Use of an Arteriovenous Fistula For Treatment of the Severely Ischemic Extremity

Matolo, Nathaniel M.; Cohen, Sheldon E.; Wolfman, Earl F.

doi:10.1097/00000658-197611000-00016

Cited by 30 publications

(9 citation statements)

References 8 publications

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“…However, amputation can confer often a worse prognosis, being an independent predictor of death. 82 , 83 In these non-revascularizable patients, currently, the new goal is to increase the local angiogenesis. Gene therapy offers a potential efficacious therapy with an acceptable rate of adverse events as documented in Phases I and II of different clinical trials.…”

Section: Current Challenges and Future Perspectivesmentioning

confidence: 99%

Critical limb ischemia: current challenges and future prospects

Uccioli¹,

Meloni²,

Izzo³

et al. 2018

VHRM

150

126

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Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels. It is associated with a high risk of major amputation, cardiovascular events and death. In this review, we presented a complete overview about physiopathology, diagnosis and holistic management of CLI. Revascularization is the first-line treatment, but several challenging cases are not treatable by conventional techniques. Unconventional techniques for the treatment of complex below-the-knee arterial disease are described. Furthermore, the state-of-the-art on gene and cell therapy for the treatment of no-option patients is reported.

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Section: Current Challenges and Future Perspectivesmentioning

confidence: 99%

Critical limb ischemia: current challenges and future prospects

Uccioli¹,

Meloni²,

Izzo³

et al. 2018

VHRM

150

126

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“…Similarly to the findings in the coronary collateral circulation, peripheral collateral-dependent blood flow was demonstrated to be higher in dogs with a chronic iliac artery ligation than in acutely ligated dogs, showing that peripheral collaterals also remodel in response to upstream occlusion (166). Matolo et al demonstrated that peripheral collateralization could be enhanced by creation of an arteriovenous fistula, suggesting the role of mechanical influences on arteriogenesis (588). Arteriogenesis in the periphery is locally regulated and occurs independently of arteriogenesis in the coronary circulation, as shown by studies in which occlusion of the femoral artery induced peripheral collateralization without any effect on the distant, nonoccluded coronary circulation (368).…”

Section: Training Adaptations Within the Active Muscle: Increasedmentioning

confidence: 99%

Exercise Training and Peripheral Arterial Disease

Haas

Lloyd

Yang

et al. 2012

Comprehensive Physiology

121

108

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Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12–15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50–1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking ~5 times/wk, at a significant intensity that requires frequent rest periods, are most significant. Pre-clinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including: improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a life style pattern, that includes enhanced physical activity prior to the advance of PAD limitations, is the most desirable and beneficial.

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“…The numbers of valves found in those veins were as follows: external iliac 0-2, common femoral 0-2, deep femoral 0-4, superficial femoral 1-5, popliteal 0-3, tibioperoneal trunk 0-2, internal anterior tibial 4-12, external anterior tibial 5-12, internal posterior tibial 4-11, external posterior tibial 3-10, internal peroneal 3-10; and external peroneal 4-10 (Tables I, II). 3. Location of Valves.…”

Section: Introductionmentioning

confidence: 99%

Anatomic and Histologic Studies on the Valves of the Venous System in Lower Extremities

Sun

Zhang

1990

Vascular Surgery

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Anatomic and histologic studies of vein valves were made on 50 adult cadavers (100 lower extremities). In the deep and superficial venous trunks, big valves were found mostly with two cuspids. At the inlets of their branches, small valves monocuspid in shape were commonly found. There was no valve in the common iliac vein, and the percentages of the other veins containing valves were: external iliac 42%, common femoral 51%, deep femoral 88%, superficial femoral 100%, popliteal 93%, tibioperoneal trunk 26%, and all the deep veins in the lower leg, including tibial and peroneal 100%. The valves in the deep venous trunk are much stronger than those in the long saphenous vein. They can resist a retrograde pressure of 180 to 420 and 100 to 260 mmHg respectively.The clinical value of this study concerning the staged arteriovenous reversal in the treatment of severely ischemic limbs and the etiology of the primary incompetence of the deep veins of the lower extremity are discussed.

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Use of an Arteriovenous Fistula For Treatment of the Severely Ischemic Extremity

Cited by 30 publications

References 8 publications

Critical limb ischemia: current challenges and future prospects

Critical limb ischemia: current challenges and future prospects

Exercise Training and Peripheral Arterial Disease

Anatomic and Histologic Studies on the Valves of the Venous System in Lower Extremities

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