Evaluation of paramalleolar and inframalleolar bypasses in dialysis- and nondialysis-dependent patients with critical limb ischemia

Kikuchi, Shinsuke; Sasajima, Tadahiro; Inaba, Masashi; Uchida, Daiki; Kokubo, Taku; Saito, Yukihiro; Koya, Atsuhiro; Uchida, Hisashi; Azuma, Nobuyoshi

doi:10.1016/j.jvs.2017.07.116

Cited by 18 publications

(6 citation statements)

References 40 publications

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“…The cumulative patency rate at 1 year was 74.4%, as reported by Holzenbein et al 10) The single vein graft had lower incidence of graft failure compared to spliced vein graft in a series of patients who underwent distal bypass surgery. 6) Less size mismatch confirmed that the large basilic vein matched with the femoral artery and the smaller cephalic vein matched with the PTA (Figs. 2E-F).…”

Section: Discussionmentioning

confidence: 67%

“…5) However, patients with CLTI are susceptible to physical stress due to multiple comorbidities, such as diabetes mellitus (DM), end-stage renal disease (ESRD), reduced heart function, and malnutrition. 6) Bypass surgery under lower extremity peripheral nerve blockades (PNB) is a novel technique that reduces stressfulness as it uses only local anesthesia without administrating general anesthesia (GA). 7) Herein, we present distal bypass grafting under PNB using the basilic-cephalic loop vein due to the limited availability of the saphenous veins for treatment of CLTI in a patient with severely deteriorated heart function and ESRD on regular dialysis.…”

Section: Introductionmentioning

confidence: 99%

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Distal Bypass Grafting Using the Basilic–Cephalic Loop Vein for Chronic Limb-Threatening Ischemia under Peripheral Nerve Blockades in a Patient with Severely-Reduced Heart Function and End-Stage Renal Disease

Tada

Kikuchi

Okuda

et al. 2019

Annals of Vascular Diseases

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A 51-year-old man with severe comorbidities required redo revascularization due to left chronic limb-threatening ischemia caused by a previous vein graft occlusion. The saphenous veins were not available due to previous surgeries. Femoro-posterior tibial artery bypass surgery was successfully performed using the basilic-cephalic loop vein under peripheral nerve blockades. This anesthesia allowed a series of surgical revascularizations without general anesthesia, and the postoperative courses were uneventful. The patient survived for 4 years with ambulatory status. In conclusion, loop graft can be an alternative single vein material for distal bypass when no saphenous veins are available.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Distal Bypass Grafting Using the Basilic–Cephalic Loop Vein for Chronic Limb-Threatening Ischemia under Peripheral Nerve Blockades in a Patient with Severely-Reduced Heart Function and End-Stage Renal Disease

Tada

Kikuchi

Okuda

et al. 2019

Annals of Vascular Diseases

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“…Chronic limb-threatening ischemia (CLTI), which is a clinical syndrome defined by the presence of PAD in combination with pain at rest, gangrene, or a lower limb ulceration >2 weeks duration, is one of the most advanced states of PAD and is associated with mortality, amputation, and impaired quality of life ( 2 ). The prognosis of patients with CLTI is poor as evidenced by the 2-year survival rate of only 60%–65% after CLTI onset; one of the most significant prognostic factors of CLTI is heart failure ( 3 , 4 ). Similarly, previous studies have reported that cardiac disease, especially coronary artery disease (CAD), which is complicated with CLTI at a rate of 40%–50%, is an independent predictive factor for poor prognosis ( 5 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Chronic Limb-Threatening Ischemia on Cardiac Surgery

et al. 2022

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PurposeThe effect of chronic limb threatening ischemia (CLTI) on advanced cardiac disease, which requires surgical treatment, has rarely been reported. The purpose of this study was to review the outcomes of cardiac surgery in patients with CLTI and determine the risk factors, with a particular focus on the severity of CLTI.PatientsThe baseline characteristics and outcomes of 33 patients who were treated for CLTI and underwent cardiac surgery were retrospectively analyzed. The states of CLTI were evaluated based on the Wound, Ischemia, and foot Infection (WIfI) classification system, and 33 patients were divided into the low-WIfI group (stages 1–2, n = 13) and high-WIfI group (stages 3–4, n = 20).ResultsThe in-hospital mortality rate was 0% in low-WIfI group and 35% in high-WIfI group (p = 0.027). Postoperative complications, particularly severe infections, occurred more frequently among high-WIfI group than low-WIfI group (70.0% vs. 23.1%, p < 0.01). Multivariable analysis identified foot infection grade as a WIfI classification factor and lower albumin levels as factors significantly associated with postoperative complications. The 1-year and 2-year survival rates were 84.6% and 67.7% in low-WIfI group and 45% and 28.1% in high-WIfI group, respectively (p = 0.011).ConclusionsCardiac surgery in patients with high WIfI stage was an extremely high-risk procedure. In such patients, lowering the WIfI stage by lower extremity revascularization and/or debridement of diseased parts prior to cardiac surgery can be considered.

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“…[3][4][5] Revascularization, either via endovascular therapy (EVT) or surgical revascularization, is an essential technique to improve the ischemic symptoms with PAD, including intermittent claudication, rest pain, and gangrene. [6][7][8][9] Revascularization is particularly needed for critical limb ischemia (CLI) to improve foot blood flow for limb salvage. However, no device exists that can capture dynamic blood flow changes during revascularization, which demonstrates the need to develop new methods that can be easily and quickly implemented to accurately assess the effect of revascularization.…”

Section: Introductionmentioning

confidence: 99%

Laser speckle flowgraphy can also be used to show dynamic changes in the blood flow of the skin of the foot after surgical revascularization

et al. 2018

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Objectives Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization. Materials and methods A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure. The laser speckle flowgraphy device was used to visualize the blood flow distribution of the target skin and processed the pulse wave velocity of synchronized heart beats. The mean blood flow, which was expressed as the area of the pulse wave as the beat strength of skin perfusion on laser speckle flowgraphy converted into a numerical value, was assessed as dynamic changes following surgery. Beat strength of skin perfusion was also investigated in non-peripheral arterial disease controls (23 patients/46 limbs). Results The suitability of beat strength of skin perfusion in non-peripheral arterial disease controls was achieved; the beat strength of skin perfusion value was significantly higher in every area of interest in non-peripheral arterial disease controls compared to that in peripheral arterial disease limbs at the preoperative stage (105.8 ± 8.2 vs. 26.3 ± 8.2; P < 0.01). Although the pulse wave before surgery was visually flat in peripheral arterial disease patients, the pulse wave was remarkably and immediately improved through surgical revascularization. Beat strength of skin perfusion showed a dynamic change in foot blood flow (26.3 ± 8.2 at preoperation, 98.5 ± 6.7 immediately after surgery, 107.6 ± 5.7 at seven days after surgery, P < 0.01 for each compared to preoperation) that correlated with an improvement in skin perfusion pressure. Conclusions Laser speckle flowgraphy is a noninvasive, contact-free modality that is easy to implement, and beat strength of skin perfusion is a useful indicator of foot circulation during the perioperative period. Further analysis with a larger number of cases is necessary to establish appropriate clinical use.

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Evaluation of paramalleolar and inframalleolar bypasses in dialysis- and nondialysis-dependent patients with critical limb ischemia

Cited by 18 publications

References 40 publications

Distal Bypass Grafting Using the Basilic–Cephalic Loop Vein for Chronic Limb-Threatening Ischemia under Peripheral Nerve Blockades in a Patient with Severely-Reduced Heart Function and End-Stage Renal Disease

Distal Bypass Grafting Using the Basilic–Cephalic Loop Vein for Chronic Limb-Threatening Ischemia under Peripheral Nerve Blockades in a Patient with Severely-Reduced Heart Function and End-Stage Renal Disease

The Impact of Chronic Limb-Threatening Ischemia on Cardiac Surgery

Laser speckle flowgraphy can also be used to show dynamic changes in the blood flow of the skin of the foot after surgical revascularization

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