Amputation for occusive arterial disease

Eneroth, Magnus; Persson, Björn M.

doi:10.1007/bf00189624

Cited by 41 publications

(2 citation statements)

References 19 publications

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“…Once systemic pathology has been managed or ruled out, peripheral edema is most often treated with graduated compression therapy [12–14]. However, patients with diabetes have a 2–5 times greater risk for developing peripheral arterial disease (PAD) [15–17] as compared to those without diabetes, and compression therapy has long been considered risky practice in patients with diabetes because of the fear of compromising vascularity [18, 19]. As a result, foot elevation as opposed to graduated compression has generally been recommended to reduce lower extremity edema, and the diabetic socks currently advocated by healthcare professionals offer either no compression or minimal compression, no greater than 8–15mmHg, to preemptively guard against exacerbating symptoms of lower extremity PAD.…”

Section: Introductionmentioning

confidence: 99%

Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks

Crews

Skratsky

et al. 2017

Diabetes Research and Clinical Practice

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Aims Persons with diabetes frequently present with lower extremity (LE) edema; however, compression therapy is generally avoided for fear of compromising arterial circulation in a population with a high prevalence of peripheral arterial disease. This double blind randomized controlled trial (RCT) assessed whether diabetic socks with mild compression could reduce LE edema in patients with diabetes without negatively impacting vascularity. Methods Eighty subjects with LE edema and diabetes were randomized to receive either mild-compression knee high diabetic socks (18–25mmHg) or non-compression knee high diabetic socks. Subjects were instructed to wear the socks during all waking hours. Follow-up visits occurred weekly for four consecutive weeks. Edema was quantified through midfoot, ankle, and calf circumferences and cutaneous fluid measurements. Vascular status was tracked via ankle brachial index (ABI), toe brachial index (TBI), and skin perfusion pressure (SPP). Results Seventy-seven subjects (39 controls and 38 mild-compression subjects) successfully completed the study. No statistical differences between the two groups in terms of age, body mass index, gender, and ethnicity. Repeated measures analysis of variance and Sidak corrections for multiple comparisons were used for data analyses. Subjects randomized to mild-compression diabetic socks demonstrated significant decreases in calf and ankle circumferences at the end of treatment as compared to baseline. LE circulation did not diminish throughout the study with no significant decreases in ABI, TBI or SPP for either group. Conclusions Results of this RCT suggest that mild compression diabetic sock may be effectively and safely used in patients with diabetes and LE edema.

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Section: Introductionmentioning

confidence: 99%

Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks

Crews

Skratsky

et al. 2017

Diabetes Research and Clinical Practice

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“…Amputation is often recommended at this end-stage of limb ischemia. 2,3 The development of new vessels and subsequent restoration of perfusion in the affected limb via augmentation of the patient's native vasculature is one of the goals of peripheral arterial disease research. Angiogenesis is defined as an extension of primitive vasculature through sprouting of new capillaries from an existing network, and arteriogenesis is defined as development of a preexisting arterial connection into true vessels.…”

Section: Introductionmentioning

confidence: 99%

Effect of Electrical Stimulation on Arteriogenesis and Angiogenesis after Bilateral Femoral Artery Excision in the Rabbit Hind-Limb Ischemia Model

Sheikh¹,

Tchekanov²,

Krum³

et al. 2005

Vasc Endovascular Surg

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The effects of electrical stimulation (ES) on arteriogenesis (the opening of preexisting collaterals) and angiogenesis (formation of new capillaries) were studied after acute bilateral hind limb ischemia was induced via bilateral femoral artery excision in a rabbit model. The study evaluated the rabbit hind limbs' normal response to acute ischemia and to application of ES by calculating changes in arterial and capillary densities. Comparisons were made with our prior study, in which the femoral artery was unilaterally excised, as we attempted to expand on the topics of arteriogenesis and angiogenesis. Twelve adult New Zealand white rabbits were randomly assigned to 1 of 2 series. In Series 1, the control group, both femoral arteries were excised and no ES was applied. In Series 2, both femoral arteries were excised and ES was applied to the left limb. One lead was implanted into the left adductor muscle near the site of the excised left femoral artery (Series 2), and a stimulator (Thera, Medtronic, Inc, Minneapolis, MN) was implanted in a separate pocket. ES was applied at a rate of 3 V, 30 contractions per minute, beginning immediately after surgery and continuously for 1 month. Angiography was performed in all 12 rabbits 1 month after surgery to establish the anatomy of the collateral vessels and to demonstrate that the femoral artery stump continued to be an end artery. Contrast-opacified arteries (COAs) that crossed the grid's midline, and the total number of grid lines intersected by COAs, were tallied according to an established method. Capillary density was calculated as the number of capillaries per square millimeter of muscle. In Series 1, after 1 month, the number of COAs crossing the grid's midline was 4.5 +/-1.5 on the left and 4.8 +/-1.2 on the right side. In Series 2, the number of COAs crossing the grid's midline was 7.9 +/-1.8 on the left side (p<0.05 vs Series 1) and 5.9 +/-1.6 on the right side of the same rabbit (p=NS vs Series 1). In Series 1, 36.7 +/-5.4 and 30.5 +/-7.7 total intersections were crossed by COAs on the left and right sides, respectively. In Series 2, total grid intersections crossed by COAs were 48.4 +/-8.5 and 47.5 +/-9.1 in the left and right sides, respectively (p<0.001 vs series 1). Baseline capillary density before femoral artery excision was 180.2 +/-21.3/mm(2). The capillary densities on the left sides were 94.2 +/-19.1 and 264.5 +/-7.6 in Series 1 and 2, respectively (p<0.001). The right sides showed a similar pattern with capillary densities of 88.5 +/-37.2 and 135.8 +/-6.8 (p<0.05) in Series 1 and 2, respectively. When capillary density was compared on the left and right sides of the same rabbit in Series 2, a statistically significant increase was also found; 264.5 +/-7.6 vs 135.8 +/-6.8 (p<0.001) in the left and right sides, respectively. Comparisons of the effect of electrical stimulation and the body's normal physiologic response to acute ischemia revealed a significant increase in the opening of preexisting collaterals (arteriogenesis) and the promotion of capill...

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Gene Therapy for Angiogenesis in the Treatment of Cardiovascular and Peripheral Arterial Disease

Shah

Lotun

Losordo

Contemporary Cardiology

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Amputation for occusive arterial disease

Cited by 41 publications

References 19 publications

Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks

Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks

Effect of Electrical Stimulation on Arteriogenesis and Angiogenesis after Bilateral Femoral Artery Excision in the Rabbit Hind-Limb Ischemia Model

Gene Therapy for Angiogenesis in the Treatment of Cardiovascular and Peripheral Arterial Disease

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