Analysis of the Elective Treatment Process for Critical Limb Ischaemia with Tissue Loss: Diabetic Patients Require Rapid Revascularisation

Abstract

Objective: To evaluate treatment outcomes of in situ abdominal aortic reconstruction with cryopreserved arterial allograft (CAA) for patients with abdominal aortic infection.Materials and methods: A retrospective review of prospectively collected data was conducted of patients who underwent in situ aortic reconstruction using CAA for primary, secondary, or prosthetic infection of the abdominal aorta between May 2006 and July 2015, at a single institution. Clinical presentation, indications for treatment, procedural details, early post-operative mortality and morbidity, late death, and graft related complications during the follow up period were investigated. Patient survival and event free survival (any death or re-operation) were calculated using the Kaplan-Meier method.Results: Twenty-five patients (male, n = 20, 80%; mean age, 70.2 6 8.7 years) underwent in situ abdominal aortic reconstruction (48% aortic, 52% aorto-bi-iliac) with vessel size and ABO matched CAA for treatment of abdominal aortic infection caused by infected abdominal aortic aneurysm (n = 15), aortic prosthesis infection (n = 7), aortic reconstruction with concomitant colon resection (n = 2), and primary suppurative aortitis (n = 1). The median follow up was 19.1 months (range 1-73 months). There were seven post-operative deaths including two (8%) early (<30 days) and five (20%) late deaths There were three (12%) graft related complications including thrombotic occlusion of the CAA, aneurysmal dilatation, and aorto-enteric fistula. Three years after CAA implantation, patient survival was 74% and the event free survival was 58%.Conclusions: It is believed that in situ abdominal aortic reconstruction with CAA is a useful option for treating primary, secondary, or prosthetic infection of the abdominal aorta.

Barriers to foot care in patients with diabetes as identified by healthcare professionals

“…A shorter time to revascularization and less tissue destruction increases the probability of healing of ischaemic foot ulcers . Also, when the delay between specialist assessment to revascularization exceeded 2 weeks, limb salvage was significantly poorer in people with diabetes compared to people without diabetes .…”

How to use clinical signs and symptoms to estimate the probability of limb ischaemia in patients with a diabetic foot ulcer

“…It has been shown that healing progress over the first 4 weeks of treatment significantly predicts healing at 12 weeks among patients with diabetic foot ulcer enrolled in a wound dressing clinical trial . When a vascular consultation is requested, though, it has been shown that limb salvage was less successful in diabetic patients if delayed for more than 2 weeks beyond the first vascular assessment visit …”

Angiosome Targeted PTA is More Important in Endovascular Revascularisation than in Surgical Revascularisation: Analysis of 545 Patients with Ischaemic Tissue Lesions

“…Such a delay, especially in diabetic patients, may lead to poorer leg salvage rates. 26 Therefore, in cases of long infrapopliteal occlusion, the policy at the study clinic is changing to opt for surgical bypass first. This strategy is supported by the present results, showing that, especially in patients with several affected angiosomes and elevated C-reactive protein levels, it seems to be significantly better to perform bypass as a first line treatment and skip the indirect angioplasty.…”