A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia

Almasri, Jehad; Adusumalli, Jayanth; Asi, Noor; Lakis, Sumaya; Alsawas, Mouaz; Prokop, Larry J.; Bradbury, Andrew W.; Kolh, Philippe; Conte, Michael S.; Murad, M. Hassan

doi:10.1016/j.jvs.2018.01.066

Cited by 156 publications

(47 citation statements)

References 15 publications

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“…Generally, CLTI patients present with more complex patterns of PAD, so the probability of a durable outcome with endovascular recanalization is less compared to bypass but many providers subscribe to an 'endo first' approach [40][41][42]. For subjects undergoing infrainguinal arterial bypass, use of single-segment ipsilateral saphenous vein and clinical stage of the CLTI presentation are the most important determinants of limb salvage [43,44]. Clinical success is highlighted by freedom from major adverse limb events, such as unplanned re-intervention, thrombosis free graft function, and/or major limb amputation.…”

Section: Pathogenesis Diagnosis and Treatment Of Padmentioning

confidence: 99%

Skeletal Muscle Mitochondrial Dysfunction and Oxidative Stress in Peripheral Arterial Disease: A Unifying Mechanism and Therapeutic Target

et al. 2020

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Peripheral artery disease (PAD) is caused by atherosclerosis in the lower extremities, which leads to a spectrum of life-altering symptomatology, including claudication, ischemic rest pain, and gangrene requiring limb amputation. Current treatments for PAD are focused primarily on re-establishing blood flow to the ischemic tissue, implying that blood flow is the decisive factor that determines whether or not the tissue survives. Unfortunately, failure rates of endovascular and revascularization procedures remain unacceptably high and numerous cell- and gene-based vascular therapies have failed to demonstrate efficacy in clinical trials. The low success of vascular-focused therapies implies that non-vascular tissues, such as skeletal muscle and oxidative stress, may substantially contribute to PAD pathobiology. Clues toward the importance of skeletal muscle in PAD pathobiology stem from clinical observations that muscle function is a strong predictor of mortality. Mitochondrial impairments in muscle have been documented in PAD patients, although its potential role in clinical pathology is incompletely understood. In this review, we discuss the underlying mechanisms causing mitochondrial dysfunction in ischemic skeletal muscle, including causal evidence in rodent studies, and highlight emerging mitochondrial-targeted therapies that have potential to improve PAD outcomes. Particularly, we will analyze literature data on reactive oxygen species production and potential counteracting endogenous and exogenous antioxidants.

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Section: Pathogenesis Diagnosis and Treatment Of Padmentioning

confidence: 99%

Skeletal Muscle Mitochondrial Dysfunction and Oxidative Stress in Peripheral Arterial Disease: A Unifying Mechanism and Therapeutic Target

et al. 2020

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“…The success of these electrospun polymer tubular grafts would offer a valuable resource for treating coronary artery diseases and peripheral vascular disease, which very commonly require the transplant of native damaged blood vessel. The currently available options for blood vessel transplant are numerous (allografts, autologous grafts, xenografts, artificial prostheses, or inert vascular graft) and they were successfully applied to replace large diameter blood vessels; nevertheless, they usually fail when used for replacing small diameter blood vessels as reported in the literature and the scientific research running in this field [1][2][3][4][5][6][7][8][9][10][11][12]. Moreover, infections arising after surgery are a frequent problem that need to be faced as they are becoming a severe problem, as well as the problem of antibiotic resistance [13].…”

Section: Introductionmentioning

confidence: 99%

Tubular Electrospun Vancomycin-Loaded Vascular Grafts: Formulation Study and Physicochemical Characterization

et al. 2021

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This work aimed at formulating tubular grafts electrospun with a size < 6 mm and incorporating vancomycin as an antimicrobial agent. Compared to other papers, the present study succeeded in using medical healthcare-grade polymers and solvents permitted by ICH Topic Q3C (R4). Vancomycin (VMC) was incorporated into polyester synthetic polymers (poly-L-lactide-co-poly-ε-caprolactone and poly lactide-co-glycolide) using permitted solvents; moreover, a surfactant was added to the formulation in order to avoid the precipitation of VMC on fiber surface. A preliminary preformulation study was carried out to evaluate solubility of VMC in different aqueous and organic solvents and its stability. To reduce size of fibers and their orientation, we studied a solvent system based on methylene chloride and acetone (DCM/acetone), at different ratios (80:20, 70:30, and 60:40). Considering conductivity of solutions and their spinnability, solvent system at a 80:20 ratio was selected for the study. SEM images demonstrated that size of fibers, their distribution, and their orientation were affected by the incorporation of VMC and surfactant into polymer solution. Surfactant allowed for the reduction of precipitates of VMC on fiber surface, which are responsible of the high burst release in the first six hours; the release was mainly dependent on graft structure porosity, number of pores, and graft absorbent capability. A controlled release of VMC was achieved, covering a period from 96 to 168 h as a function of composition and structure; the concentration of VMC was significantly beyond VMC minimum inhibitory concentration (MIC, 2 ug/mL). These results indicated that the VMC tubular electrospun grafts not only controlled the local release of VMC, but also avoided onset of antibiotic resistance.

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“…Lower extremity peripheral artery disease ranks third place among atherosclerotic cardiovascular morbidity, right after coronary events and stroke [1]. For example, 202 million people were affected with peripheral artery diseases in 2010 [2]. The disease prevalence shows the range of 3 % to 10 %, increasing to 15 % to 20 % in people over 70 years old [3].…”

Section: Introductionmentioning

confidence: 99%

“…The 5-year mortality rate for these individuals is higher than those of ones with cardiovascular or cerebrovascular disease [8,9]. From 1 % to 2 % of persons with atherosclerotic lesions of lower extremities suffer from critical limb ischemia (CLI) as the most severe form of the peripheral arterial disease [2,10]. The main reason for difficult CLI is multilevel peripheral arterial lesions [11].…”

Section: Introductionmentioning

confidence: 99%

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Endovascular interventions in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries

Shaprynskyі¹,

Suleimanova²

2021

Eureka: HS

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Peripheral artery diseases are a worldwide medical and social problem. Approximately 30 % of patients with critical limb ischemia will undergo amputations and 25 % will die after 1 year. These patients require reconstructive and angioplastic interventions to preserve the limb. The aim of the study is to compare the effectiveness of different endovascular surgical technologies in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries. Materials and methods. Among 243 endovascular interventions, 51 patients were presented with multilevel steno-occlusive lesions of the infrarenal aortic arteries as a result of atherosclerosis obliterans. 42 patients (82.4 %) had two-level lesions and 9 (17.6 %) had three-level lesions. Results. Among 42 patients with a two-level lesion, 29 (56.9 %) ones had femoral arterial segment affection in combination with tibial artery affection. 13 (25.5 %) patients suffered from the lesion of the iliac segment in combination with the affection of the femoral segment arteries. In 9 (17.6 %) patients the lesions of three or more levels were determined: an iliac segment in combination with femoral and popliteal arteries – in 4 patients, and in 2 patients there were lesions of the femoral, popliteal and tibial segments, in 3 patients there was a lesion of the iliac, femoral, popliteal and tibial-foot segments in different degrees of severity. 7 balloon angioplasties and 13 stenting procedures were performed in two and three-level lesions in which the iliac arterial segment was affected. Only balloon angioplasty was used to revascularize the infraingvinal arterial segments. In the early postoperative period, the complications included thrombosis appeared in 6 patients. It was possible to restore the blood flow and save the limb only in 3 persons. For the other 3 ones, the attempts to restore the patency of the arteries were unsuccessful and resulted in the amputation of the lower extremity. Mortality in the early postoperative period was 3.9 % (2 death due to myocardial infarction). Conclusions. The persons with multilevel steno-obstructive lesions of the infrarenal aortic arteries are the most difficult category of patients with CLI. The surgical method of choice for patients with multilevel steno-occlusive lesions is the endovascular angioplasty with or without stenting.

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A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia

Cited by 156 publications

References 15 publications

Skeletal Muscle Mitochondrial Dysfunction and Oxidative Stress in Peripheral Arterial Disease: A Unifying Mechanism and Therapeutic Target

Skeletal Muscle Mitochondrial Dysfunction and Oxidative Stress in Peripheral Arterial Disease: A Unifying Mechanism and Therapeutic Target

Tubular Electrospun Vancomycin-Loaded Vascular Grafts: Formulation Study and Physicochemical Characterization

Endovascular interventions in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries

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