Evaluation of Perfusion Index as a Screening Tool for Developing Critical Limb Ischemia

Yamamoto, Noriaki; Sakashita, Hideaki; Miyama, Noriyuki; Takai, Kanako; Komai, Hiroyoshi

doi:10.3400/avd.oa.21-00100

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…Recently, we have developed a new technique to diagnose ischemia of the lower limbs that can be performed easily as a bedside examination using percutaneous oxygen saturation measurement. 16) In any case, when foot lesions are detected in patients with diabetes, the presence or absence of ischemia, i.e. the presence or absence of ASO, should be diagnosed before simply performing debridement.…”

Section: Diagnosis Of Aso In Patients With Diabetesmentioning

confidence: 99%

Vascular Disease and Diabetes

Komai

2024

Annals of Vascular Diseases

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by vascular surgeons, although strictly speaking, this is not a vascular disease. This paper provides a commentary about arteriosclerosis obliterans (ASO), which is a typical vascular disease of the lower limbs, and makes reference to diabetic foot as a condition to differentiate from ASO. Diabetes and Foot LesionsFoot lesions caused by diabetes are broadly divided into two types. One type is diabetic foot, which characterized by foot ulcers and necrosis caused by neuropathy and foot deformity but is not necessarily accompanied by impaired blood flow. The other type includes ulcers and necrosis associated with impaired blood flow caused by reduced blood supply in the lower limbs due to diabetes-induced arteriosclerosis. Even in developed countries, the annual incidence of foot lesions caused by diabetes is approximately 2%, and approximately 1% of patients with diabetes undergo lower extremity amputation.2) The treatment approaches for neurogenic and ischemic lesions are completely different, and it is thus important to differentiate between the two; however, in recent years, it has been found that many lesions are neuroischemic, i.e., concurrently neurogenic and ischemic. The 2017 revised version of European guidelines of peripheral arterial disease (PAD) and the Global Vascular Guidelines (GVG), which are global guidelines for severe ischemia, have been created on the premise that there are more patients requiring revascularization than before. Diabetes and ASOIn the case of diabetes, hyperglycemia leads to an increase in advanced glycation end-products (AGEs) and promotes oxidative stress and inflammation, which cause vascular damages, including ASO. 3) Furthermore, diabetes is associated with thrombogenic tendency, and it has also been reported that the abovementioned AGEs, C-reactive protein, and oxidated low-density lipoproteins facilitate intimal plaque rupture by producing matrix metalloproteinase-9. All of these promote arteriosclerosis progression; therefore, the incidence of ASO is approximately 2-4-fold higher, 4) and the incidence of ulcers caused by severe ischemia is also approximately 4-fold greater in patients with type 2 diabetes than that in nondiabetic patients. 5) Moreover, theThe most important vascular lesion associated with diabetes is arteriosclerosis obliterans (ASO). Differential diagnosis from diabetic foot lesions that produce neurogenic ulcers is important, and the presence of ischemia must be diagnosed as soon as possible. It has been reported that diabetes makes ASO more severe and often leads to lower extremity amputation. In addition to the need for appropriate early control of diabetes, vascular surgeons are required to perform immediate revascularization in cases of ulcer and necrosis, and to aggressively use surgical treatment with good longterm prognosis. (This is a translation of Jpn

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Section: Diagnosis Of Aso In Patients With Diabetesmentioning

confidence: 99%

Vascular Disease and Diabetes

Komai

2024

Annals of Vascular Diseases

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Prediction of wound complications after major amputation for patients with critical limb ischemia

El-Sayed El-Imam

2022

Journal of the Arab Society for Medical Research

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Background/aim Management of patients with critical limb ischemia from peripheral vascular disease is still a big issue for vascular and endovascular surgeons. For patients who are not candidates for revascularization, 20–40% will undergo major amputation within 6–12 months. Mortality following major amputation of the lower extremity in these patients has been high. This study aims at identifying important factors that lead to wound complications following major amputation in patients with end-stage critical ischemia. Patients and methods This study enrolled 120 in patients who underwent major lower extremity amputations affected by critical limb ischemia, since January 2017 and till March 2020, in the Vascular Surgery Departments at Al-Azhar University Hospitals, Cairo, Egypt. A total of 67 patients underwent transfemoral above-knee amputations (AKA) and 53 underwent transtibial below-knee amputations (BKA). The follow-up was done at first week and first, third, and sixth months postoperatively, and 1-year mortality was assessed as well. The various risk factors were analyzed in this study, including age, coronary artery disease, chronic heart failure, cerebrovascular disease, hypertension, diabetes mellitus, hemodialysis, white blood cell (WBC) count, C-reactive protein-quantitative (CRP), lactate dehydrogenase, and serum albumin level. Results The present study exhibited that most cases were men (75%) and former smokers (64.2%). A total of 91 patients (75.8%) had a history of hypertension. Univariate analysis exhibited that there were defiantly more wound occurrences (P<0.05) for those patients who underwent BKA in the greater than or equal to 55-year-old age group, smokers, patients with high WBCs, patients with low serum albumin level and with positive CRP, and dialysis-dependent patients. However, the patients who underwent an AKA, the multivariate analysis determined positive CRP and dialysis dependent as significant predictors (P<0.05) of a wound occurrence. Conclusion Predictors that significantly increased the risks of delayed recovery for those who underwent BKAs are greater than or equal to 55-year-old group, smokers, patients with elevated WBCs, and patients on dialysis proved to be predictive, and for AKA the predictive factors were low serum albumin level, patients with high WBCs, and patients with dialysis dependence.

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Evaluation of Perfusion Index as a Screening Tool for Developing Critical Limb Ischemia

Cited by 2 publications

References 11 publications

Vascular Disease and Diabetes

Vascular Disease and Diabetes

Prediction of wound complications after major amputation for patients with critical limb ischemia

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