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Complications of open aortofemoral bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Often unilateral limb thrombosis clinically presents as claudication due to aforementioned collateral flow to the leg, but up to a quarter of patients will present with acute critical limb ischemia. In this case, concomitant infrapopliteal disease is often present, and should be interrogated preoperatively. In this subset of patients, additional infrainguinal bypass may necessary at the time of thrombectomy.
Stents
Published in Vikram S. Kashyap, Matthew Janko, Justin A. Smith, Endovascular Tools & Techniques Made Easy, 2020
Arterial stenting follows the same principles and indications that have been established for open intervention. In the lower extremities, disabling claudication and critical limb ischemia are the main indications for treatment. Similarly, patients who present with severe arm claudication and ischemic ulcers of the hand may benefit from endovascular stenting. Visceral stenting focuses on the treatment of patients with medically refractory hypertension due to renal artery stenosis and mesenteric ischemia from celiac artery and superior mesenteric artery stenosis. Carotid stenting is reserved for patients who are high operative risk for conventional carotid endarterectomy. The indications for peripheral vascular stent placement are summarized in Table 10.1.
Thirty-Year Trends in Aortofemoral Bypass for Aortoiliac Occlusive Disease
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Inclusion/Exclusion Criteria The study included all patients undergoing aorto-femoral bypass for aorto-iliac occlusive disease as determined by preoperative conventional aortography, computed tomographic imaging, or magnetic resonance angiography at our tertiary referral, academic medical center from 1985 to 2015. Patients had peripheral arterial disease manifest either as claudication or critical limb ischemia. There were no acute limb ischemia patients.
Health-related quality of life and prosthesis use among patients amputated due to peripheral arterial disease – a one-year follow-up
Published in Disability and Rehabilitation, 2022
Eva Torbjörnsson, Carin Ottosson, Lennart Boström, Lena Blomgren, Jonas Malmstedt, Ann-Mari Fagerdahl
In Europe, 90% of the major lower limb amputations are performed in patients with the peripheral arterial disease (PAD) [1]. PAD is divided into three stages: asymptomatic disease, intermittent claudication, and critical limb ischemia. Critical limb ischemia, defined as chronic ischemic rest pain or non-healing ulceration or gangrene, is the most severe form, and most of the patients who underwent an amputation have this stage [2]. Patients with critical limb ischemia is a patient group with multiple chronic co-morbidities, especially diabetes and cardiovascular disease [3]. The mortality is 16–35% in the first year after being diagnosed with critical limb ischemia, and it seems to continue at the same level [4,5]. PAD is a disease with a large impact on the patient’s Health-Related Quality of Life (HRQoL) as it is associated with a high risk of lower extremity amputation, morbidity, and death [6–8]. It is a disease associated with a lower HRQoL in comparison with the general population, and revascularization may improve the patient’s perceived health status [9–10]. Primary amputation is a treatment alternative, often decided when no other treatment is possible, and many times associated with intense anxiety. However, amputation may bring about a better outcome in perceived HRQoL than repeated revascularization attempts with little likelihood of wound healing [11,12].
The FlowOx device for the treatment of peripheral artery disease: current status and future prospects
Published in Expert Review of Medical Devices, 2021
For patients with critical limb ischemia, early endovascular or open surgical revascularization is the cornerstone treatment. However, revascularization is dependent on the severity and extent of the disease, patient comorbidities, and the risk of procedural-related complications. For patients with critical limb ischemia not amenable to revascularization, amputation has been the only option. In a case study of four patients with critical limb ischemia, FlowOx treatment for 1 hour, twice daily for 8 weeks had a beneficial effect on wound healing [13]. Based on promising results, a pilot trial investigating the effects of FlowOx treatment in patients with non-option critical limb ischemia was initiated (Ref: ISRCTN51433523). However, patients with critical limb ischemia are often severely comorbid with a 1-year mortality of 25% [18]. Hence, a proper sample size of patients with non-option critical limb ischemia treated with FlowOx over weeks turned out to be very difficult to achieve. As a very low number of patients were treated according to protocol before the trial was terminated, no clear conclusions on the treatment effect could be drawn from that trial. Unpublished feedback from the early market introduction (n = 99 patients) in the UK, Germany, and Scandinavia indicates that FlowOx treatment could reduce pain and improve wound healing in more than 50% of the treated patients with critical limb ischemia (Iacob Mathiesen, CSO, Otivio AS, unpublished observations).
Effect of conservative treatment in aortoiliac occlusive disease
Published in Acta Chirurgica Belgica, 2020
W. Wen, G. H. Ho, E. J. Veen, H. G. W. de Groot, M. G. Buimer, L. van der Laan
Demographic and clinical data were retrospectively collected from all patients referred to the Department of Vascular Surgery, Amphia Hospital Breda, The Netherlands from December 2012 to September 2017. Patients with proven AIOD and IC in one or both legs who were primarily treated with conservative therapy, which consisted of optimal pharmacotherapy with or without SET, were included. Patients receiving endovascular or surgical revascularization as primary initiated therapy were excluded. Patients with critical limb ischemia or tissue loss were excluded. The management of these patients was discussed in a multidisciplinary vascular meeting with a group of certified radiological interventionalists and vascular surgeons. An individual informed consent was omitted because this study was based on a regular patient care.