When in critical limb ischemia (CLI) the healing process aborts or does not follow an orderly and timely sequence, a chronic vascular wound develops. The latter is major problem today, as their epidemiology is continuously increasing due to the aging population and a growth in the incidence of the underlying diseases. In the US, the mean annualized prevalence of necrotic wounds due to the fact of CLI is 1.33% (95% CI, 1.32–1.34%), and the cost of dressings alone has been estimated at USD 5 billion per year from healthcare budgets. A promising cell treatment in wound healing is the local injection of peripheral blood mononuclear cells (PBMNCs). The treatment is aimed to induce angiogenesis as well to switch inflammatory macrophages, called the M1 phenotype, into anti-inflammatory macrophages, called M2, a phenotype devoted to tissue repair. This mechanism is called polarization and is a critical step for the healing of all human tissues. Regarding the clinical efficacy of PBMNCs, the level of evidence is still low, and a considerable effort is necessary for completing the translational process toward the patient bed site. From this point of view, it is crucial to identify some candidate biomarkers to detect the switching process from M1 to M2 in response to the cell treatment.
(0.5%) for iliac branch occlusion. None of the single anatomic factors analysed came out to be negative predictor of reintervention. Only the association of !2 complex iliac anatomic factors was predictor of related reintervention (OR 4.91, 95% confidence interval 1.11-21.55; p¼ 0.035); however the crude reintervention rate in this complex subgroup of patients was low (n¼4/48; 8.3%). Conclusion: This endograft demonstrated excellent early and mid-term outcomes also in cases with complex anatomy. The contemporary presence of !2 complex iliac anatomic factors still represent an issue for EVAR success; however the technical caractheristics of this device seems to guarantee low reintervention rates also in these challenging cases.
underwent ligation and excision only experienced significant claudication, and 33% resulted in amputation of the limb. We wished to avoid the likely complication of lower extremity amputation if our patient's pseudoaneurysm was treated with conventional methods. Prosthetic grafts would have been inappropriate with active Pseudomonas infection. Conclusions: Use of a mature, patent arteriovenous fistula graft as a conduit for bypass of a common femoral artery pseudoaneurysm appears to be a safe and effective option for revascularization.
the chi-squared and Mann-Whitney U Test. The log-rank test was utilised to compare freedom from major amputation and amputation-free survival rates. Given the potential for cross-over between groups, outcomes for cases were analysed based upon their first group. Results: Two-hundred and ninety-nine cases (295 patients, median age¼73 years, male¼205) were assessed within the clinic over a 12-month period. Of these, 172 (57.3%) cases occurred in patients with diabetes. A total of 226 (75.6%) cases were diagnosed with CLTI following assessment. Median time from referral to assessment was 2.1 [IQR 1.3-4.1] days. Subsequently, 141 cases underwent revascularisation (endovascular¼116, 82.3%) in a median time from assessment of 6.1 [IQR 4.0-11.0] days. No difference in the baseline demographics (age, gender, diabetes, ischaemic heart disease, previous stroke, hypertension, hyperlipidaemia) were observed between cohorts. Since inception of the clinic the mean number of cases managed for CLTI has increased by 34.2% (28.0 cases/ month (Pre-clinic) to 37.6 (Post-clinic)). The median time from assessment to first revascularisation was comparable following the implementation of the clinic, despite this increasing case-load ('Pre-clinic'¼6.1days, 'Post-clinic'¼6.0days, p¼.346). At 90-days, the rate of major amputation fell from 15.5% ('Pre-clinic') to 8.2% ('Post-clinic')(p¼.004) with freedom from major amputation being significantly higher in the post-clinic group (Figure 1, p¼.005). The subsequent rate of amputation-free survival at 90 days showed a trend toward improvement in the 'Post-clinic' group (p¼.226) and was significantly higher when restricting the analysis to emergency/urgent cases only (p¼.05). Conclusion: The inception of a novel limb salvage clinic has seen an increase in the number of cases being treated with early data indicating a significant reduction in the rate of major amputation. Whilst these results are encouraging, longer follow-up data is required to fully assess the effect of this model of care
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