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Kawarada O. Color coded circulation in the field of infrapopliteal intervention. Cardiovasc Interv Ther 2020; 36:131-133. [PMID: 32077009 DOI: 10.1007/s12928-020-00652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, Hanwa Memorial Hospital, 7-11-1 Karita, Sumiyoshiku, Osaka City, Osaka, 558-0011, Japan.
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Higashimori A, Takahara M, Utsunomiya M, Fukunaga M, Kawasaki D, Mori S, Takimura H, Hirano K, Tsubakimoto Y, Nakama T, Yokoi Y. Utility of indigo carmine angiography in patients with critical limb ischemia: Prospective multi-center intervention study (DIESEL-study). Catheter Cardiovasc Interv 2018; 93:108-112. [PMID: 30144339 DOI: 10.1002/ccd.27813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/23/2018] [Accepted: 07/14/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To assess the efficacy of indigo carmine angiography for wound healing after successful below-the-knee intervention in patients with critical limb ischemia (CLI). METHODS A multi-center prospective intervention study was conducted. Fifty-four limbs of 53 patients in Rutherford categories 5 and 6 underwent endovascular therapy (EVT). After successful EVT, 5 mL of indigo carmine was injected through a catheter at the distal popliteal artery and color changes in the foot were evaluated. The results of indigo carmine angiography were divided into three groups: In type I, the color change of the wound was deeper than the surrounding tissue; in type II, the change in wound color was similar to the surrounding tissue; and in type III, no discoloration of the wound was observed by the indigo carmine. RESULTS The wound healing rates at 3 months were 78% (25/32) for type I, 70% (7/10) for type II, and 42% (5/12) for type III (P for trend = 0.025). Indigo carmine angiography-related complications were not seen. CONCLUSION Indigo carmine angiography was found to be a safe and useful procedure to provide visual information on foot perfusion. This dye coloring method demonstrated that after successful angioplasty, the perfused area was made visible at the microcirculation level. Indigo carmine angiography can thus be considered an important predictor for wound healing by EVT in patients with CLI.
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Affiliation(s)
- Akihiro Higashimori
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Osaka Prefecture, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Prefecture, Japan
| | | | - Masashi Fukunaga
- Department of Cardiology, Morinomiya Hospital, Osaka, Osaka Prefecture, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Osaka Prefecture, Japan
| | - Shinsuke Mori
- Department of Cardiology, Saisekikai Tobu Hospital, Yokohama, Kanagawa Prefecture, Japan
| | | | - Keisuke Hirano
- Department of Cardiology, Saisekikai Tobu Hospital, Yokohama, Kanagawa Prefecture, Japan
| | - Yoshinori Tsubakimoto
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Kyoto Prefecture, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki-City, Miyazaki, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Osaka Prefecture, Japan
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Kawarada O, Zen K, Hozawa K, Ayabe S, Huang HL, Choi D, Kim SH, Kim J, Kato T, Tsubakimoto Y, Nakama T, Ichihashi S, Fujimura N, Higashimori A, Fujihara M, Sato T, Yan BPY, Pang SYC, Wongwanit C, Leong YP, Chua B, George RK, Yokoi Y, Motomura H, Obara H. Contemporary critical limb ischemia: Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care. Cardiovasc Interv Ther 2018; 33:297-312. [PMID: 29654408 PMCID: PMC6153892 DOI: 10.1007/s12928-018-0523-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
The burden of peripheral artery disease (PAD) and diabetes in Asia is projected to increase. Asia also has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world. Therefore, most Asian patients with PAD might have diabetic PAD or ESRD-related PAD. Given these pandemic conditions, critical limb ischemia (CLI) with diabetes or ESRD, the most advanced and challenging subset of PAD, is an emerging public health issue in Asian countries. Given that diabetic and ESRD-related CLI have complex pathophysiology that involve arterial insufficiency, bacterial infection, neuropathy, and foot deformity, a coordinated approach that involves endovascular therapy and wound care is vital. Recently, there is increasing interaction among cardiologists, vascular surgeons, radiologists, orthopedic surgeons, and plastic surgeons beyond specialty and country boundaries in Asia. This article is intended to share practical Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care for CLI.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Japan.
- Department of Cardiovascular Medicine, Ikuwakai Memorial Hospital, Osaka, Japan.
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Shinobu Ayabe
- Department of Plastic Surgery, Yao Tokushukai General Hospital, Yao, Japan
| | - Hsuan-Li Huang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Hong Kim
- Department of Cardiology, Busan Veterans Hospital, Busan, South Korea
| | - Jiyoun Kim
- Department of Orthopedic Surgery, Busan Veterans Hospital, Busan, South Korea
| | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | | | - Tasuya Nakama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tomoyasu Sato
- Department of Radiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Bryan Ping-Yen Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Skyi Yin-Chun Pang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | | | - Yew Pung Leong
- Department of Vascular Surgery, Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Benjamin Chua
- Department of Vascular Surgery, Vascular and Interventional Centre Singapore, Mount Elizabeth Novena Specialist Centre, The Farrer Park Hospital, Singapore, Singapore
| | - Robbie K George
- Department of Vascular Surgery, Narayana Hrudayalaya and Mazumdar Shaw Medical Centre, Bengaluru, India
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Osaka City University, Osaka, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Mills JL. Commentary: Is Deep Vein Arterialization for Limb-Threatening Ischemia Effective? A Novel Percutaneous Technique May Lead to an Answer. J Endovasc Ther 2017; 24:627-628. [PMID: 28830275 DOI: 10.1177/1526602817728045] [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)
- Joseph L Mills
- 1 Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Nakatsuji T, Kawarada O, Noguchi T, Ogawa H, Yasuda S. Potential of Using Occult Collateral Vessels for Transcollateral Intervention in Infrapopliteal Chronic Occlusion. Ann Vasc Surg 2016; 38:320.e9-320.e12. [PMID: 27575309 DOI: 10.1016/j.avsg.2016.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/10/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
The transcollateral approach is a contemporary crossing technique for treating infrapopliteal chronic occlusion. However, in the setting of critical limb ischemia with multilevel disease, angiographically occult collateral vessels may be missed as a treatment opportunity. Herein, we report the potential of using occult collateral vessels for transcollateral intervention in infrapopliteal chronic occlusion.
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Affiliation(s)
- Takashi Nakatsuji
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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Rundback JH, Armstrong EJ, Contos B, Iida O, Jacobs D, Jaff MR, Matsumoto AH, Mills JL, Montero-Baker M, Pena C, Tallian A, Uematsu M, Wilkins LR, Shishehbor MH. Key Concepts in Critical Limb Ischemia: Selected Proceedings from the 2015 Vascular Interventional Advances Meeting. Ann Vasc Surg 2016; 38:191-205. [PMID: 27569717 DOI: 10.1016/j.avsg.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 01/28/2023]
Abstract
Over 500,000 patients each year are diagnosed with critical limb ischemia (CLI), the most severe form of peripheral artery disease. CLI portends a grim prognosis; half the patients die from a cardiovascular cause within 5 years, a rate that is 5 times higher than a matched population without CLI. In 2014, the Centers for Medicare and Medicaid Services paid approximately $3.6 billion for claims submitted by hospitals for inpatient and outpatient care delivered to patients with CLI. Although significant advances in diagnosis, treatment, and follow-up of patients with CLI have been made, many challenges remain. In this article, we summarize selected presentations from the 2015 Vascular Interventional Advances Conference related to the modern demographics, diagnosis, and management of patients with CLI.
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Affiliation(s)
- John H Rundback
- Interventional Institute, Holy Name Medical Center, Teaneck, NJ.
| | - Ehrin J Armstrong
- Department of Vascular Surgery, VA Eastern Colorado Healthcare System and University of Colorado, Denver, CO
| | | | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Donald Jacobs
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Michael R Jaff
- Department of Vascular Medicine, Massachusetts General Hospital, Boston, MA
| | - Alan H Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX
| | - Miguel Montero-Baker
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX
| | - Constantino Pena
- Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, FL
| | | | - Masaaki Uematsu
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Luke R Wilkins
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Higashimori A, Iida O, Yamauchi Y, Kawasaki D, Nakamura M, Soga Y, Zen K, Yokoi Y. Outcomes of One straight-line flow with and without pedal arch in patients with critical limb ischemia. Catheter Cardiovasc Interv 2015; 87:129-33. [PMID: 26489531 DOI: 10.1002/ccd.26164] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 07/27/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to compare the outcomes of revascularization strategies for patients with critical limb ischemia (CLI) whereby single vessel run off to the foot was established with or without flow into a patent pedal arch. METHODS We retrospectively analyzed data from 312 consecutive patients with CLI who underwent endovascular therapy (EVT) between December 2009 and February 2011. Below-the-knee angiography identified one vessel run off in 137 patients (44%), and we aimed to compare the outcomes between those patients where revascularization resulted in one-straight-line flow into a patent pedal arch (76 limbs, Group A) versus those who attained one straight-line flow to the distal end of a tibial vessel without flow into a patent pedal arch (61 limbs, Group B). The study endpoints were amputation free survival rate, limb salvage rate and wound healing rate at 12 months after EVT. RESULTS Amputation free survival rate differed significantly between groups (88.2% in group A vs. 65.6% in group B, P = 0.01). Limb salvage rate also differed between groups (98.4% vs.89.3%, P = 0.03). Wound healing rate showed a trend towards difference between the two groups (89.4% vs. 80.6% P = 0.11). CONCLUSIONS Among patients with CLI where only one vessel runoff can be established to the foot, direct flow into a patent pedal arch is essential to improve their clinical outcomes. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | | | - Daizo Kawasaki
- Cardiovascular Center, Morinomiya Hospital, Osaka, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
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Nakama T, Watanabe N, Kimura T, Ogata K, Nishino S, Furugen M, Koiwaya H, Furukawa K, Nakamura E, Yano M, Daian T, Kuriyama N, Shibata Y. Clinical Implications of Additional Pedal Artery Angioplasty in Critical Limb Ischemia Patients With Infrapopliteal and Pedal Artery Disease. J Endovasc Ther 2015; 23:83-91. [PMID: 26442951 DOI: 10.1177/1526602815610119] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the clinical implications of additional pedal artery angioplasty (PAA) for patients with critical limb ischemia (CLI). METHODS Twenty-nine patients (mean age 77.8±8.6 years; 21 men) with CLI (32 limbs) presenting with de novo infrapopliteal and pedal artery (Kawarada type 2/3) disease were reviewed. The need for PAA was based on the existence of sufficient wound blush (WB) around the target wounds after conventional above-the-ankle revascularization. Fourteen patients with insufficient WB in 14 limbs received additional PAA, while 15 patients with sufficient WB in 18 limbs did not. The groups were compared for overall survival, limb salvage, and amputation-free survival within 1 year after the procedure. The wound healing rate, time to wound healing, and freedom from reintervention rate were also evaluated. RESULT The success rate of additional PAA was 93% (13/14). All limbs with successful PAA achieved sufficient WB (13/13). Despite insufficient WB before the additional PAA, overall survival (86% vs 73%, p=0.350), limb salvage (93% vs 83%, p=0.400), amputation-free survival (79% vs 53%, p=0.102), and freedom from reintervention (64% vs 73%, p=0.668) rates were similar in both groups. Furthermore, the wound healing rate (93% vs 60%, p=0.05) was higher and time to wound healing (86.0±18.7 vs 152.0±60.2 days, p=0.05) was shorter in the patients who received PAA. CONCLUSION Additional PAA might improve the WB and clinical outcomes (especially speed and extent of wound healing) in patients with CLI attributed to infrapopliteal and pedal artery disease.
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Affiliation(s)
- Tatsuya Nakama
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Nozomi Watanabe
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Toshiyuki Kimura
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kenji Ogata
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Shun Nishino
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Makoto Furugen
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Hiroshi Koiwaya
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Koji Furukawa
- Department of Cardiovascular Surgery, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Eisaku Nakamura
- Department of Cardiovascular Surgery, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Mitsuhiro Yano
- Department of Cardiovascular Surgery, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Takehiro Daian
- Department of Plastic and Reconstructive Surgery, Miyazaki Konan Hospital, Miyazaki, Japan
| | - Nehiro Kuriyama
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
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