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Suzuki R, Horiuchi K, Iida O, Takahara M, Dannoura Y, Asakawa N, Makino T, Yokoshiki H. Comparison of Subsequent Inframalleolar Bypass Surgery and Repeat Endovascular Therapy for Infrapopliteal Restenosis in Patients With Chronic Limb-Threatening Ischemia Undergoing Primary Endovascular Therapy. J Endovasc Ther 2024:15266028241267735. [PMID: 39091096 DOI: 10.1177/15266028241267735] [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: 08/04/2024]
Abstract
PURPOSE Although endovascular therapy (EVT) is considered a vital strategy for treating infrapopliteal lesions in chronic limb-threatening ischemia (CLTI), the recurrence rate after EVT exceeds that after bypass surgery (BSX). The optimal approach for managing infrapopliteal lesion recurrence in patients with CLTI and unhealed ulcers remains uncertain. This study aimed to evaluate the clinical outcomes of repeat EVT and subsequent inframalleolar BSX for CLTI with infrapopliteal lesion recurrence. MATERIALS AND METHODS We conducted a retrospective analysis of 140 patients with CLTI (mean age, 70±10 years; male, 71.4%; diabetes mellitus, 73.6%; dialysis, 74.3%; Rutherford 5, 79.3%; and Rutherford 6, 20.7%) who had an unhealed wound due to the recurrence of infrapopliteal lesions between January 2015 and May 2020. We compared the clinical outcomes of 40 patients who underwent the subsequent inframalleolar BSX with those of 100 patients who underwent repeat EVT. The outcome measures were amputation-free survival (AFS) and wound healing rate. Propensity score matching analysis was conducted to minimize differences in baseline characteristics. RESULTS Propensity score matching extracted 38 pairs (38 patients in the subsequent BSX group and 83 patients in the repeat EVT group). AFS was not significantly different between the repeat EVT and subsequent BSX groups (81.9% vs 82.6% at 1 year, p=0.97). Neither was cumulative wound healing (42.8% vs 43.3% at 1 year, p=0.55). No baseline characteristics had any significant interaction effect on the association between repeat EVT, subsequent BSX, and failure of AFS. CONCLUSION This study using propensity score matching revealed that the clinical outcomes following repeat EVT were comparable with those following subsequent inframalleolar BSX, indicating that repeat EVT may be a viable treatment option for CLTI with infrapopliteal lesion recurrence. CLINICAL IMPACT Although endovascular therapy (EVT) has expanded the treatment options for chronic limb-threatening ischemia (CLTI), the recurrence rate after EVT is higher than that after bypass surgery (BSX). This retrospective study compared the clinical outcomes of repeat EVT with those of subsequent BSX for CLTI with infrapopliteal lesion recurrence. After propensity score matching, amputation-free survival (AFS) was not significantly different between the repeat EVT and subsequent BSX groups (81.9% vs 82.6% at 1 year, p=0.97). Neither was cumulative wound healing (42.8% vs 43.3% at 1 year, p=0.55). There was no difference between the 2 revascularization strategies when treating infrapopliteal restenosis lesions.
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Affiliation(s)
- Riho Suzuki
- Department of Cardiology, Sapporo City General Hospital, Sapporo, Japan
| | - Katsumi Horiuchi
- Department of Plastic Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yutaka Dannoura
- Department of Cardiology, Sapporo City General Hospital, Sapporo, Japan
| | - Naoya Asakawa
- Department of Cardiology, Sapporo City General Hospital, Sapporo, Japan
| | - Takao Makino
- Department of Cardiology, Sapporo City General Hospital, Sapporo, Japan
| | - Hisashi Yokoshiki
- Department of Cardiology, Sapporo City General Hospital, Sapporo, Japan
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Barillà C, Pipitò N, Squillaci D, Castellana FM, Fittipaldi A, De Caridi G, Benedetto F. Popliteal-to-Distal Extreme Bypass in Endovascular Era. Ann Vasc Surg 2024; 104:276-281. [PMID: 38588950 DOI: 10.1016/j.avsg.2024.02.005] [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: 10/29/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) is characterized by rest pain and tissue loss, with an annual mortality rate of 20% and amputation rate of 40%, if not treated. Open bypass surgery is recommended in CLTI, depending on the availability of good quality venous material, outflow artery patency, and surgical expertise. The aim of the study is to analyze primary patency, limb salvage, and survival rate in patients undergoing popliteal-to-distal bypass. METHODS All consecutive patients who underwent popliteal-to-distal bypass surgery between January 2016 and December 2021 were enrolled in the study. Primary outcomes were primary patency, limb salvage, and overall survival. Secondary outcomes included amputation-free survival and secondary patency. RESULTS Forty-nine patients were included during the study. Technical success was achieved in 100% of cases. Target outflow artery was in 27% (n. 13) of cases the anterior tibial artery, in 27% (n. 13) the dorsalis pedis, in 2% (n. 1) the peroneal artery, in 30% (n. 15) the retromalleolar tibial artery, in 10% (n. 5) the medial plantar artery, and in 4% (n. 2) the tarsal artery. Two-year primary patency was 85% ± 5. Secondary patency rates were 86% ± 3 at 2 years. The overall survival was 81% ± 6 at 2 years, the amputation-free survival was 70% ± 9, and the limb salvage rate was 81% ± 6. CONCLUSIONS Popliteal-to-distal bypass requires high technical expertise to be performed. When a good autologous vein and adequate outflow artery are present, they can be feasible with good patency rates and overall survival.
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Affiliation(s)
- Chiara Barillà
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Narayana Pipitò
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Domenico Squillaci
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Federica Maria Castellana
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Alessandra Fittipaldi
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy.
| | - Giovanni De Caridi
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
| | - Filippo Benedetto
- Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy
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Zhong T, Gao N, Guan Y, Liu Z, Guan J. Co-Delivery of Bioengineered Exosomes and Oxygen for Treating Critical Limb Ischemia in Diabetic Mice. ACS NANO 2023; 17:25157-25174. [PMID: 38063490 PMCID: PMC10790628 DOI: 10.1021/acsnano.3c08088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Diabetic patients with critical limb ischemia face a high rate of limb amputation. Regeneration of the vasculature and skeletal muscles can salvage diseased limbs. Therapy using stem cell-derived exosomes that contain multiple proangiogenic and promyogenic factors represents a promising strategy. Yet the therapeutic efficacy is not optimal because exosomes alone cannot efficiently rescue and recruit endothelial and skeletal muscle cells and restore their functions under hyperglycemic and ischemic conditions. To address these limitations, we fabricated ischemic-limb-targeting stem cell-derived exosomes and oxygen-releasing nanoparticles and codelivered them in order to recruit endothelial and skeletal muscle cells, improve cell survival under ischemia before vasculature is established, and restore cell morphogenic function under high glucose and ischemic conditions. The exosomes and oxygen-releasing nanoparticles, delivered by intravenous injection, specifically accumulated in the ischemic limbs. Following 4 weeks of delivery, the exosomes and released oxygen synergistically stimulated angiogenesis and muscle regeneration without inducing substantial inflammation and reactive oxygen species overproduction. Our work demonstrates that codelivery of exosomes and oxygen is a promising treatment solution for saving diabetic ischemic limbs.
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Affiliation(s)
- Ting Zhong
- Department of Mechanical Engineering & Materials Science, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Ning Gao
- Institute of Materials Science and Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Ya Guan
- Institute of Materials Science and Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Zhongting Liu
- Institute of Materials Science and Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Jianjun Guan
- Department of Mechanical Engineering & Materials Science, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
- Institute of Materials Science and Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
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Taylor S, Gormley S, Mani M, Mani K, Khashram M. Definitive coverage of distal vein graft in a case of early skin necrosis following popliteal to dorsalis pedis bypass. J Vasc Surg Cases Innov Tech 2023; 9:101233. [PMID: 37822946 PMCID: PMC10562842 DOI: 10.1016/j.jvscit.2023.101233] [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: 12/12/2022] [Accepted: 05/15/2023] [Indexed: 10/13/2023] Open
Abstract
Inframalleolar bypass is an effective intervention for chronic limb threatening ischemia. A successful outcome can be compromised by early pedal wound disruption with secondary bypass exposure. We describe the case of a 74-year-old man with a WIfI (wound, ischemia, foot infection) clinical stage 4 foot who underwent popliteal-dorsalis pedis bypass, complicated by early skin necrosis overlying the pedal anastomosis. This necessitated a multidisciplinary approach to obtain tissue coverage over the anastomosis. The wound healed within 28 days, and at 2 years, the patient was mobilizing independently. We outline the approach taken and discuss the management of this challenging limb salvage problem.
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Affiliation(s)
- Sam Taylor
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Sinead Gormley
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Maria Mani
- Section of Plastic Surgery, Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Rajendran S, Ramachandran Nair H. One-Year Follow-Up of an Inframalleolar Collateral Artery Bypass. Cureus 2023; 15:e36192. [PMID: 37065410 PMCID: PMC10104480 DOI: 10.7759/cureus.36192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Successful revascularization and restoration of blood flow to one of the pedal arteries is the mainstay to prevent major limb amputation. Here, we report a rare case of successful bypass to the inframalleolar ankle collateral artery in a middle-aged female with rheumatoid arthritis presenting with gangrene of the toes of the left foot. A computed tomography angiography (CTA) demonstrated normal infrarenal aorta, common iliac, external iliac, and common femoral arteries on the left side. The left superficial femoral, popliteal, tibial, and peroneal arteries were occluded. Extensive collateralization was noted in the left thigh and leg, with distal reformation in large ankle collateral. A successful bypass was done using from the common femoral artery to the ankle collateral using the great saphenous vein harvested from the same limb. At a one-year follow-up, the patient was symptom-free, and a CTA showed a patent bypass graft.
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Didenko SN, Ratushniuk AV, Liksunov OV, Orlych OM, Hupalo YM, Makivchuk DA. FINE-NEEDLE ANGIOGRAPHY IN CHRONIC LIMB-THREATENING ISCHEMIA DIABETIC PATIENTS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2581-2584. [PMID: 36591735 DOI: 10.36740/wlek202211104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: The features and efficiency of performing fine-needle angiography for Chronic Limb-Threatening Ischemia (CLTI) in Diabetic Patients diagnosis. PATIENTS AND METHODS Materials and methods: From 2015-2020, a total of 180 angiography procedures were performed in below-the-knee (BTK) arterial disease diabetic patients with CLTI (Rutherford category 4 to 6). Relative contraindications such as severe heart failure, myocardial infarction (MI), arterial hypertension, impaired renal function, allergy to contrast media and intolerance to antiplatelet therapy we carefully evaluated and compared with the major amputation risks. Patients were selected with adequate inflow to the common and popliteal arterys, as defined by presence of normal ipsilateral femoral and popliteal pulse, biphasic or triphasic Doppler waveform. Ultrasound controlled fine-needle angiography, by retrograde puncture of the superficial femoral artery (SFA) was performed with an 18G-70mm angiographic needle in 96 patients (1st group). Antegrade angiography using femoral sheath in 84 patients (2nd group). RESULTS Results: We have obtained adequate visualization BTK vessels by administering "Omnipak 300" 70% solution 9 mL with a power injector at a 3 mL/sec rate through the needle. Through the sidearm of the femoral sheath a total of contrast 15 mL, administered at 5 mL/sec rate. Fine-needle angiography 2.16 times reduces the injected contrast amount in patients. The hemorrhagic events frequency in the 1st group was significantly lower. CONCLUSION Conclusions: Fine-needle angiography is recommended for CLTI Diabetic Patients diagnosis.
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Affiliation(s)
- Sergii N Didenko
- CLINICAL HOSPITAL «FEOFANIYA» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Andrii V Ratushniuk
- STATE INSTITUTION "NATIONAL INSTITUTE OF SURGERY AND TRANSPLANTOLOGY N.A. O. SHALIMOV NATIONAL MEDICAL SCIENCES ACADEMY OF UKRAINE", KYIV, UKRAINE
| | - Oleksandr V Liksunov
- STATE INSTITUTION "NATIONAL INSTITUTE OF SURGERY AND TRANSPLANTOLOGY N.A. O. SHALIMOV NATIONAL MEDICAL SCIENCES ACADEMY OF UKRAINE", KYIV, UKRAINE
| | | | - Yurii M Hupalo
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Dmytro A Makivchuk
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
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Wang Z, Sheng L, Gu H, Yang F, Xie H, Li M. Neutrophil-to-Lymphocyte Ratio Predicts Restenosis After Drug-Coated Balloon Therapy for Femoropopliteal Artery Lesions: A Retrospective Study. Front Cardiovasc Med 2022; 9:868656. [PMID: 35911526 PMCID: PMC9330156 DOI: 10.3389/fcvm.2022.868656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/23/2022] [Indexed: 01/22/2023] Open
Abstract
BackgroundPeripheral artery disease (PAD) is a common atherosclerotic vascular disease. The use of drug-coated balloon (DCB) for the treatment of femoropopliteal artery disease has gradually increased. A certain percentage of patients developed target lesion restenosis after DCB treatment of the femoral popliteal artery. The neutrophil-to-lymphocyte ratio (NLR) is closely related to the level of inflammatory activity and has predictive value for atherosclerotic vascular disease. This study aimed to analyze the relationship between NLR and 1-year restenosis after DCB for femoropopliteal artery disease.MethodsPatients with femoropopliteal artery disease who were treated with DCBs at our hospital from May 2016 to December 2020 were retrospectively included. Baseline data during the patient’s first hospital stay and data during follow-up were collected. Demographic data, laboratory test results, lesion examination results, and major adverse events during the follow-up period were collected. Logistic regression was used to analyze the factors associated with restenosis after DCB.ResultsA total of 117 patients were included. During 1-year follow-up, 19 cases (16.2%) of restenosis were detected. Five of these patients (4.3% of total included patients) were readmitted for symptomatic ischemia. No deaths or amputations occurred. Baseline NLR in patients with restenosis was higher than that in patients without restenosis (2.4 (2.1, 3.4) vs. 1.8 (1.3, 2.3), P < 0.001). Logistic univariate and multivariate analysis showed that baseline hs-CRP level (OR = 1.10, 95%CI: 1.05–1.34), lesion length (OR = 1.04, 95%CI: 1.02–1.27), use of rivaroxaban (OR = 1.08, 95%CI: 1.05–1.39), NLR (OR = 1.47, 95%CI: 1.13–2.48), LDL-C level (OR = 1.25, 95%CI: 1.05–1.52), and diabetes (OR = 1.25, 95%CI: 1.05–1.52) = 1.18, 95%CI: 1.06–1.66) were predictors of restenosis.ConclusionBaseline NLR before DCB can predict the risk of restenosis after surgery.
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Armstrong EJ. Intensifying our focus on critical limb ischemia. Vasc Med 2021; 26:121-122. [PMID: 33825576 DOI: 10.1177/1358863x211000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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