Characteristics and clinical outcomes of repeat endovascular therapy after infrapopliteal balloon angioplasty in patients with critical limb ischemia

Kobayashi, Noboru; Hirano, Keisuke; Yamawaki, Masahiro; Araki, Motoharu; Sakai, Tsuyoshi; Sakamoto, Yasunari; Mori, Shinsuke; Tsutsumi, Masahiro; Honda, Yohsuke; Tokuda, Takahiko; Momose, Kazutaka; Shirai, Shinichi; Ito, Yoshiaki

doi:10.1002/ccd.27238

Cited by 21 publications

(13 citation statements)

References 18 publications

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“…To date, no prospective trials have been conducted randomizing patients to open versus endovascular revascularization based on WIfI clinical stage. However, in functional patients with available vein conduit presenting with Stage 4 limbs, open bypass may be more effective and durable than endovascular therapy (32), which has been associated with higher rates of failure of wound healing, the need for repeat revascularization, and limb amputation (33).…”

Section: Recognizing and Treating Peripheral Artery Diseasementioning

confidence: 99%

Diagnosis and Management of Diabetic Foot Complications

et al. 2018

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| At least half of all amputations occur in people with diabetes, most commonly because of an infected diabetic foot ulcer. A thorough understanding of the causes and management of diabetic foot ulceration is essential to reducing lower-extremity amputation risk. This compendium elucidates the pathways leading to foot ulcers and enumerates multiple contributory risk factors. The authors emphasize the importance of appropriate screening and wound classification and explain when patients should be referred for specialist care, targeted education, or therapeutic shoes or insoles. They provide a comprehensive review of treatment approaches, including devices for foot lesion off-loading and aggressive wound debridement through mechanical, enzymatic, autolytic, biologic, and surgical means. Because infection and peripheral artery disease are key contributors to amputation risk, the authors discuss the diagnosis and management of these conditions in detail. They also review the expanding armamentarium of evidence-based adjunctive treatments for foot ulcers, including growth factors, skin substitutes, stem cells, and other biologics. Because Charcot neuroarthropathy is a serious but frequently missed condition in people with diabetic neuropathy, the authors explain the differential diagnosis of the hot, swollen foot that is a hallmark of this condition. The article ends with an overview of four strategies for maintaining a foot in remission, followed by a brief look at the future of diabetic foot care.

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Section: Recognizing and Treating Peripheral Artery Diseasementioning

confidence: 99%

Diagnosis and Management of Diabetic Foot Complications

et al. 2018

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“…22 It has also been shown to correlate closely with wound healing time [23][24][25][26][27] and, most recently, may be useful in stratifying patients into those who would benefit from revascularization (i.e., WIfI stage 3/4) versus those in whom revascularization may not be necessary to achieve wound healing (i.e., WIfI stage 1/2). 28,29 Understanding the risks and benefits of lower extremity revascularization procedures, as well as an individual's prognosis for limb salvage, will allow physicians to engage in more patientcentered care. This approach may ultimately contain costs by focusing resources on patients who have a high likelihood for limb salvage.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis patients have worse outcomes after infrageniculate revascularization procedures

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Kirkland

et al. 2018

Journal of Surgical Research

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“…In practical terms, endovascular revascularization has come to be accepted as the first line strategy in many institutions for diabetic CLTI patients because the typical diffuse below‐the‐knee (BTK) disease makes open distal bypass technically challenging, particularly in the presence of severe calcification. Performing open bypass as the initial revascularization strategy for patients with WIfI clinical stage 4 DFUs, on long‐term dialysis, or with low left ventricular ejection fractions may achieve superior outcomes such as amputation‐free survival and freedom from major amputation, but there are no significant differences in wound healing times . These severe comorbidities together with the lack of distal vessel targets with suitable run‐off often preclude these patients from surgical bypass in actual clinical practice.…”

Section: Revascularization Strategymentioning

confidence: 99%

Treatment of lower limb ischaemia in patients with diabetes

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Tang

Cheng

et al. 2019

Diabetes Metabolism Res

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Diabetic chronic limb‐threatening ischaemia is a challenging clinical problem with patients at high risk of diabetic foot ulceration (DFU) and limb loss. Patients often remain asymptomatic even in the presence of severe pedal ischaemia until first presenting with tissue loss such as DFU or frank gangrene. Limb salvage units should have the facilities and expertise to provide multidisciplinary team‐based holistic care through best medical therapy, rapid diagnosis, prompt revascularisation with endovascular or open surgical techniques and expert wound management. Endovascular revascularisation has become the first line strategy in contemporary clinical practice because of similar outcomes in wound healing and amputation rates in most patients when compared with open surgery. The primary goal is restoration of pulsatile in‐line blood flow to the ankle or foot, with an angiosome‐directed approach possibly achieving superior outcomes especially in diabetics with poor collaterals. A comprehensive overview of conventional endovascular techniques (such as antegrade true lumen and subintimal approaches), advanced techniques for complex disease (such as retrograde subintimal and pedal‐plantar loop approaches or even deep venous arterialisation) and the various treatment options are described. Diabetic limb salvage rates can be excellent with suitable multidisciplinary expertise and care.

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Characteristics and clinical outcomes of repeat endovascular therapy after infrapopliteal balloon angioplasty in patients with critical limb ischemia

Abstract: The clinical outcomes of CLI patients requiring repeat EVT three or more times were poor. The SVS WIfI clinical stage may be useful to predict the necessity of repeat EVT.

Cited by 21 publications

References 18 publications

Diagnosis and Management of Diabetic Foot Complications

Diagnosis and Management of Diabetic Foot Complications

Hemodialysis patients have worse outcomes after infrageniculate revascularization procedures

Treatment of lower limb ischaemia in patients with diabetes

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