputation-free survival (AFS); secondary outcomes were overall survival (OS) and amputation-free time (AFT). All outcomes were evaluated in Cox proportional hazards models; the results are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The Cox regression analysis revealed a significantly greater hazard of amputation or death after BG (HR 1.78, 95% CI 1.05 to 3.03, p=0.028). The models for AFT and overall survival also suggested a higher hazard for BG, but the differences were not significant (AFT: HR 1.66, 95% CI 0.78 to 3.53, p=0.188; OS: HR 1.41, 95% CI 0.80 to 2.47, p=0.348). The absence of runoff vessels (HR 1.73, 95% CI 1.15 to 2.60, p=0.008) was associated with a decreased AFS. The likelihood of amputation was higher in male patients (HR 2.21, 95% CI 1.10 to 4.45, p=0.027) and was associated with a lack of runoff vessels (HR 1.95, 95% CI 0.96 to 3.95, p=0.065) and myocardial infarction (HR 3.74, 95% CI 1.23 to 11.35, p=0.020). Death was more likely in patients without runoff vessels (HR 1.76, 95% CI 1.11 to 2.80, p=0.016) and those with a higher risk score (HR 1.73, 95% CI 1.03 to 2.91, p=0.038). Conclusion: This analysis suggested that BG was associated with poorer AFS than EVT in patients with non-dialysis-dependent CKD and CLTI. Male sex, previous myocardial infarction, and the absence of runoff vessels were additionally identified as predictors of poorer outcomes.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Germany
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Asimakis Gkremoutis
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Thomas Zeller
- Clinic Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | - Markus Steinbauer
- Department of Vascular Surgery, Barmherzige Brueder Regensburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Germany
- Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
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Zubair M. Prevalence and interrelationships of foot ulcer, risk-factors and antibiotic resistance in foot ulcers in diabetic populations: A systematic review and meta-analysis. World J Diabetes 2020; 11:78-89. [PMID: 32180896 PMCID: PMC7061236 DOI: 10.4239/wjd.v11.i3.78] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/21/2019] [Accepted: 01/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diabetic foot ulceration (DFU) is the prime health concern globally. It accounts for the major burden related to disease mortality and morbidity and economic cost. The timely and early recognition of the DFU can help present its occurrence and improve clinical outcomes.
AIM To evaluate interrelationships between foot ulcers, risk factors, and antibiotic resistance among diabetic patients having ulcers in their foot.
METHODS The databases such as PubMed, ERIC, Medline, and Google Scholar were extensively used for the extraction of studies. The selected studies were published within the time-period of 2014-2018. Ten studies were selected, which were found to be completely relevant to the current study.
RESULTS The prevalence of diabetic foot ulcers among the population was evaluated, and the associated risk factors with its prevalence. Moreover, few studies also reported on the bacteria that are found to be most prevailing among diabetic patients. A narrative discussion was drawn through this analysis, which was used to highlight the specific area of research through selected studies, extraction of the significant information that matched with the topic of research, and analysis of problem through the findings of the selected articles. The results helped in assessing significant knowledge regarding the risk factors of diabetic foot ulcers and the role of antimicrobial resistant in its treatment.
CONCLUSION The gram-negative bacteria were found to be the most common reason for diabetic foot ulcers. The study only included 10 studies that are not sufficient to produce generalized results, and no information was reported on the tests required to analyze antimicrobial susceptibility that can guide clinicians to propose better and sound treatment plans. It is evident that most study results depicted that the most common risk factors were found to be hypertension and neuropathy.
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Affiliation(s)
- Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia
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Bates KM, Ghanem H, Hague J, Matheiken SJ. Standardisation of Technique and Volume of Iodinated Contrast Administration During Infrainguinal Angioplasty. Curr Pharm Des 2019; 25:4667-4674. [PMID: 31814551 DOI: 10.2174/1381612825666191209123821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute Kidney injury is recognised to occur after administration of iodinated contrast during endovascular interventions for peripheral arterial disease. There are no standardised protocols for contrast delivery during infrainguinal angiography. OBJECTIVE The objective of this paper is to review published practice regarding the technique of conventional infrainguinal angiography and intervention, and describe a standard set of subtraction views, injection rates and contrast volumes for infrainguinal angioplasty. METHODS Database searches and review of papers containing (Angioplasty or Angiography) and ("lower limb" or peripheral or infrainguinal) and (method or technique or guidelines or protocol) was performed and defined procedures assessed. RESULTS A small number of papers provided specific technical details relating to contrast volumes and angiography views. There was considerable variation from authors who have described the contrast volumes used for lower limb angiography. We describe our simple and consistent method. The precise pathophysiology of contrast related nephropathy is under scrutiny. There is interest in new technology to minimise contrast induced kidney injury. CONCLUSION Few publications specify iodinated contrast doses, injection volumes or imaging views for infrainguinal arteriography. Standard infrainguinal angioplasty can be performed with conventional equipment using relatively small volumes of contrast by following a systematic technique.
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Affiliation(s)
- Kersten Morgan Bates
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, MK42 9DJ, United Kingdom
| | - Huthayfa Ghanem
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, MK42 9DJ, United Kingdom
| | - Julian Hague
- Royal Free London NHS Foundation Trust, London NW3 5NU, United Kingdom
| | - Sean Joy Matheiken
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, MK42 9DJ, United Kingdom
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Uccioli L, Meloni M, Izzo V, Giurato L, Merolla S, Gandini R. Critical limb ischemia: current challenges and future prospects. Vasc Health Risk Manag 2018; 14:63-74. [PMID: 29731636 PMCID: PMC5927064 DOI: 10.2147/vhrm.s125065] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels. It is associated with a high risk of major amputation, cardiovascular events and death. In this review, we presented a complete overview about physiopathology, diagnosis and holistic management of CLI. Revascularization is the first-line treatment, but several challenging cases are not treatable by conventional techniques. Unconventional techniques for the treatment of complex below-the-knee arterial disease are described. Furthermore, the state-of-the-art on gene and cell therapy for the treatment of no-option patients is reported.
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Affiliation(s)
| | | | | | | | - Stefano Merolla
- Department of Interventional Radiology, Università di Tor Vergata Roma, Rome, Italy
| | - Roberto Gandini
- Department of Interventional Radiology, Università di Tor Vergata Roma, Rome, Italy
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Cury MVM, Matielo MF, Brochado Neto FC, Soares RDA, Adami VL, Morais JDF, Futigami AY, Sacilotto R. The Incidence, Risk Factors, and Outcomes of Contrast-Induced Nephropathy In Patients With Critical Limb Ischemia Following Lower Limb Angiography. Angiology 2018; 69:700-708. [PMID: 29390867 DOI: 10.1177/0003319718754984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves. Overall, there was a predominance of males (57%), with a mean age of 70.5 (10.7) years. The incidence of CIN was 35.5%, and chronic kidney failure was the only factor associated with elevated risk of this condition (relative risk [RR] = 1.9; 95% confidence interval = 1.17-3.09; P = .017). The median follow-up was 645 days, and in 720-day analyses, patients who experienced CIN had worse HI (81.2% vs 96.3%; P = .0107) and OS (49.5% vs 66.3%; P = .0463). The current study found a high incidence of CIN in patients with CLI after DSA. This renal impairment was associated with a worse prognosis in terms of survival.
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Affiliation(s)
- Marcus Vinícius Martins Cury
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Marcelo Fernando Matielo
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Francisco Cardoso Brochado Neto
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Rafael de Athayde Soares
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Vinícius Lopes Adami
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Jalíese Dantas Fernandes Morais
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Aline Yoshimi Futigami
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Roberto Sacilotto
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
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Freisinger E, Malyar NM, Reinecke H, Lawall H. Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis. Cardiovasc Diabetol 2017; 16:41. [PMID: 28376797 PMCID: PMC5379505 DOI: 10.1186/s12933-017-0524-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/25/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Patients with diabetes concomitant to critical limb ischemia (CLI) represent a sub-group at particular risk. Objective of this analysis is to evaluate the actual impact of diabetes on treatment, outcome, and costs in a real-world scenario in Germany. METHODS We obtained routine-data on 15,332 patients with CLI with tissue loss from the largest German health insurance, BARMER GEK from 2009 to 2011, including a follow-up until 2013. Patient data were analyzed regarding co-diagnosis with diabetes with respect to risk profiles, treatment strategy, in-hospital and long-term outcome including costs. RESULTS Diabetic patients received less overall revascularizations in Rutherford grades 5 and 6 (Rutherford grade 5: 45.0 vs. 55.5%; Rutherford grade 6: 46.5 vs. 51.8; p < 0.001) and less vascular surgery (Rutherford grade 5: 13.4 vs. 23.4; Rutherford grade 6: 19.7 vs. 29.6; p < 0.001), however more often endovascular revascularization in Rutherford grade 6 (31.0 vs. 28.1; p = 0.004) compared to non-diabetic patients. Diabetes was associated with a higher observed ratio of infections (35.3 vs. 23.5% Rutherford grade 5; 44.3 vs. 27.4% Rutherford grade 6; p < 0.001) and in-hospital amputations (13.0 vs. 7.3% Rutherford grade 5; 47.5 vs. 36.7% Ruth6; p < 0.001). Diabetes further increased the risk for amputation during follow-up [Rutherford grade 5: HR 1.51 (1.38-1.67); Rutherford grade 6: HR 1.33 (1.25-1.41); p < 0.001], but not for death. CONCLUSIONS Diabetes increases markedly the risk of amputation attended by higher costs in CLI patients with tissue loss (OR 1.67 at Rutherford 5, OR 1.53 at Rutherford 6; p < 0.001), but is associated with lower revascularizations. However, in Rutherford grades 5 and 6, concomitant diabetes does not further worsen the overall poor survival.
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Affiliation(s)
- Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany.
| | - Nasser M Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Holger Lawall
- Praxis für Herzkreislauferkrankungen und Akademie für Gefaeßkrankheiten, Ettlingen, Germany
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