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Xu X, Fu Y, Bao M. Comparison Between the Efficacy of Spinal Cord Stimulation and of Endovascular Revascularization in the Treatment of Diabetic Foot Ulcers: A Retrospective Observational Study. Neuromodulation 2023; 26:1424-1432. [PMID: 37610397 DOI: 10.1016/j.neurom.2023.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE We aimed to compare the effects of spinal cord stimulation (SCS) with those of endovascular revascularization on the treatment of diabetic foot ulcers. MATERIALS AND METHODS A total of 104 patients with diabetic foot ulcers who met the inclusion criteria were retrospectively analyzed and classified to the SCS treatment group (n = 46) and endovascular revascularization treatment group (n = 46). The quality-of-life scores (Quality of Life Scale for Patients with Liver Cancer v2.0), visual pain analog scale score, lower limb skin temperature, lower limb arterial ultrasound results, and lower extremity electromyography results were analyzed to compare the efficacy of the two treatments for diabetic foot ulcers in the two groups before surgery and six months after surgery. RESULTS A total of 92 patients (men: 73.9%, mean age: 66.51 ± 11.67 years) completed the six-month postoperative follow-up period. The patients in the SCS treatment group had a higher quality-of-life score (25.54% vs 13.77%, p < 0.05), a larger reduction in pain scores (69.18% vs 37.21%, p < 0.05), and a larger reduction in foot temperature (18.56% vs 7.24%, p < 0.05) than those of the endovascular revascularization treatment group at six months after surgery. The degree of vasodilation in the lower limbs on color Doppler arterial ultrasound and the nerve conduction velocity were higher in the SCS treatment group than in the endovascular revascularization treatment group at six months after surgery (p < 0.05). CONCLUSION SCS was more effective than endovascular revascularization in improving quality of life, relieving pain, improving lower limb skin temperature, increasing lower limb blood flow, and improving nerve conduction in patients with diabetic foot ulcers at six months after surgery.
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Affiliation(s)
- Xin Xu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Fu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Bao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.
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Min J, Park SW, Hwang JH, Kwon YW, Shin DH. Management of Complications during Below-the-Knee Endovascular Treatment: A Technical Note. Korean J Radiol 2020; 21:935-945. [PMID: 32677378 PMCID: PMC7369206 DOI: 10.3348/kjr.2019.0743] [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] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/15/2022] Open
Abstract
We retrospectively reviewed the cases in which complications occurred during below-the-knee (BTK) endovascular treatments that were performed at our hospital from 2005 to 2014. Several interesting cases have been described herein. All the patients had diabetes and non-healing wounds on their feet and/or rest pain in their foot or leg, and therefore, endovascular treatment was performed for the BTK arteries of the affected lower extremity. The complications that occurred during the procedure were classified into six categories-vascular spasm, flow limiting dissection, perforation, broken guidewire, distal thromboembolism, and unusual puncture site bleeding. Each complication has its own solutions and management. We discuss these different classes of complications and describe how cases of each type were managed.
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Affiliation(s)
- JeeYoung Min
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea.
| | - Jin Ho Hwang
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Yong Wonn Kwon
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Dong Hyeok Shin
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea
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Caetano AP, Conde Vasco I, Veloso Gomes F, Costa NV, Luz JH, Spaepen E, Formiga A, Coimbra É, Neves J, Bilhim T. Successful Revascularization has a Significant Impact on Limb Salvage Rate and Wound Healing for Patients with Diabetic Foot Ulcers: Single-Centre Retrospective Analysis with a Multidisciplinary Approach. Cardiovasc Intervent Radiol 2020; 43:1449-1459. [PMID: 32743744 DOI: 10.1007/s00270-020-02604-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Analyze the impact of endovascular revascularization on major amputation rates and wound healing for patients with diabetic foot ulcers (DFUs). MATERIALS AND METHODS Single-center retrospective study from 2014-2018 including 314 patients with DFUs submitted to endovascular revascularizations. Group A-patients with a successful endovascular revascularization (n = 285; 90.8%); Group B-patients submitted to a failed attempt of endovascular revascularization (n = 29; 9.2%). Baseline data were not significantly different between the 2 groups (p > 0.05). Both groups were compared regarding: major amputation rates; wound healing, mortality and adverse events. Survival and regression analyses were used. RESULTS Mean follow-up time was 734.1 ± 610.2 days. Major amputation rates were 3.9% versus 24.1% (p < 0.0001) and complete wound healing was 53.7% versus 20.7% (p < 0.0001) for patients from Group A versus Group B, respectively. Major adverse events were registered in 2 patients (one from each group); minor adverse events included 10 patients from Group A and 2 patients from Group B (p = 0.3654). Major amputation rates were: 3.9% versus 27.5% at 1 year; 4.6% versus 27.5% at 2-5 years for Group A versus Group B, respectively (p < 0.0001). Survival rates were: 87.8% at 1 year; 84.4% at 2 years; and 77.9% at 5 years with no significant differences between groups. Predictors for major amputation included failed revascularization (p < 0.0001), older age (p = 0.0394), prior stroke (0.0018), dialysis (0.0476). Predictors for mortality included older age (p < 0.0001) and coronary artery disease (p = 0.0388). CONCLUSION Endovascular revascularization for patients with DFUs is safe and has a significant impact on limb salvage and wound healing.
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Affiliation(s)
- António Proença Caetano
- Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Conde Vasco
- Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - Filipe Veloso Gomes
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nuno Vasco Costa
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - José Hugo Luz
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Ana Formiga
- Diabetic Foot Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - Élia Coimbra
- Head Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - José Neves
- Head of Diabetic Foot Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - Tiago Bilhim
- Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal.
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
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Cury MVM, Brochado Neto FC, Matielo MF, de Athayde Soares R, dos Santos Póvoa RM, de Melo LSBST, Pecego CS, Sacilotto R. Evaluation of the BASIL Survival Prediction Model in Patients Undergoing Infrapopliteal Interventions for Critical Limb Ischemia. Ann Vasc Surg 2019; 55:85-95. [DOI: 10.1016/j.avsg.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 11/24/2022]
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Jeon EY, Cho YK, Yoon DY, Kim DJ, Woo JJ. Clinical outcome of angiosome-oriented infrapopliteal percutaneous transluminal angioplasty for isolated infrapopliteal lesions in patients with critical limb ischemia. Diagn Interv Radiol 2017; 22:52-8. [PMID: 26573976 DOI: 10.5152/dir.2015.15129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the clinical usefulness and outcome of angiosome-oriented percutaneous transluminal angioplasty (IP-PTA) and its clinical outcome for isolated infrapopliteal lesions in diabetic critical limb ischemia. METHODS We retrospectively reviewed 70 patients (82 limbs) with diabetic critical limb ischemia who had localized disease at the level of the infrapopliteal artery. Patients underwent IP-PTA between January 2011 and December 2013 and were followed up for a mean of 13 months. The primary target arterial lesions were chosen according to the angiosome concept. We evaluated clinical findings, technical success, and patients' clinical outcome. The angiographic outcome of IP-PTA was assessed using the angiosome score. We analyzed the relationship between the angiosome score and the amputation rate. RESULTS There were 69 anterior tibial artery (ATA) lesions, 70 posterior tibial artery (PTA) lesions, and 58 peroneal artery (PA) lesions. The primary target arteries were the ATA (n=43), PTA (n=26), PA (n=2), and ATA + PTA (n=11). We divided the treated limbs into target (n=63) and nontarget (n=19) groups. The overall initial technical success rate was 91.4%. Successful wound healing rates were 87.3% (55/63) and 47.3% (9/19) in the target and nontarget groups, respectively (P < 0.05). CONCLUSION Angiosome-oriented primary targeted IP-PTA shows a highly effective treatment outcome in diabetic critical limb ischemia. In cases with inadequate angioplastic results of the target artery, IP-PTA of the nontarget artery should be recommended to improve the limb salvage rates.
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Affiliation(s)
- Eui-Yong Jeon
- Department of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Percutaneous Transluminal Angioplasty in Patients With Infrapopliteal Arterial Disease. Circ Cardiovasc Interv 2016; 9:e003468. [DOI: 10.1161/circinterventions.115.003468] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/21/2016] [Indexed: 11/16/2022]
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Razavi MK, Mustapha JA, Miller LE. Contemporary Systematic Review and Meta-Analysis of Early Outcomes with Percutaneous Treatment for Infrapopliteal Atherosclerotic Disease. J Vasc Interv Radiol 2014; 25:1489-96, 1496.e1-3. [DOI: 10.1016/j.jvir.2014.06.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 12/01/2022] Open
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Siablis D, Kitrou PM, Spiliopoulos S, Katsanos K, Karnabatidis D. Paclitaxel-coated balloon angioplasty versus drug-eluting stenting for the treatment of infrapopliteal long-segment arterial occlusive disease: the IDEAS randomized controlled trial. JACC Cardiovasc Interv 2014; 7:1048-56. [PMID: 25234679 DOI: 10.1016/j.jcin.2014.04.015] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 04/24/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study sought to report the results of a prospective randomized controlled trial comparing paclitaxel-coated balloons (PCB) versus drug-eluting stents (DES) in long infrapopliteal lesions. BACKGROUND DES have an established role in the treatment of short infrapopliteal lesions, whereas there is increasing evidence for the use of PCB in longer below-the-knee lesions. METHODS Inclusion criteria were patients with Rutherford classes 3 to 6 and angiographically documented infrapopliteal disease with a minimum lesion length of 70 mm. The primary endpoint was target lesion restenosis >50% assessed by digital angiography at 6 months. Secondary endpoints included immediate post-procedure stenosis and target lesion revascularization. RESULTS Fifty patients were randomized to undergo infrapopliteal PCB angioplasty (25 arteries in 25 limbs; PCB group) or primary DES placement (30 arteries in 27 limbs; DES group). Immediate residual post-procedure stenosis was significantly lower in DES (9.6 ± 2.2% vs. 24.8 ± 3.5% in PCB; p < 0.0001). At 6 months, 5 patients died (2 in PCB vs. 3 in DES; p = 1.00) and 3 suffered a major amputation (1 in PCB vs. 2 in DES; p = 1.00). In total, 44 angiograms were evaluable with quantitative vessel analysis. Binary (>50%) angiographic restenosis rate was significantly lower in DES (7 of 25 [28%] vs. 11 of 19 [57.9%] in PCB; p = 0.0457). There were no significant differences with regard to target lesion revascularization (2 of 26 [7.7%] in DES vs. 3 of 22 [13.6%] in PCB; p = 0.65). Positive vessel wall remodeling was observed in 3 cases in the PCB arm (3 of 19 [(15.8%)] vs. 0 of 19 [0%] in DES; p = 0.07). CONCLUSIONS Compared with PCB in long infrapopliteal lesions, DES are related with significantly lower residual immediate post-procedure stenosis and have shown significantly reduced vessel restenosis at 6 months. PCB may produce positive vessel remodeling. (Infrapopliteal Drug-Eluting Angioplasty Versus Stenting [IDEAS-I]; NCT01517997).
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Affiliation(s)
- Dimitris Siablis
- Interventional Radiology Department, Patras University Hospital, Patras, Greece
| | - Panagiotis M Kitrou
- Interventional Radiology Department, Patras University Hospital, Patras, Greece
| | | | - Konstantinos Katsanos
- Interventional Radiology Department, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London, United Kingdom
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Naoum JJ, Arbid EJ. Endovascular techniques in limb salvage: infrapopliteal angioplasty. Methodist Debakey Cardiovasc J 2014; 9:103-7. [PMID: 23805344 DOI: 10.14797/mdcj-9-2-103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Critical limb ischemia (CLI) results from inadequate blood flow to supply and sustain the metabolic needs of resting muscle and tissue. Infragenicular atherosclerosis is the most common cause of CLI, and it is more likely to develop when multilevel or diffuse arterial disease coincides with compromised run-off to the foot. Reports of good technical and clinical outcomes have advanced the endovascular treatment options, which have gained a growing acceptance as the primary therapeutic strategy for CLI, especially in patients with significant risk factors for open surgical bypass. In fact, endovascular recanalization of below-the-knee arteries has proven to be feasible and safe, reduce the need for amputation, and improve wound healing. The distribution of various vascular territories or angiosomes in the foot has been recognized, and it appears advantageous to revascularize the artery supplying the territory directly associated with tissue loss. In addition, the targeted application and local delivery of drugs using drug-coated balloons (DCB) during angioplasty has the potential to improve patency rates compared to balloon angioplasty alone.
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Singh GD, Armstrong EJ, Yeo KK, Singh S, Westin GG, Pevec WC, Dawson DL, Laird JR. Endovascular recanalization of infrapopliteal occlusions in patients with critical limb ischemia. J Vasc Surg 2014; 59:1300-7. [PMID: 24393279 DOI: 10.1016/j.jvs.2013.11.061] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular therapies are increasingly used for treatment of critical limb ischemia (CLI). Infrapopliteal (IP) occlusions are common in CLI, and successful limb salvage may require restoration of arterial flow in the distribution of a chronically occluded vessel. We sought to describe the procedural characteristics and outcomes of patients with IP occlusions who underwent endovascular intervention for treatment of CLI. METHODS All patients with IP interventions for treatment of CLI from 2006 to 2012 were included. Angiographic and procedural data were compared between patients who underwent intervention for IP occlusions vs IP stenosis. Restenosis was determined by Doppler ultrasound imaging. Limb salvage was the primary end point of the study. Additional end points included primary patency, primary assisted patency, secondary patency, occlusion crossing success, procedural success, and amputation-free survival. RESULTS A total of 187 patients with CLI underwent interventions for 356 IP lesions, and 77 patients (41%) had interventions for an IP occlusion. Patients with an intervention for IP occlusion were more likely to have zero to one vessel runoff (83% vs 56%; P < .001) compared with interventions for stenosis. Compared with IP stenoses, IP occlusions were longer (118 ± 86 vs 73 ± 67 mm; P < .001) and had a smaller vessel diameter (2.5 ± 0.8 vs 2.7 ± 0.5 mm; P = .02). Wire crossing was achieved in 83% of IP occlusions, and the overall procedural success for IP occlusions was 79%. The overall 1-year limb salvage rate was 84%. Limb salvage was highest in the stenosis group, slightly lower in the successful occlusion group, and lowest in the failed occlusion group (92% vs 75% vs 58%, respectively; P = .02). Unsuccessfully treated IP occlusions were associated with a significantly higher likelihood of major amputation (hazard ratio, 5.79; 95% confidence interval, 1.89-17.7) and major amputation or death (hazard ratio, 2.69; 95% confidence interval, 1.09-6.63). CONCLUSIONS Successful endovascular recanalization of IP occlusions can be achieved with guidewire and support catheter techniques in most patients. In patients selected for an endovascular-first approach for IP occlusions in CLI, this strategy can be successfully implemented with favorable rates of limb salvage.
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Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - Ehrin J Armstrong
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - Khung-Keong Yeo
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif; Division of Cardiovascular Medicine, National Heart Centre Singapore, Singapore
| | - Satinder Singh
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - Gregory G Westin
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - William C Pevec
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - David L Dawson
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - John R Laird
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif.
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Bae JI, Won JH, Han SH, Lim SH, Hong YS, Kim JY, Kim JD, Kim JS. Endovascular revascularization for patients with critical limb ischemia: impact on wound healing and long term clinical results in 189 limbs. Korean J Radiol 2013; 14:430-8. [PMID: 23690709 PMCID: PMC3655296 DOI: 10.3348/kjr.2013.14.3.430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/02/2013] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI). Materials and Methods This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method. Results TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively. Conclusion Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.
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Affiliation(s)
- Jae-Ik Bae
- Department of Radiology, Ajou University School of Medicine, Suwon 443-721, Korea
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