Current assessment of endovascular therapy for infrainguinal arterial occlusive disease in patients with diabetes

Ihnat, Daniel M.; Mills, Joseph L.

doi:10.1016/j.jvs.2010.06.014

Cited by 28 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As emphasized earlier, extended calcifications in long segment chronic occlusions or tight stenoses are commonly encountered during angiosome-targeted revascularization. Following local learning curves and evolving skills, our initially observed global technical failure rate of 20%17 seems to match similar critical limb ischemia angioplasty feasibility reports, ranging from 69%–85% for occlusions and 77%–95% for severe stenoses 3–7,30,31. In an attempt to address these technical limitations, we have favored antegrade approaches, long (50–70 cm) sheaths reinforced by stiff catheters (Lumax/Cook, UK or 5-French Pier, Cordis, New York, NY) and a stiff shaft with 0.018 in over-a-wire balloons (ReeKross, Clear Stream Technologies Ltd, Wexford, Ireland).…”

Section: Limitations and Challenges Of Angiosome-based Strategiessupporting

confidence: 80%

Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?

Alexandrescu¹,

Hubermont²

2011

DMSO

View full text Add to dashboard Cite

The angiosome principle was first described by Jan Taylor in 1987 in the plastic reconstructive surgery field, providing useful information on the vascular anatomy of the human body. Specifically concerning foot and ankle pathology, it may help the clinician to select better vascular access and specific strategies for revascularization. This knowledge may be particularly beneficial when treating diabetic neuroischemic foot wounds associated with particularly aggressive atherosclerotic disease and a poor collateral circulation. The implementation of angiosome-based strategies in diabetic infragenicular vascular reconstruction may afford encouraging wound healing and limb preservation rates using both bypass and endovascular techniques. The minimal invasiveness of these novel strategies enables us to perform more specific and more distal tibial and/or foot arterial reconstructions, in one or multiple targeted vessels. This paper reviews the available literature on this revascularization strategy and focuses on the potential benefit of angiosome-guided primary angioplasty for diabetic ischemic foot ulcers.

show abstract

Section: Limitations and Challenges Of Angiosome-based Strategiessupporting

confidence: 80%

Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?

Alexandrescu¹,

Hubermont²

2011

DMSO

View full text Add to dashboard Cite

show abstract

“…Diyabet dışındaki PAH'ta oklüzyona karşı kollateral gelişimi ortaya çıkarken, diyabetik olgularda kollateralizasyon sisteminde de bozukluklar vardır (87). Diyabetik aterosklerotik makroanjiyopati tipik olarak tibial turunkusu ve infrageniküler bölgeyi tutar; media tabakasında, konsantrik ve genel olarak sürekli kalsifikasyonla nitelenir.…”

Section: Soru 1: Diyabetik Ayak İnfeksiyonu Ve Periferik Arter Hastalunclassified

“…Primer PTA, baldır arterlerinin rekanalizasyonunu sağlamak için birden fazla uygulamaya izin vermesi nedeniyle ek bir üstünlük sağlar. Ancak DA yarası olan olgularda kalp debisinin azalmış olması, kollateral ağın bozulması ya da yok olması, tüm arteriyel rekonstrüksiyon tipleri için risk oluşturur (87,99). DA yarası ve PAH olan olguların %16'sında lezyonlar tamamen kalsifiye olmuştur ve endovasküler girişim uygun değildir (107-109).…”

Section: Soru 9: Diyabetik Ayak Yarası Olan Olgularda Endovasküler Giunclassified

Diagnosis, Treatment and Prevention of Diabetic Foot Wounds and Infections: Turkish Consensus Report

Saltoğlu¹,

Kılıçoğlu²,

Baktiroğlu³

et al. 2016

Klimik Dergisi

View full text Add to dashboard Cite

Study Group for Diabetic Foot Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist societies and the Ministry of Health to issue a national consensus report on the diagnosis, treatment and prevention of diabetic foot (DF) wounds and diabetic foot infections (DFIs) in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions as to pathogenesis, microbiology, assessment and grading, treatment, prevention and control of diabetic foot were identified. Upon reviewing related literature and international guidelines, these questions were provided

show abstract

“…Clinical studies are limited by the heterogeneity of disease, lack of randomized trials, multiplicity of techniques used, exclusion of early treatment failures, and crossover to open bypass during follow-up [17,18].…”

Section: Percutaneous Transluminal Angioplastymentioning

confidence: 99%

SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use

Gray

Díaz‐Sandoval

Dieter

et al. 2014

Cathet Cardio Intervent

View full text Add to dashboard Cite

Intervention to treat infrapopliteal arterial disease can be challenging because the patients' comorbidities, the anatomic variables, and the limitations of our techniques. Clinical scenarios based on anatomic and clinical variables are presented. Recommendations regarding intervention (appropriate care, may be appropriate care, rarely appropriate care) are made based on best evidence. V C 2014 Wiley Periodicals, Inc.Key words: peripheral intervention; appropriate use; peripheral arterial disease INTRODUCTION Infrapopliteal (IP) arterial disease or "below the knee" arterial disease is commonly seen in patients with long-standing diabetes mellitus, chronic kidney disease, or the elderly. The most concerning manifestation of peripheral arterial disease (PAD) in these high risk patients is the development of critical limb ischemia (CLI: ischemic rest pain or ischemic ulcers). This arterial bed consists of relatively small caliber vessels, which are often calcified and associated with diffuse, multilevel disease. Due to the complexity of this patient population, their co-morbidities, and severity of vascular disease, there is a paucity of scientific evidence for the generalizability of percutaneous revascularization.In general, non-ambulatory patients with a short life expectancy and extensive necrosis or gangrene should undergo primary amputation. Ambulatory patients who are acceptable surgical candidates, expected to survive more than two years with a patent IP artery that provides direct flow to the foot (considered to be a good distal target), and an adequate autologous venous conduit should be considered for surgical bypass. Patients with significant medical co-morbidities that limit life expectancy, those at increased risk for surgery, those without an adequate distal target for bypass, or with poor venous conduit should be considered for an endovascular-first approach.This document was developed to guide physicians in clinical decision-making in the modern practical application of endovascular intervention for patients with IP arterial disease. ANATOMIC CONSIDERATIONSPatients with CLI typically have disease involving multiple levels (i.e., aorto-iliac, femoropopliteal (FP) and IP), but less than 10% of patients with CLI have hemodynamically significant disease in all three levels [1][2][3] (Table I). Infrainguinal disease (FP and IP) can be further subdivided into those with predominantly isolated IP disease ( 33%) and those with both FP and IP disease ( 67%) [4][5][6][7].Additional Supporting Information may be found in the online version of this article. Catheterization and Cardiovascular Interventions 84:539-545 (2014) Isolated IP disease is mainly seen in the elderly (>80-years old), diabetic, or dialysis-dependent patients [5]. These patients are at higher risk for amputation and have a shorter amputation-free survival compared to those with FP and IP disease (median amputation-free survival: 17 months (95% CI ¼ 9-24 m) versus 37 months (95% CI ¼ 28-44 m), P ¼ 0.001) [6]. Clinical and non-invasive cr...

show abstract

Current assessment of endovascular therapy for infrainguinal arterial occlusive disease in patients with diabetes

Cited by 28 publications

References 36 publications

Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?

Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?

Diagnosis, Treatment and Prevention of Diabetic Foot Wounds and Infections: Turkish Consensus Report

SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use

Contact Info

Product

Resources

About