Is Limb Loss Always Inevitable for Critical Neuro-Ischemic Foot Wounds in Diabetic Patients with End Stage Renal Disease and Unfit for Vascular Reconstructions?

Alexandrescu, Vlad

doi:10.5772/26361

Cited by 4 publications

(9 citation statements)

References 41 publications

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“…[2][3][4][5][6][7][8][9][11][12][13][14] Despite being predominantly retrospective 3-8,14-18 studies rather than prospective 19 trials (although there are 3 recent meta-analyses 9,20,21 ), these articles offer somewhat encouraging results of ischemic wound healing for direct (angiosome-or wound-oriented) vs. indirect (wound-indifferent) arterial reconstruction whenever the former is feasible. [2][3][4][5][6][7][8][9][18][19][20][21] While most authors find the angiosome concept appropriate in distal bypass, 2,4,5,18 endovascular below-theknee (BTK) reperfusion, 3,[6][7][8]16 and even extreme deep vein arterialization, [22][23][24] others have reservations about acknowledging the benefits of surgical 25 or transcatheter 26 angiosome-guided distal leg revascularization.…”

Section: Direct Vs Indirect Revascularizationmentioning

confidence: 99%

“…More refined information is now available regarding the ''choke vessels'' 1,2 that connect the foot angiosomes 1,2,4,16 in specific populations, such as diabetic 3,7,8,18,27 or renal 16,24,25 patients with scarce collateral reserve. 7,16 Identification of the importance of the foot arches, 2,14 the large (.0.5 mm) arterial-arterial collaterals, 2,4,16,28 and the key role of metatar-sal perforators 2,8,[15][16][17] has also occurred since wound-oriented vs. blind revascularization was conceived.…”

Section: Direct Vs Indirect Revascularizationmentioning

confidence: 99%

“…Modern clinical and diagnostic information provides clinicians with valuable clues about macro-and microcirculatory patterns in each foot ulcer presentation. [1][2][3][4]16,28 Still, some complex CLI wounds, particularly in diabetic 27,33,36 or renal 24,25 patients, may involve two or three distal leg or forefoot angiosomes in about 35% to 55% of global presentations. [15][16][17][18] Explicit angiosome orientation by ''routine'' examination may be more challenging or even misleading in some situations.…”

Section: Wound-directed Revascularization From a Macro-and Microcirculatory Perspectivementioning

confidence: 99%

See 2 more Smart Citations

Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand?

Alexandrescu¹

2014

Journal of Endovascular Therapy

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Section: Direct Vs Indirect Revascularizationmentioning

confidence: 99%

Section: Direct Vs Indirect Revascularizationmentioning

confidence: 99%

Section: Wound-directed Revascularization From a Macro-and Microcirculatory Perspectivementioning

confidence: 99%

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Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand?

Alexandrescu¹

2014

Journal of Endovascular Therapy

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“…As previously described [23,24], the foot angiosomes are 3-D dynamic and continuously interacting structures [30]. Although their primary anatomical distribution seems accurately reproduced in more than 90% of subjects (owing 6-9% eventual anatomival variants) [23,24,26,91], their interconnections ("choke vessels") are yet submitted to continuous changes, according to each type of CLI pathology [72,[95][96][97][98].…”

Section: The "Angiosome Concept" In Ischemic Wound Healing: a Succincmentioning

confidence: 90%

“…Alternatively, extreme venous limb arterialization [94,95] and cell stem treatment [1,29] parallel to rising "multidisciplinary team" practice [57,87,88] have also been developed and seem to revolutionize previous CLI paradigms of care [1,29,[92][93][94].…”

Section: New Strategies For "Wound Targeted Revascularization"mentioning

confidence: 99%

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Alexandrescu¹,

Triffaux²

2016

Wound Healing - New Insights Into Ancient Challenges

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During the recent decades, soaring progresses in vascular disease knowledge, particularly in critical limb ischemia (CLI) treatment, enhanced novel diagnostic and interventional strategies with high serviceableness in patient's selection, arterial recanalization, and dedicated ischemic ulcer follow-up. However, despite undeniable advances in medical technology and clinical judgment, limb salvage, the ambulation recovery, and patient's survival seem only scarcely affected in this heterogeneous CLI group, particularly concerning the diabetic and renal patients. Innovative strategies such as "end artery occlusive disease" treatment or "wound-targeted revascularization" were equally proposed by following the angiosomal anatomical distribution associating individual foot collateral assessment in a unified macro-and micro-circulatory judgment. However, despite encouraging clinical results, prospective evidence still lacks on this concern. It also appears that specific wounds could not always stand for the lowest perfusion areas according to current CLI criteria, since severe neuropathy, inflammatory swelling, local infection, and skin trauma may add complementary hindrances to tissue viability.The present chapter endeavor to summarize main available treatment principles for ischemic ulcer recovery that every modern practitioner eventually disposes in an updated contemporary view."

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Critical Limb Ischemia Treatment Strategies in Diabetics: Present Deeds and Future ChallengesCritical Limb Ischemia Treatment Strategies in Diabetics: Present Deeds and Future Challenges

Alexandrescu¹

2015

CRDOJ

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The worldwide number of people suffering from diabetes is anticipated to exceed 350 million by 2030 and the risk for developing critical limb ischemia (CLI) has been documented to reach considerably higher levels in these patients. Contemporary data show that 40% to 50% among diabetics may experience an amputation while 20% to 25% are prone to die, during the first year of CLI diagnosis. Despite remarkable advances in peripheral arterial revascularization in the last two decades, major amputation rate seems scarcely affected in this group of patients by simultaneous increase of CLI presentations each year.The present article proposes a succinct review of main revascularization techniques currently reported using surgical, endovascular, or hybrid approaches together with new strategies in enhancing wound-targeted arterial flow reconstruction. Planning to achieve pulsatile flow toward specific foot territories and ischemic ulcers seems to considerably improve the time and quality of tissue healing in diabetic CLI presentation with better limb salvage rates. Novel clinical data equally highlight the importance of parallel macro-and microcirculatory CLI diagnosis inside the multifaceted "diabetic foot syndrome", probably a new paradigm in maximizing postoperative tissue regeneration. In sum, CLI invariably unfolds a multifarious limb-threatening phenomenon particularly pictured in diabetic patients that always have and will request multidisciplinary advises and high-priority local wound and revascularization treatment.

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Is Limb Loss Always Inevitable for Critical Neuro-Ischemic Foot Wounds in Diabetic Patients with End Stage Renal Disease and Unfit for Vascular Reconstructions?

Cited by 4 publications

References 41 publications

Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand?

Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand?

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Critical Limb Ischemia Treatment Strategies in Diabetics: Present Deeds and Future ChallengesCritical Limb Ischemia Treatment Strategies in Diabetics: Present Deeds and Future Challenges

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