1
|
Davidson AL, Sutherland MA, Siska RC, Janis JE. Practical Review on the Contemporary Diagnosis and Management of Compartment Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5637. [PMID: 38463703 PMCID: PMC10923313 DOI: 10.1097/gox.0000000000005637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024]
Abstract
Acute compartment syndrome (ACS) is a limb-threatening pathology that necessitates early detection and management. The diagnosis of ACS is often made by physical examination alone; however, supplemental methods such as compartment pressure measurement, infrared spectroscopy, and ultrasound can provide additional information that support decision-making. This practical review aims to incorporate and summarize recent studies to provide evidence-based approaches to compartment syndrome for both resource-rich and -poor settings among several patient populations.
Collapse
Affiliation(s)
- Amelia L. Davidson
- From the Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Mason A. Sutherland
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Robert C. Siska
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
2
|
Lim EH, Kim SY, Kim DS, Won YH, Park SH, Ko MH, Seo JH, Kim GW. Neuromuscular complications of the lower extremity after thrombectomy in a patient with superficial femoral artery occlusion: Case series. J Back Musculoskelet Rehabil 2024; 37:89-97. [PMID: 37482979 DOI: 10.3233/bmr-220398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Ischemia reperfusion (IR) injury may result in rhabdomyolysis and compartment syndrome when blood supply returns after thrombectomy for patients with acute limb ischemia. OBJECTIVE We highlight the value of early diagnosis and treatment in post-thrombectomy patients with IR injuries in their lower legs. CASE DESCRIPTION Two patients received thrombectomy due to left superficial femoral artery occlusion. Both patients complained of left calf pain during ambulation at the 1- and 3-day follow up post-thrombectomy, as well as a heating sensation, swelling, weakness, and sensory changes in the affected leg. For early diagnosis musculoskeletal ultrasounds were performed and in both cases revealed swelling and change of echogenicity in the left calf. To further diagnosis, magnetic resonance imaging of the left leg revealed limb IR-induced muscular injury and rhabdomyolysis, respectively. In both cases, an electrodiagnostic study revealed peripheral nerve injury in the left leg. Medications were provided for neuropathic pain control and early rehabilitation was performed to improve function. In both cases, patients reported during their follow-up that their pain and muscle weakness had improved. CONCLUSION When post-thrombectomy calf pain occurs early evaluation and treatment should be performed to identify any potential IR injury.
Collapse
Affiliation(s)
- Eun-Hee Lim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Seong-Yeol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| |
Collapse
|
3
|
Indriani S, Dewangga R, Adiarto S, Siddiq T, Dakota I, Andriantoro H, Vuylsteke M. Acute Limb Ischemia after Cardiovascular Surgery: A Deadly Duo Combination with High Mortality. Int J Angiol 2023; 32:158-164. [PMID: 37576529 PMCID: PMC10421682 DOI: 10.1055/s-0043-1761290] [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: 02/16/2023] Open
Abstract
Acute limb ischemia (ALI) is a predictor of high morbidity and mortality. Previous studies showed that ALI developed after cardiac surgery may increase mortality. This study aimed to elucidate the clinical course and identify risk factors contributing to mortality in patients with ALI after cardiovascular surgery. This is a single-center retrospective cohort study. We analyzed data from 52 patients with ALI after cardiovascular surgery between 2016 and 2020. We evaluated the risk factors for 1-year mortality using Cox proportional hazards regression analysis. Most of the patients with ALI were male and the median age was 56 years (23-72 years). Most of the patients with ALI had coronary artery diseases. The 1-year mortality rate was 55.8% ( n = 29 patients). Multivariable analysis revealed that cardiopulmonary bypass (CPB) time ≥ 100 minutes (hazard ratio [HR]: 3.067, 95% confidence interval [CI]: 1.158-8.120) and postoperative acute kidney injury (HR: 2.927, 95% CI: 1.358-6.305) were significantly increasing the risk of mortality in patients with ALI after an operation. ALI after cardiovascular surgery was associated with high 1-year mortality in our study and long CPB time and postoperative acute kidney injury contributed to the mortality.
Collapse
Affiliation(s)
- Suci Indriani
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Raditya Dewangga
- Department of Emergency Medicine, Gunung Jati General Hospital, Cirebon, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Taofan Siddiq
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Marc Vuylsteke
- Department of Vascular Surgery, Sint-Andriesziekenhuis, Tielt, Belgium
| |
Collapse
|
4
|
Danışan G, Taydaş O, Özdemir M, Ateş ÖF, Küpeli A, Öğüşlü U, Erkin A, Neşelioğlu S, Eren F. Dynamic thiol-disulphide homeostasis as a biomarker for predicting the development of contrast medium-associated acute kidney injury in the endovascular treatment of peripheral arterial disease: should intravenous N-acetylcysteine be given before the procedure? Clin Radiol 2023; 78:466-472. [PMID: 36941180 DOI: 10.1016/j.crad.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
AIM To determine the predictive ability of serum thiol-disulphide levels for contrast medium-associated acute kidney injury (CA-AKI) after endovascular treatment (EVT) of peripheral arterial disease (PAD) and evaluate the efficacy of intravenous N-acetylcysteine (NAC) in preventing CA-AKI. MATERIAL AND METHODS This double-blind, randomised controlled study included 85 consecutive adult patients who underwent EVT for PAD. Patients were divided into NAC negative (NAC-) and positive (NAC+) groups. While the NAC- group received only 500 ml saline, the NAC + group received 500 ml saline plus intravenous 600 mg NAC before the procedure. Intra- and intergroup patient characteristics, procedural details, preoperative thiol-disulphide levels, and ischaemia-modified albumin (IMA) levels were recorded. RESULTS There was a significant difference between NAC- and NAC + groups regarding native thiol, total thiol, disulphide/native thiol ratio (D/NT), and disulphide/total thiol ratio (D/TT). There was also a significant difference between the NAC- (33.3%) and NAC+ (13%) groups in CA-AKI development. Logistic regression analysis showed that the D/TT (OR 2.463) and D/NT (OR 2.121) were the most influential parameters for CA-AKI development. In the receiver operating characteristic (ROC) curve analysis, the sensitivity of native thiol to detect the development of CA-AKI was 89.1%. The negative predictive values of native thiol and total thiol were 95.6% and 94.1%, respectively. CONCLUSION The serum thiol-disulphide level can be used as a biomarker to detect CA-AKI development and reveal patients with a low risk for CA-AKI development before EVT of PAD. Furthermore, thiol-disulphide levels allow for the indirect quantitative monitoring of NAC. Preprocedural intravenous NAC administration significantly inhibits CA-AKI development.
Collapse
Affiliation(s)
- G Danışan
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey.
| | - O Taydaş
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - M Özdemir
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - Ö F Ateş
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - A Küpeli
- Kanuni Training and Research Hospital, Department of Radiology, Trabzon, Turkey
| | - U Öğüşlü
- Medicana International Hospital, Department of Radiology, Istanbul, Turkey
| | - A Erkin
- Sakarya University Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya, Turkey
| | - S Neşelioğlu
- Ankara City Hospital, Department of Biochemistry, Ankara, Turkey
| | - F Eren
- Ankara City Hospital, Department of Biochemistry, Ankara, Turkey
| |
Collapse
|
5
|
Araujo ST, Moreno DH, Cacione DG. Percutaneous thrombectomy or ultrasound-accelerated thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev 2022; 1:CD013486. [PMID: 34981833 PMCID: PMC8725191 DOI: 10.1002/14651858.cd013486.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acute limb ischaemia (ALI), the sudden and significant reduction of blood flow to the limb, is considered a vascular emergency. In the general population, the incidence is estimated as 14 per 100,000. Prognosis depends on the time it takes to diagnose the condition and begin appropriate treatment. Standard initial interventional treatments include conventional open surgery and endovascular interventions such as catheter-directed thrombolysis (CDT). Percutaneous interventions, such as percutaneous thrombectomy (PT, including mechanical thrombectomy or pharmomechanical thrombectomy) and ultrasound-accelerated thrombolysis (USAT), are also performed as alternative endovascular techniques. The proposed advantages of PT and USAT include reduced time to revascularisation and when combined with catheter-directed thrombolysis, a reduction in dose of thrombolytic agents and infusion time. The benefits of PT or USAT versus open surgery or thrombolysis alone are still uncertain. In this review, we compared PT or USAT against standard treatment for ALI, in an attempt to determine if any technique is comparatively safer and more effective. OBJECTIVES To assess the safety and effectiveness of percutaneous thrombectomy or ultrasound-accelerated thrombolysis for the initial management of acute limb ischaemia in adults. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, the World Health Organization (WHO) International Clinical Trials Registry Platform, and ClinicalTrials.gov to 3 March 2021. We searched reference lists of relevant studies and papers. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared PT (any modality, including mechanical thrombectomy (aspiration, rheolysis, rotation) or pharmomechanical thrombectomy) or USAT with open surgery, thrombolysis alone, no treatment, or another PT modality for the treatment of ALI. DATA COLLECTION AND ANALYSIS Two review authors independently selected the studies, assessed risk of bias, extracted data, performed data analysis, and assessed the certainty of evidence according to GRADE. Outcomes of interest were primary patency, amputation rate, major bleeding, clinical success, secondary patency, and adverse effects. MAIN RESULTS We included one RCT in this review. This study had a total of 60 participants and compared USAT with standard treatment (CDT). The study included 32 participants in the CDT group and 28 participants in the USAT group. We found no evidence of a difference between USAT and CDT alone for the following evaluated outcomes: amputation rate (risk ratio (RR) 1.14, 95% confidence interval (CI) 0.17 to 7.59); major bleeding (RR 1.71, 95% CI 0.31 to 9.53); clinical success (RR 1.00, 95% CI 0.94 to 1.07); and adverse effects (RR 5.69, 95% CI 0.28 to 113.72). We rated the certainty of the evidence as very low for these outcomes. We downgraded the certainty of the evidence for amputation rate, major bleeding, clinical success, and adverse effects by two levels due to serious limitations in the design (there was a high risk of bias in critical domains) and by two further levels due to imprecision (a small number of participants and only one study included). The study authors reported 30-day patency, but did not report primary and secondary patency separately. The patency rate in the successfully lysed participants was 71% (15/21) in the USAT group and 82% (22/27) in the CDT group. The study authors did not directly report secondary patency, which is patency after secondary procedures, but they did report on secondary procedures. Secondary procedures were subdivided into embolectomy and bypass grafting. Embolectomy was performed on 14% (4/28) of participants in the USAT group versus 3% (1/32) of participants in the CDT group. Bypass grafting was performed on 4% (1/28) of participants in the USAT group versus 0% in the CDT group. As we did not have access to the specific participant data, it was not possible to assess these outcomes further. We did not identify studies comparing the other planned interventions. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the safety and effectiveness of USAT versus CDT alone for ALI for our evaluated outcomes: amputation rate, major bleeding, clinical success, and adverse effects. Primary and secondary patency were not reported separately. There was no RCT evidence for PT. Limitations of this systematic review derive from the single included study, small sample size, short clinical follow-up period, and high risk of bias in critical domains. For this reason, the applicability of the results is limited. There is a need for high-quality studies to compare PT or USAT against open surgery, thrombolysis alone, no treatment, or other PT modalities for ALI. Future trials should assess outcomes, such as primary patency, amputation rate, major bleeding, clinical success, secondary patency, and adverse effects.
Collapse
Affiliation(s)
- Samuel T Araujo
- Division of Vascular and Endovascular Surgery, Department of Surgery, UNIFESP - Escola Paulista de Medicina, São Paulo, Brazil
| | - Daniel H Moreno
- Division of Vascular and Endovascular Surgery, Department of Surgery, UNIFESP - Escola Paulista de Medicina, São Paulo, Brazil
| | - Daniel G Cacione
- Division of Vascular and Endovascular Surgery, Department of Surgery, UNIFESP - Escola Paulista de Medicina, São Paulo, Brazil
| |
Collapse
|
6
|
Medical Therapy Following Urgent/Emergent Revascularization in Peripheral Artery Disease Patients (Canadian Acute Limb Ischemia Registry [CANALISE I]). CJC Open 2021; 3:1325-1332. [PMID: 34901800 PMCID: PMC8640583 DOI: 10.1016/j.cjco.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Following severe limb ischemia requiring urgent/emergent revascularization, peripheral arterial disease patients suffer a high risk of recurrent atherothrombosis. Methods Patients discharged from Hamilton General Hospital (Hamilton, Ontario) between April 2016 and September 2017 following severe limb ischemia requiring urgent/emergent revascularization were identified via the Local Health Integration Network CorHealth database, with supplemental information from chart review. Results A total of 158 patients admitted for urgent/emergent revascularization were identified (148 alive at discharge). Among patients without a pre-existing indication for anticoagulation, 38.8% (n = 47) were discharged on single-antiplatelet therapy, 27.3% (n = 33) on dual-antiplatelet therapy, 19.8% (n = 24) on anticoagulants plus antiplatelet therapy, 6.6% (n = 8) on anticoagulants alone, and 2.6% (n = 3) on unknown therapy. Patients who received angioplasty with stenting were more likely be discharged on dual-antiplatelet therapy (hazard ratio [HR]: 7.14; 95% confidence interval [CI]: 2.87-17.76; P < 0.01); patients who received an embolectomy/thrombectomy were more likely be discharged on an anticoagulant alone (HR: 2.61; 95% CI: 1.00-6.81; P = 0.049); and patients who received peripheral bypass grafting were more likely be discharged on single-antiplatelet therapy (HR: 2.28; 95% CI: 1.11-4.69; P = 0.024). Neither statins (60.8% vs 56.3%; P = 0.23) nor renin–angiotensin–aldosterone system inhibitors (48.7% vs 50.6%; P = 0.58) were prescribed at higher rates at discharge, compared with the rate at admission. Conclusions Substantial heterogeneity exists in antithrombotic prescription following urgent/emergent revascularization. No intensification of non-antithrombotic vascular protective medications occurred during hospitalization. Clinical trials and health system interventions to optimize medical therapy in peripheral arterial disease patients are urgently needed.
Collapse
|
7
|
Almanza‐Hurtado A, Rodríguez‐Yanez T, Martínez‐Ávila MC, Paternina‐Mendoza MC, Martínez‐Monterrosa JL. A man with pain and bluish discoloration of left arm. J Am Coll Emerg Physicians Open 2021; 2:e12611. [PMID: 34877568 PMCID: PMC8630358 DOI: 10.1002/emp2.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
|
8
|
Hertanto DM, Sutanto H, Adi S. Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia. F1000Res 2021; 10:584. [PMID: 34642600 PMCID: PMC8430448 DOI: 10.12688/f1000research.54193.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/23/2022] Open
Abstract
Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.
Collapse
Affiliation(s)
- Decsa Medika Hertanto
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Jawa Timur, 60132, Indonesia.,Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya, Jawa Timur, 60286, Indonesia
| | - Henry Sutanto
- Department of Cardiology, Maastricht University, Maastricht, Limburg, 6229ER, The Netherlands.,Department of Physiology and Pharmacology, SUNY Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Soebagijo Adi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Jawa Timur, 60132, Indonesia.,Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya, Jawa Timur, 60286, Indonesia
| |
Collapse
|
9
|
Vezzosi T, Buralli C, Briganti A, Vannozzi I, Giacomelli E, Talamanca GF, Sansoni A, Domenech O, Tognetti R. Surgical embolectomy in a cat with cardiogenic aortic thromboembolism. J Vet Cardiol 2020; 28:48-54. [PMID: 32339993 DOI: 10.1016/j.jvc.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 01/22/2023]
Abstract
A seven-year-old, spayed female, domestic longhair cat was referred for management of a sudden aortic thromboembolism (ATE). Echocardiography showed hypertrophic cardiomyopathy with severe left atrial enlargement. Ultrasonography of the abdominal aorta confirmed a large thrombus at the level of the aortic trifurcation, involving both iliac arteries. Considering the recent onset and bilateral involvement of the iliac arteries, the cat underwent emergent surgical embolectomy (SE) of the aortoiliac embolus. A standard caudal celiotomy was performed and the abdominal aorta was identified. Vessel loops with tourniquets were placed around the abdominal aorta proximal to the thrombus and on both iliac arteries distal to the thrombus. A full-thickness incision was made in the ventral surface of the aorta. The aortic thromboembolus was removed. The trifurcation was subsequently flushed with sterile saline. The SE resulted in a good outcome, with both clinical and ultrasound signs of complete reperfusion of the rear limbs within a few hours. Long-term treatment included antiplatelet drugs, furosemide and benazepril. Eighteen months after surgery, the cat was free of clinical signs, without recurrence of ATE or congestive heart failure. Based on the present case, SE could be considered as a feasible alternative to traditional conservative treatment in cats with a very recent onset of bilateral ATE.
Collapse
Affiliation(s)
- T Vezzosi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy; Department of Cardiology, Anicura Istituto Veterinario di Novara, Strada Provinciale 9, Granozzo con Monticello, 28060, Novara, Italy.
| | - C Buralli
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - A Briganti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - I Vannozzi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - E Giacomelli
- Department of Cardiothoracic and Vascular Surgery, Careggi Hospital, Largo G. A. Brambilla 3, 50134, Firenze, Italy
| | - G F Talamanca
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - A Sansoni
- Vet Hospital, Via dei Vanni 25, 50142, Firenze, Italy
| | - O Domenech
- Department of Cardiology, Anicura Istituto Veterinario di Novara, Strada Provinciale 9, Granozzo con Monticello, 28060, Novara, Italy
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| |
Collapse
|
10
|
Araujo ST, Moreno DH, Cacione DG. Percutaneous thrombectomy for initial management of acute limb ischaemia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samuel T Araujo
- UNIFESP - Escola Paulista de Medicina; Division of Vascular and Endovascular Surgery, Department of Surgery; São Paulo Brazil
| | - Daniel H Moreno
- UNIFESP - Escola Paulista de Medicina; Division of Vascular and Endovascular Surgery, Department of Surgery; São Paulo Brazil
| | - Daniel G Cacione
- UNIFESP - Escola Paulista de Medicina; Division of Vascular and Endovascular Surgery, Department of Surgery; São Paulo Brazil
| |
Collapse
|
11
|
Olinic DM, Stanek A, Tătaru DA, Homorodean C, Olinic M. Acute Limb Ischemia: An Update on Diagnosis and Management. J Clin Med 2019; 8:jcm8081215. [PMID: 31416204 PMCID: PMC6723825 DOI: 10.3390/jcm8081215] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/20/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022] Open
Abstract
This review presents an update on the diagnosis and management of acute limb ischemia (ALI), a severe condition associated with high mortality and amputation rates. A comprehensive spectrum of ALI etiology is presented, with highlights on embolism and in situ thrombosis. The steps for emergency diagnosis are described, emphasizing the role of clinical data and imaging, mainly duplex ultrasound, CT angiography and digital substraction angiography. The different therapeutic techniques are presented, ranging from pharmacological (thrombolysis) to interventional (thromboaspiration, mechanical thrombectomy, and stent implantation) techniques to established surgical revascularization (Fogarty thrombembolectomy, by-pass, endarterectomy, patch angioplasty or combinations) and minor or major amputation of necessity. Postprocedural management, reperfusion injury, compartment syndrome and long-term treatment are also updated.
Collapse
Affiliation(s)
- Dan-Mircea Olinic
- Medical Clinic No. 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Interventional Cardiology Department, Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Agata Stanek
- Department of Internal Diseases, Angiology and Physical Medicine, School of Medicine wih Division of Dentistry in Zabrze, Medical University of Silesia, 41-902 Bytom, Poland
| | - Dan-Alexandru Tătaru
- Medical Clinic No. 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
- Interventional Cardiology Department, Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania.
| | - Călin Homorodean
- Medical Clinic No. 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Interventional Cardiology Department, Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Maria Olinic
- Medical Clinic No. 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Interventional Cardiology Department, Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania
| |
Collapse
|
12
|
Volotovska NV, Kashchak TV. ANTIOXIDANT ENZYMES ACTIVITY IN EXPERIMENTAL ISCHEMIA-REPERFUSION INJURY. INTERNATIONAL JOURNAL OF MEDICINE AND MEDICAL RESEARCH 2019. [DOI: 10.11603/ijmmr.2413-6077.2019.1.10308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Blood loss during civil and military limb trauma is the most common cause of preventable death. Complications due to the use of a hemostatic tourniquet are widely investigated nowadays. Therefore, the standards of the past have to be improved.
Objective. The aim of the research is to study the reaction of the enzyme chain of the liver antioxidant system in the presence of modifications of ischemia-reperfusion injury (IRI).
Methods. 210 white male-rats, aged 5-5.5 months, were used in the research. The dynamics of antioxidant enzymes activity catalase (Cat) and superoxide dismutase (SOD) in liver tissue in cases of modifications of ischemia-reperfusion injury (IRI) were studied. The period of investigation was in 24 hours, 3, 7, 14 days after the injury.
Results. In cases of simulated IRI the catalase level mainly decreased at each period of the experiment. The peak of SOD activity was evidenced on the 1st, 3rd or 7th days after the experimental IRI according to the degree of trauma severity. Thus, IRI combined with severe blood loss and mechanical trauma caused the severest affection of the antioxidant system. Even a single application of hemostatic tourniquet caused similar wavelike reactions at different times.
Conclusions. The development of IRI is accompanied by a significant depression of the liver antioxidant system. The most significant changes were evidenced in cases of IRI combined with blood loss and mechanical trauma, but even a single application of a tourniquet caused active response of the antioxidant enzymes.
Collapse
|
13
|
Abstract
Acute limb ischemia (ALI) is a rapid decrease in lower limb blood flow due to acute occlusion of peripheral artery or bypass graft, and in ALI not only limbs but also life prognosis will be poor unless quick and appropriate treatment is given. The etiology is broadly divided into embolism and thrombosis with various comorbidities. The symptoms of ALI are abrupt with pain, numbness, and coldness of lower limb, and paresthesia, contracture, and irreversible purpura will appear with the exacerbation of ischemia. Severity and treatment strategy should be determined based on physical findings and image findings. Considering life prognosis, limb amputation should be done without hesitation when the limb was diagnosed as irreversible. ALI can be treated by means of open surgical revascularization, endovascular, or hybrid approach with rapid systemic administration of heparin. In any cases, evaluating the lesions by intraoperative angiography and appropriate additional treatment are important. ALI is a serious disease requiring urgent treatment, and it is essential to promptly perform the best initial treatment that can be performed at each facility. (This is a translation of Jpn J Vasc Surg 2018; 27: 109–114.)
Collapse
Affiliation(s)
- Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Addevico F, Nucci AM, Rosati M, Poggetti A, Scaglione M. Traumatic anterior dislocation of a prosthetic knee, from trauma to delayed onset of vascular injury. Arthroplast Today 2018; 4:407-410. [PMID: 30569005 PMCID: PMC6287958 DOI: 10.1016/j.artd.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 12/03/2022] Open
Abstract
Anterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described in the past and have never been linked with neurovascular injury. This could lead orthopaedic surgeons to focus on the implant instability factors and underrate other complications. The authors report a case of a patient who experienced popliteal artery dissection 80 hours after traumatic anterior knee dislocation of a previously well-functioning total knee arthroplasty. Given that there is a lack of clinical cases that have established guidelines for management of this problem, the authors have focused on the importance of performing computed tomography angiography in the management of an anterior traumatic knee dislocation of a prosthetic knee.
Collapse
Affiliation(s)
- Francesco Addevico
- Orthopeadic and Traumatology, I orthopedic and traumatological Clinic, University of Pisa, Pisa, Pisa, Italy
| | - Anna Maria Nucci
- Orthopeadic and Traumatology, I orthopedic and traumatological Clinic, University of Pisa, Pisa, Pisa, Italy
| | - Marco Rosati
- I orthopedic and traumatological Clinic, AOUP, Pisa, Pisa, Italy
| | - Andrea Poggetti
- Chirugia della mano e Microchirurgia ricostruttiva, AUO, Careggi, Firenze, Firenze, Italy
| | | |
Collapse
|
15
|
Wesslén C, Wahlgren CM. Contemporary Management and Outcome After Lower Extremity Fasciotomy in Non-Trauma-Related Vascular Surgery. Vasc Endovascular Surg 2018; 52:493-497. [PMID: 29716475 DOI: 10.1177/1538574418773503] [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
INTRODUCTION Acute compartment syndrome (ACS) is a challenging and recognized complication to vascular surgery revascularization. The aim of this study was to investigate the current epidemiology, management, and early outcomes of fasciotomy in vascular surgery. METHODS Retrospective cohort study of all patients undergoing lower extremity fasciotomy at a single university center between January 2008 and December 2014. Patient demographics, operative techniques, and outcomes were analyzed. RESULTS The cohort (n = 113 limbs; 107 patients; 48% women; mean age was 74 (12) years [range, 50-97 years]) included 81 (72%) limbs undergoing revascularization for acute limb ischemia, 7 (6.2%) limbs related to acute aortic disease, and 23 (20%) limbs undergoing elective vascular surgery. Five patients underwent bilateral lower extremity fasciotomy. In all, 64 (57%) limbs had signs of ACS and underwent a therapeutic fasciotomy, while 49 (43%) fasciotomies were prophylactic. There were 20 (18%) fasciotomies performed after endovascular interventions. A 4-compartment fasciotomy was performed in 82% (n = 93) of limbs with a double incision technique. Split thickness skin graft was required in 11% (12/112) and vacuum-assisted closure treatment in 11% (12/111). The mean length of stay in hospital was 11 (9) days. Most common complication was lower extremity nerve deficit 32% (33/104) followed by wound infection 30% (32/108). At 30-day follow-up, amputation rate was 13% (14/107 limbs) and mortality 23% (25/107 patients). In the multivariate logistic regression analysis, prophylactic fasciotomy was associated with amputation (odds ratio: 28.9; 95% confidence interval: 1.96-425; P = .014). CONCLUSION Acute compartment syndrome is primarily related to acute ischemic conditions but occurs after both aortic or elective vascular procedures and endovascular treatments. There are significant complications related to lower extremity fasciotomy in vascular surgery.
Collapse
Affiliation(s)
- Charlotte Wesslén
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.,2 Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.,2 Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Acute Limb Ischemia-Much More Than Just a Lack of Oxygen. Int J Mol Sci 2018; 19:ijms19020374. [PMID: 29373539 PMCID: PMC5855596 DOI: 10.3390/ijms19020374] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 12/12/2022] Open
Abstract
Acute ischemia of an extremity occurs in several stages, a lack of oxygen being the primary contributor of the event. Although underlying patho-mechanisms are similar, it is important to determine whether it is an acute or chronic event. Healthy tissue does not contain enlarged collaterals, which are formed in chronically malperfused tissue and can maintain a minimum supply despite occlusion. The underlying processes for enhanced collateral blood flow are sprouting vessels from pre-existing vessels (via angiogenesis) and a lumen extension of arterioles (via arteriogenesis). While disturbed flow patterns with associated local low shear stress upregulate angiogenesis promoting genes, elevated shear stress may trigger arteriogenesis due to increased blood volume. In case of an acute ischemia, especially during the reperfusion phase, fluid transfer occurs into the tissue while the vascular bed is simultaneously reduced and no longer reacts to vaso-relaxing factors such as nitric oxide. This process results in an exacerbative cycle, in which increased peripheral resistance leads to an additional lack of oxygen. This whole process is accompanied by an inundation of inflammatory cells, which amplify the inflammatory response by cytokine release. However, an extremity is an individual-specific composition of different tissues, so these processes may vary dramatically between patients. The image is more uniform when broken down to the single cell stage. Because each cell is dependent on energy produced from aerobic respiration, an event of acute hypoxia can be a life-threatening situation. Aerobic processes responsible for yielding adenosine triphosphate (ATP), such as the electron transport chain and oxidative phosphorylation in the mitochondria, suffer first, thus disrupting the integrity of cellular respiration. One consequence of this is irreparable damage of the cell membrane due to an imbalance of electrolytes. The eventual increase in net fluid influx associated with a decrease in intracellular pH is considered an end-stage event. Due to the lack of ATP, individual cell organelles can no longer sustain their activity, thus initiating the cascade pathways of apoptosis via the release of cytokines such as the BCL2 associated X protein (BAX). As ischemia may lead to direct necrosis, inflammatory processes are further aggravated. In the case of reperfusion, the flow of nascent oxygen will cause additional damage to the cell, further initiating apoptosis in additional surrounding cells. In particular, free oxygen radicals are formed, causing severe damage to cell membranes and desoxyribonucleic acid (DNA). However, the increased tissue stress caused by this process may be transient, as radical scavengers may attenuate the damage. Taking the above into final consideration, it is clearly elucidated that acute ischemia and subsequent reperfusion is a process that leads to acute tissue damage combined with end-organ loss of function, a condition that is difficult to counteract.
Collapse
|
17
|
Utility of a 0.035″ compatible rapid-exchange balloon (Metacross RX™) as a perfusion balloon in endovascular therapy compared with conventional percutaneous coronary intervention: A mini-review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:619-622. [DOI: 10.1016/j.carrev.2017.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022]
|
18
|
|