1
|
Yuksel A, Velioglu Y, Cayir MC, Kumtepe G, Gurbuz O. Current Status of Arterial Revascularization for the Treatment of Critical Limb Ischemia in Infrainguinal Atherosclerotic Disease. Int J Angiol 2018; 27:132-137. [PMID: 30154631 DOI: 10.1055/s-0037-1620242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease (PAD) that may result in limb loss and even death; thus, the fast and proper treatment should be employed as earlier as possible to prevent these catastrophic consequences. Arterial revascularization is almost always an indispensable treatment option for CLI. Although both endovascular and surgical revascularization procedures have an important role, nowadays, the hybrid revascularization as a combination of these revascularization procedures has also gained increasing popularity in the treatment of patients with CLI. This review provides an update on the arterial revascularization strategies for the treatment of CLI.
Collapse
Affiliation(s)
- Ahmet Yuksel
- Department of Cardiovascular Surgery, Bursa State Hospital, Bursa, Turkey
| | - Yusuf Velioglu
- Department of Cardiovascular Surgery, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | | | - Gencehan Kumtepe
- Department of Cardiovascular Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Orcun Gurbuz
- Department of Cardiovascular Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| |
Collapse
|
2
|
Chen X, Li J, Zheng C, He Y, Jia J, Wang X, Li D, Shang T, Li M. Drug-delivering endovascular treatment versus angioplasty in artery occlusion diseases: a systematic review and meta-analysis. Curr Med Res Opin 2018; 34:95-105. [PMID: 28837370 DOI: 10.1080/03007995.2017.1372114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The best management of patients with femoropopliteal and infrapopliteal artery occlusion disease is not clear. This study aimed to compare the efficacy of drug-coated balloons (DCBs) and drug-eluting stents (DESs) with percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal or infrapopliteal arterial occlusive disease. METHODS Medline, Cochrane, Embase, and Google Scholar databases were searched for randomized controlled trials from 1 January 2000 until 30 June 2016. RESULTS Compared with PTA, significant benefits in favor of DCB and DES were found for target lesion revascularization (TLR) (OR = 0.38, 95% CI = 0.22 to 0.66, p = .001 for DCB; OR = 0.51, 95% CI = 0.32 to 0.81, p < .001 for DES). Primary patency rate was greater with DCB (p = .001) and DES (p < .001) than PTA. Compared with PTA, a significant reduction in mortality was observed in the DCB group (p = .039) but not in the DES group. Subgroup analysis found a lower rate of TLR and a higher rate of primary patency in the active group (DCB and DES) compared with the control group (PTA) in patients with femoropopliteal arterial occlusion (p ≤ .016) but not in patients with infrapopliteal arterial occlusion (p ≥ .063). Mortality was similar between active replacement and control groups both in the femoropopliteal arterial occlusion and the infrapopliteal arterial occlusion subgroups (all p > .05). CONCLUSIONS Significantly better TLR and primary patency rate were found in the drug-delivering endovascular treatments compared with the PTA group for patients with femoropopliteal arterial occlusion but not for patients with infrapopliteal arterial occlusion.
Collapse
Affiliation(s)
- Xudong Chen
- a Department of Vascular Surgery , Zhejiang Provincial People's Hospital, Hangzhou, 310004 , China
| | - Jianhui Li
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Chengfei Zheng
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Yunjun He
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Junjun Jia
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Xiaohui Wang
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Donglin Li
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Tao Shang
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| | - Ming Li
- b Department of Vascular Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , China
| |
Collapse
|
3
|
Chang CC, Chen MY, Shen JH, Lin YB, Hsu WW, Lin BS. A quantitative real-time assessment of Buerger exercise on dorsal foot peripheral skin circulation in patients with diabetes foot. Medicine (Baltimore) 2016; 95:e5334. [PMID: 27861361 PMCID: PMC5120918 DOI: 10.1097/md.0000000000005334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Buerger exercise can improve the peripheral circulation of lower extremities. However, the evidence and a quantitative assessment of skin perfusion immediately after this exercise in patients with diabetes feet are still rare.We recruited 30 patients with unilateral or bilateral diabetic ulcerated feet in Chang Gung Memorial Hospital, Chia-Yi Branch, from October 2012 to December 2013. Real-time dorsal foot skin perfusion pressures (SPPs) before and after Buerger exercise were measured and analyzed. In addition, the severity of ischemia and the presence of ulcers before exercise were also stratified.A total of 30 patients with a mean age of 63.4 ± 13.7 years old were enrolled in this study. Their mean duration of diabetes was 13.6 ± 8.2 years. Among them, 26 patients had unilateral and 4 patients had bilateral diabetes foot ulcers. Of the 34 wounded feet, 23 (68%) and 9 (27%) feet were classified as Wagner class II and III, respectively. The real-time SPP measurement indicated that Buerger exercise significantly increased the level of SPP by more than 10 mm Hg (n = 46, 58.3 vs 70.0 mm Hg, P < 0.001). In terms of pre-exercise dorsal foot circulation condition, the results showed that Buerger exercise increased the level of SPP in severe ischemia (n = 5, 22.1 vs 37.3 mm Hg, P = 0.043), moderate ischemia (n = 14, 42.2 vs 64.4 mm Hg, P = 0.001), and borderline-normal (n = 7, 52.9 vs 65.4 mm Hg, P = 0.028) groups, respectively. However, the 20 feet with SPP levels more than 60 mm Hg were not improved significantly after exercise (n = 20, 58.3 vs 71.5 mm Hg, P = 0.239). As to the presence of ulcers, Buerger exercise increased the level of SPP in either unwounded feet (n = 12, 58.5 vs 66.0 mm Hg, P = 0.012) or wounded feet (n = 34, 58.3 vs 71.5 mm Hg, P < 0.001). The majority of the ulcers was either completely healed (9/34 = 27%) or still improving (14/34 = 41%).This study quantitatively demonstrates the evidence of dorsal foot peripheral circulation improvement after Buerger exercise in patients with diabetes.
Collapse
Affiliation(s)
- Chang-Cheng Chang
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chiayi
- School of Medicine, College of Medicine, China Medical University, Taichung
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Guiren, Tainan
| | - Men-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Kwei-Shan Taoyuan
| | - Jen-Hsiang Shen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kueishan, Taoyuan
| | - Yen Bin Lin
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Wen-Wei Hsu
- Department of Orthopedics, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Guiren, Tainan
| |
Collapse
|
4
|
Yang Y, Qi P, Yang Z, Huang N. Nitric oxide based strategies for applications of biomedical devices. BIOSURFACE AND BIOTRIBOLOGY 2015. [DOI: 10.1016/j.bsbt.2015.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
5
|
Kumagai M, Marui A, Tabata Y, Takeda T, Yamamoto M, Yonezawa A, Tanaka S, Yanagi S, Ito-Ihara T, Ikeda T, Murayama T, Teramukai S, Katsura T, Matsubara K, Kawakami K, Yokode M, Shimizu A, Sakata R. Safety and efficacy of sustained release of basic fibroblast growth factor using gelatin hydrogel in patients with critical limb ischemia. Heart Vessels 2015; 31:713-21. [PMID: 25861983 DOI: 10.1007/s00380-015-0677-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/01/2015] [Indexed: 12/22/2022]
Abstract
As a form of therapeutic angiogenesis, we sought to investigate the safety and efficacy of a sustained-release system of basic fibroblast growth factor (bFGF) using biodegradable gelatin hydrogel in patients with critical limb ischemia (CLI). We conducted a phase I-IIa study that analyzed 10 CLI patients following a 200-μg intramuscular injection of bFGF-incorporated gelatin hydrogel microspheres into the ischemic limb. Primary endpoints were safety and transcutaneous oxygen pressure (TcO2) at 4 and 24 weeks after treatment. During the follow-up, there was no death or serious procedure-related adverse event. After 24 weeks, TcO2 (28.4 ± 8.4 vs. 46.2 ± 13.0 mmHg for pretreatment vs after 24 weeks, p < 0.01) showed significant improvement. Regarding secondary endpoints, the distance walked in 6 min (255 ± 105 vs. 318 ± 127 m, p = 0.02), the Rutherford classification (4.4 ± 0.5 vs. 3.1 ± 1.4, p = 0.02), the rest pain scale (1.7 ± 1.0 vs. 1.2 ± 1.3, p = 0.03), and the cyanotic scale (2.0 ± 1.1 vs. 0.9 ± 0.9, p < 0.01) also showed improvement. The blood levels of bFGF were within the normal range in all patients. A subanalysis of patients with arteriosclerosis obliterans (n = 7) or thromboangiitis obliterans (Buerger's disease) (n = 3) revealed that TcO2 had significantly improved in both subgroups. TcO2 did not differ between patients with or without chronic kidney disease. The sustained release of bFGF from biodegradable gelatin hydrogel may offer a safe and effective form of angiogenesis for patients with CLI.
Collapse
Affiliation(s)
- Motoyuki Kumagai
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akira Marui
- Division of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.,Department of Experimental Therapeutics, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Takahide Takeda
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Experimental Therapeutics, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Masaya Yamamoto
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Data Science, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Shigeki Yanagi
- Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamoto, Japan
| | - Toshiko Ito-Ihara
- Department of Clinical Innovative Medicine, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Takafumi Ikeda
- Department of Experimental Therapeutics, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Toshinori Murayama
- Department of Clinical Innovative Medicine, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiya Katsura
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Kazuo Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Data Science, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Masayuki Yokode
- Department of Clinical Innovative Medicine, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Akira Shimizu
- Department of Experimental Therapeutics, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| |
Collapse
|
6
|
Kojima I, Ninomiya T, Hata J, Fukuhara M, Hirakawa Y, Mukai N, Yoshida D, Kitazono T, Kiyohara Y. A Low Ankle Brachial Index is Associated with an Increased Risk of Cardiovascular Disease: The Hisayama Study. J Atheroscler Thromb 2014; 21:966-73. [DOI: 10.5551/jat.22608] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
7
|
Naghavi N, de Mel A, Alavijeh OS, Cousins BG, Seifalian AM. Nitric oxide donors for cardiovascular implant applications. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2013; 9:22-35. [PMID: 23136136 DOI: 10.1002/smll.201200458] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/13/2012] [Indexed: 06/01/2023]
Abstract
In an era of increased cardiovascular disease burden in the ageing population, there is great demand for devices that come in to contact with the blood such as heart valves, stents, and bypass grafts that offer life saving treatments. Nitric oxide (NO) elution from healthy endothelial tissue that lines the vessels maintains haemostasis throughout the vasculature. Surgical devices that release NO are desirable treatment options and N-diazeniumdiolates and S-nitrosothiols are recognized as preferred donor molecules. There is a keen interest to investigate newer methods by which NO donors can be retained within biomaterials so that their release and kinetic profiles can be optimized. A range of polymeric scaffolds incorporating microparticles and nanomaterials are presenting solutions to current challenges, and have been investigated in a range of clinical applications. This review outlines the application of NO donors for cardiovascular therapy using biomaterials that release NO locally to prevent thrombosis and intimal hyperplasia (IH) and enhance endothelialization in the fabrication of next generation cardiovascular device technology.
Collapse
Affiliation(s)
- Noora Naghavi
- UCL Centre for Nanotechnology & Regenerative Medicine, University College London, UK
| | | | | | | | | |
Collapse
|
8
|
Peña-Cortés R, Sanz-Pastor N, Fernández-Samos R, Alonso-Argüeso G, Ortega-Martín J, Vaquero-Morillo F. Tratamiento de la isquemia crítica de las extremidades inferiores. Cirugía distal y endovascular. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
9
|
Fernández-Samos Gutiérrez R. El modelo angiosoma en la estrategia de revascularización de la isquemia crítica. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
10
|
Rollins K, Coughlin P. Functional Outcomes following Revascularisation for Critical Limb Ischaemia. Eur J Vasc Endovasc Surg 2012; 43:420-5. [DOI: 10.1016/j.ejvs.2012.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/15/2012] [Indexed: 10/14/2022]
|
11
|
Shinozaki N. Effect of Body Position on Skin Perfusion Pressure in Patients With Severe Peripheral Arterial Disease. Circ J 2012; 76:2863-6. [DOI: 10.1253/circj.cj-12-0562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Norihiko Shinozaki
- Department of Cardiology, Tokai University School of Medicine, Isehara; Department of Cardiology, Naganoken Koseiren Shinonoi General Hospital
| |
Collapse
|
12
|
Jaff MR. The Breakthrough Balloon for Critical Limb Ischemia? J Am Coll Cardiol 2011; 58:1110-1. [DOI: 10.1016/j.jacc.2011.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 06/07/2011] [Indexed: 10/17/2022]
|
13
|
Komai H, Obitsu Y, Shigematsu H. Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients. Circ J 2011; 75:2460-4. [DOI: 10.1253/circj.cj-11-0156] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yukio Obitsu
- Department of Vascular Surgery, Tokyo Medical University
| | | |
Collapse
|