Limb Salvage and Survival in Chronic Limb-Threatening Ischemia: The Need for a Fast-Track Team-Based Approach

Ventoruzzo, Giorgio; Mazzitelli, Giulia; Ruzzi, Umberto; Liistro, Francesco; Scatena, Alessia; Martelli, Eugenio

doi:10.3390/jcm12186081

Cited by 9 publications

(4 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Molecular therapies such as mesenchymal stem cells or gene therapy are currently being investigated in this field and will hopefully improve outcomes [36][37][38][39], but until the widespread use of those innovative techniques in clinical practice, it remains advisable to use team-based care to provide the best treatment option in each patient to deal with any anatomic difficulties such as ectasic veins. Close collaboration among surgeons, clinicians and biomedical engineers is crucial to tailor the treatment for each patient [40,41], similarly to the lessons of the Heart Team in cardiology. In this scenario, patient-reported outcomes play a pivotal role in evaluating the cost-effectiveness of each treatment [2,5,42] as well as circulating biomarkers to promptly detect complications even before clinical events [43].…”

Section: Discussionmentioning

confidence: 99%

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Montelione,

Catanese,

Nenna

et al. 2024

JCM

View full text Add to dashboard Cite

Background: The surgical treatment of chronic limb-threatening ischemia and optimal conduit choice are extensively debated. The presence of suboptimal autologous material, such as varicosities or venous aneurysms, might impair long-term outcomes. Therefore, kink-resistant external supports have been advocated in the recent literature to improve the conduit quality and outcomes. This study analyzes the FRAME external support in venous ectasic grafts in patients with chronic limb-threatening ischemia. Methods: From September 2017 to September 2023, a total of sixteen patients underwent CLTI surgery with FRAME external support for venous grafts. The inclusion criteria for FRAME applications were varicose or ectasic autologous material with a diameter ≥ 4.5 and ≤ 8 mm in an isolated segment or in the entire vein and a higher risk of bypass extrinsic compression (e.g., extra-anatomical venous bypass course). Results: Technical success and intraoperative patency were achieved in all cases. At 30 days, the limb salvage and survival rates were 100%. The primary bypass patency was 93.7% due to an early graft occlusion. No graft infection was registered. In one case, dehiscence of the surgical wound was treated by surgical debridement and antibiotic therapy. Minor amputation was required in four patients. Over a median follow-up of 32 months, two occlusions were observed; one was treated with reoperation and the other with major amputation. The primary patency was 68.7% and the assisted primary patency was 75%. Limb salvage rates observed during the entire follow-up period were 87.5%. No graft infections or dilatation of the reinforced veins were registered. Conclusions: For patients with CLTI undergoing infrainguinal bypass, satisfactory results in terms of patency and limb salvage rates were achieved using the autologous venous material, even if ectasic or varicose, with the vascular external support FRAME.

show abstract

Section: Discussionmentioning

confidence: 99%

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Montelione,

Catanese,

Nenna

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…The end-stage form of the disease, described as chronic or critical limb ischemia (CLI), affects up to 10% of patients with PAD and is characterized by a high risk of major amputation and mortality. CLI is primarily driven by progressive atherosclerotic disease [43].…”

Section: Discussionmentioning

confidence: 99%

Ghrelin Expression in Atherosclerotic Plaques and Perivascular Adipose Tissue: Implications for Vascular Inflammation in Peripheral Artery Disease

Peiu,

Iosep,

Danciu

et al. 2024

JCM

View full text Add to dashboard Cite

Atherosclerosis, a leading cause of peripheral artery disease (PAD), is driven by lipid accumulation and chronic inflammation within arterial walls. Objectives: This study investigates the expression of ghrelin, an anti-inflammatory peptide hormone, in plaque morphology and inflammation in patients with PAD, highlighting its potential role in age-related vascular diseases and metabolic syndrome. Methods: The analysis specifically focused on the immunohistochemical expression of ghrelin in atherosclerotic plaques and perivascular adipose tissue (PVAT) from 28 PAD patients. Detailed immunohistochemical staining was performed to identify ghrelin within these tissues, comparing its presence in various plaque types and assessing its association with markers of inflammation and macrophage polarization. Results: Significant results showed a higher prevalence of calcification in fibro-lipid plaques (63.1%) compared to fibrous plaques, with a notable difference in inflammatory infiltration between the two plaque types (p = 0.027). Complicated plaques exhibited increased ghrelin expression, suggesting a modulatory effect on inflammatory processes, although this did not reach statistical significance. The correlation between ghrelin levels and macrophage presence, especially the pro-inflammatory M1 phenotype, indicates ghrelin’s involvement in the inflammatory dynamics of atherosclerosis. Conclusions: The findings propose that ghrelin may influence plaque stability and vascular inflammation, pointing to its therapeutic potential in managing atherosclerosis. The study underlines the necessity for further research to clarify ghrelin’s impact on vascular health, particularly in the context of metabolic syndrome and age-related vascular alterations.

show abstract

“…Such a program requires a coordinated effort of physicians, nurses, allied health professionals, and administrators who are dedicated to the cause of treating PAD and saving and maintaining functional limbs. Prompt and appropriate diagnosis followed by a multidisciplinary approach to treatment is critical to successfully treating patients with PAD ( 4 ). Programs should incorporate risk reduction with appropriate medical therapy.…”

Section: Multidisciplinary Approach To Optimize Pad Managementmentioning

confidence: 99%

Management of peripheral arterial disease in the context of a multidisciplinary limb program

Neville

2024

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Peripheral artery disease (PAD) continues to increase in prevalence worldwide due to risk factors such as advanced age, diabetes mellitus, and obesity. Critical limb ischemia (CLTI) is the advanced form of PAD that can result in a lack of healing and limb loss as the most devastating consequence. Patients with PAD, especially CLTI, benefit from multidisciplinary care to optimize outcomes by reducing cardiovascular morbidity and mortality and preventing lower extremity amputation. Collaboration between various specialties allows a focus on problems involved in treating the patient with PAD including prevention, screening, medical care, wound care, infection, and revascularization when needed. Although there is no clear definition or consensus on the structure of the PAD team, certain guidelines are applicable to most clinical scenarios emphasizing “provider champions” in leading a clinical program. A vascular specialist (vascular surgery, interventional radiology, interventional cardiology) and a soft tissue specialist (podiatry, plastic surgery) are the typical “champions,” often involving orthopedics, general surgery, vascular medicine, diabetology/endocrinology, infectious disease, nephrology, and rehabilitation medicine. The team should also include wound nurses, nutritionists, occupational therapists, orthotists, pharmacists, physical therapists, prosthetists, and social workers. This paper presents a brief overview of the structure of the multidisciplinary team with key components and functions of such a team to optimize treatment outcomes for PAD and CLTI.

show abstract

Limb Salvage and Survival in Chronic Limb-Threatening Ischemia: The Need for a Fast-Track Team-Based Approach

Cited by 9 publications

References 55 publications

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Ghrelin Expression in Atherosclerotic Plaques and Perivascular Adipose Tissue: Implications for Vascular Inflammation in Peripheral Artery Disease

Management of peripheral arterial disease in the context of a multidisciplinary limb program

Contact Info

Product

Resources

About