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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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2
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Katz J, Rotstein I. Acute periapical dental abscesses and increased risk for extracranial carotid artery aneurysms. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2023. [DOI: 10.1051/mbcb/2022035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: To assess the prevalence of acute periapical abscesses (PAs) in patients with a history of extracranial carotid artery aneurysms (ECAA). Materials and methods: History of acute PAs and ECAA diagnosis was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with history of ECAA were then calculated. Results: The prevalence of acute PAs in patients with a history ECAA was significantly higher as compared to the general hospital patient population (p < 0.0001). The OR was 5.5. Females were more affected than males by 1.7 folds (p < 0.001). Whites were more affected than African Americans by 1.6 folds (p < 0.00001). Conclusions: The high prevalence of acute PAs in patients with a history of ECAA may suggest an association between these two conditions warranting a thorough medical examination.
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Kumar K, Bamezai S, Sharma SB, Zhou S, Spector M, Obi AT. Unusual presentation of distal ICA aneurysm in relation to dental abscess. J Vasc Surg Cases Innov Tech 2022; 8:542-544. [PMID: 36081740 PMCID: PMC9445861 DOI: 10.1016/j.jvscit.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Mycotic extracranial carotid artery aneurysms are a rare vascular phenomenon with a number of implicated pathogens, most commonly Staphylococcus aureus and Salmonella. Presentation of a mycotic extracranial carotid artery aneurysm after dental abscess or procedure is similarly not frequently described in the literature. We present a unique case of a large, distal mycotic internal carotid artery aneurysm, which developed secondary to Haemophilus parainfluenzae infection and dental abscess.
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Affiliation(s)
- Kiran Kumar
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Sharika Bamezai
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Sriganesh B. Sharma
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Shiwei Zhou
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Andrea T. Obi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
- Correspondence: Andrea T. Obi, MD, University of Michigan, Vascular Surgery, 1500 East Medical Center Dr, SPC 5867, Ann Arbor, MI 48109-5867
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Mycotic Aneurysm of Internal Carotid Artery Secondary to Livestock-associated Methicillin-resistant Staphylococcus Aureus Clonal Complex CC398. Ann Vasc Surg 2021; 78:379.e7-379.e10. [PMID: 34481883 DOI: 10.1016/j.avsg.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/17/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022]
Abstract
The aim of this article is to present a case of mycotic aneurysm of internal carotid artery secondary to livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) treated with resection and common-to-internal carotid artery bypass with autologous vein graft in a male pig farmer. A 69-year-old man, pig farmer, with recent dental extraction was admitted with a right cervical pulsatile mass, dysphonia, pain, leukocytosis and elevated C-reactive protein (CRP). Ultrasonography (US) and computed tomography angiography (CTA) showed a 3.9 × 4.5 cm mycotic aneurysm of right internal carotid artery with hypermetabolic uptake in positron emission tomography (PET) scan. Resection of the mycotic aneurysm and a common-to-internal carotid artery bypass with major saphenous vein graft were performed. LA-MRSA clonal complex (CC) 398 was detected in intraoperative samples and antibiotic therapy was changed according to antibiogram. Patient was discharged at the seventh postoperative day and received antibiotic therapy for 6 weeks. US 12 months later showed patency of the bypass without collections. Mycotic aneurysms of internal carotid artery are very infrequent. MRSA isolation is rare, and to the best of our knowledge this is the first case caused by multi-drug resistant LA-MRSA CC398. The treatment includes mycotic aneurysm resection and reconstruction with venous graft bypass plus intensive antibiotic therapy.
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Galyfos G, Eleftheriou M, Theodoropoulos C, Vouros D, Georgiou K, Kimpizi D, Rentifis L, Sigala F, Filis K. Open versus endovascular repair for extracranial carotid aneurysms. J Vasc Surg 2021; 74:1017-1023.e5. [PMID: 33940071 DOI: 10.1016/j.jvs.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extracranial carotid artery aneurysms (ECCAs) are rare; however, they are associated with a high risk of stroke and mortality if untreated. In the present review, we compared the major outcomes between open and endovascular repair of ECCAs. METHODS We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for clinical studies reported online up to September 2020 that had evaluated major outcomes after both open and endovascular repair of ECCAs. Eligible studies were required to have evaluated at least the 30-day mortality or stroke and/or transient ischemic attack rates. The quality of the studies was also evaluated. RESULTS Overall, seven studies (three high quality, two medium quality, and two low quality) with 374 patients and 383 ECCAs were eligible. All the studies had been reported from 2004 to 2020. In total, 220 open repairs were compared with 81 endovascular repairs. The open and endovascular treatments showed similar 30-day mortality rates (4% vs 0%; pooled odds ratio [OR], 2.67; 95% confidence interval [CI], 0.291-24.451) and stroke and transient ischemic attack rates (5.5% vs 1.2%; pooled OR, 1.42; 95% CI, 0.412-4.886). Open repair was associated in six studies with a greater incidence of cranial nerve injury compared with endovascular repair (14.5% vs 0%; OR, 3.98; 95% CI, 1.178-13.471). The hematoma or bleeding rate was also similar between the two methods in six studies (5.2% vs 0%; OR, 1.92; 95% CI, 0.518-7.094). CONCLUSIONS Open and endovascular repair of ECCAs is associated with similarly low early mortality and cerebrovascular event rates, although open repair showed a greater risk of cranial nerve injuries. An endovascular approach could be more appropriate when the aneurysm is located distally or requires extensive dissection. More studies are needed with standardized follow-up durations to evaluate late outcomes.
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Affiliation(s)
- George Galyfos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece.
| | - Malvina Eleftheriou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Charis Theodoropoulos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Dimitris Vouros
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Georgiou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Despina Kimpizi
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Loukas Rentifis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Frangiska Sigala
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
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Molina G, Mesías C, Calispa J, Arroyo K, Jaramillo K, Lluglla L, Gutierrez B, Gálvez P. Mycotic pseudoaneurysm of the extracranial carotid artery, a severe and rare disease, a case report. Int J Surg Case Rep 2020; 71:382-385. [PMID: 32487475 PMCID: PMC7322741 DOI: 10.1016/j.ijscr.2020.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mycotic pseudoaneurysm of the carotid artery is a severe and rare disease. When it ruptures, it can produce severe morbidity and high mortality. It presents clinically as a pulsatile mass, usually diagnosable by computed tomography angiography with definitive confirmation achieved by establishing the presence of the pathogen in the tissue sample. CASE PRESENTATION We present the case of a 68-year-old male patient with a history of total laryngectomy. He presented with painful and pulsatile mass in his neck and, after precise evaluation, a ruptured carotid mycotic pseudoaneurysm was promptly detected and treated. After a surgical intervention and an adequate course of antibiotics, the patient successfully recovered. CONCLUSIONS Mycotic pseudoaneurysms of the extracranial carotid artery are uncommon and should always be surgically treated. Due to the high risk of potential complications, restoration of the arterial flow should be attempted in all occasions. High clinical awareness is imperative when approaching a mycotic pseudoaneurysm due to its wide spectrum of clinical symptoms, and must always be considered when diagnosing tumors of the neck. Despite its rarity, early detection and prompt treatment are critical to minimize the possibility of a fatal outcome.
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Affiliation(s)
- Gabriel Molina
- PGY4 Surgery Resident at Pontificia Universidad del Ecuador, Quito, Ecuador
| | - Carolina Mesías
- Head and Neck Surgery, Universidad Autónoma de México, Mexico
| | - Juan Calispa
- Hospital de Especialidades Fuerzas Armadas, Quito, Ecuador
| | - Kevin Arroyo
- Universidad Central del Ecuador, Department of Surgery, Quito, Ecuador
| | - Katherine Jaramillo
- Pontificia Universidad Católica del Ecuador, Department of Surgery, Quito, Ecuador
| | | | | | - Patricio Gálvez
- Docente Carrera de Medicina, Facultad de Ciencias Médicas, Universidad de las Américas, Quito, Ecuador.
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Mohorko J, Glavan M, Čizmarevič B, Lanišnik B. Mycotic Aneurysm of the Extracranial Internal Carotid Artery Following Otitis Media. Indian J Otolaryngol Head Neck Surg 2019; 71:1453-1457. [PMID: 31750195 PMCID: PMC6841752 DOI: 10.1007/s12070-018-1545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022] Open
Abstract
Mycotic aneurysm of the internal carotid artery following otomastoiditis can manifest as a nasopharyngeal mass. This is a very rarely described condition. The case of a patient diagnosed with a retropharyngeal mycotic aneurysm of the left internal carotid artery following otitis media, treated with exclusion of the mycotic aneurysm from the circulation and transnasal drainage. Infection of the mastoid can spread to the parapharyngeal space of the nasopharynx and damage the carotid artery wall, resulting in an infected aneurysm. There are no guidelines on how to surgically approach those aneurysms. An endoscopic transnasal approach can be beneficial.
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Affiliation(s)
- Janez Mohorko
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Matic Glavan
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Bogdan Čizmarevič
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Boštjan Lanišnik
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, Faculty of Medicine, University of Maribor, Maribor, Slovenia
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8
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Fok KC, Chan YC, Law Y, Cheng SW. Septic Carotid Endarterectomy Patch as a Result of Preoperative Tooth Extraction. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Kasangana K, Shih M, Saunders P, Rhee R. Common carotid artery pseudoaneurysm secondary to Mycobacterium tuberculosis treated with resection and reconstruction with saphenous vein graft. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 3:192-195. [PMID: 29349420 PMCID: PMC5764893 DOI: 10.1016/j.jvscit.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022]
Abstract
Extracranial carotid artery aneurysms secondary to Mycobacterium tuberculosis infection are exceedingly rare. Despite an uncommon location and offending pathogen, the treatment paradigm follows that of all mycotic aneurysms. We report the case of a right common carotid artery pseudoaneurysm caused by a tuberculous infection, successfully treated with antibiotics, resection, and autologous interposition graft.
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Affiliation(s)
- Kalenda Kasangana
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Paul Saunders
- Division of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Robert Rhee
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
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Piccirilli M, Prizio E, Cannizzaro D, Tropeano MP, Guidetti G, Santoro A. The only case of mycotic aneurysm of the PICA: Clinical-radiological remarks and review of literature. J Clin Neurosci 2017; 38:62-66. [DOI: 10.1016/j.jocn.2016.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
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11
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Di Santo D, Giordano L, Bertazzoni G, Galli A, Tulli M, Bussi M. Rupture of the extracranial carotid artery caused by misdiagnosed infected pseudoaneurysm during deep cervical abscess drainage: A case report. Auris Nasus Larynx 2016; 44:355-358. [PMID: 27346681 DOI: 10.1016/j.anl.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/15/2016] [Accepted: 06/06/2016] [Indexed: 12/01/2022]
Abstract
Infected aneurysms or pseudoaneurysms of the extracranial carotid artery are extremely rare, but they can lead to lethal complications. In some cases, infected pseudoaneurysms can be masked by the excessive inflammation of surrounding tissues. Here we describe the case of a 69-year-old woman with several comorbidities, who presented with a rapidly enlarging left neck bulge. CT was suggestive of an abscess involving the left common carotid artery. Colour Doppler ultrasound did not document intralesional flow. Abscess drainage under ultrasonographic assistance was attempted unsuccessfully, with collection of creamy, purple material. Surgical drainage of the abscess was, therefore, decided. As soon as necrotic tissue debridement was started, a massive haemorrhage originating from the common carotid artery invaded the surgical field. The carotid artery was then repaired with a bovine pericardial patch and covered with a pectoralis major muscle flap. The patient recovered without any neurological consequences. Revision of CT imaging revealed a very small misdiagnosed infected pseudoaneurysm. With better preoperative surgical planning and a good suspicion index, such a life-threatening emergency could have been avoided.
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Affiliation(s)
- Davide Di Santo
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy.
| | - Leone Giordano
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Giacomo Bertazzoni
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Andrea Galli
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Michele Tulli
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Mario Bussi
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
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Garrido P, Mendes Pedro L, Silvestre L, Fernandes e Fernandes R, Sousa G, Fernandes e Fernandes J. Falso aneurisma micótico carotídeo – o que fazer? ANGIOLOGIA E CIRURGIA VASCULAR 2016. [DOI: 10.1016/j.ancv.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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13
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Armstrong DG, Cohen K, Courric S, Bharara M, Marston W. Diabetic foot ulcers and vascular insufficiency: our population has changed, but our methods have not. J Diabetes Sci Technol 2011; 5:1591-5. [PMID: 22226282 PMCID: PMC3262731 DOI: 10.1177/193229681100500636] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diabetic foot complications are increasing in prevalence worldwide. Care and attention to these complications have improved greatly. Many advanced therapies are now being investigated or taken through final stages of clinical studies worldwide. However, the data upon which assumptions regarding morbidity, healing, and mortality have been based are grossly outdated. The purpose of this brief article is to report on current data regarding neuropathic and neuroischemic wounds and to propose that the latter category of advanced-stage diabetic foot wound may now be emerging as the most commonly encountered lesion in the developed world. Unfortunately, it is still systematically excluded from most clinical study criteria. Additionally, just as in the care of cancer, we call for therapy of these advanced-stage diabetic foot ulcers to be managed in similarly interdisciplinary centers where patients may have access to potentially beneficial clinical trials.
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Affiliation(s)
- David G Armstrong
- Southern Arizona Limb Salvage Alliance, University of Arizona College of Medicine, Tucson, Arizona 85724 , USA
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