Critical Limb Ischemia: Current Trends and Future Directions

Teraa, Martin; Conte, Michael S.; Moll, Frans L.; Verhaar, Marianne C.

doi:10.1161/jaha.115.002938

Cited by 197 publications

(172 citation statements)

References 89 publications

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“…4 Observational studies have shown that one year after diagnosis of CLI, 25% of patient experiences a major amputation, 25% had died and only 50% survived without requiring a major amputation though some have rest pain, ulcer or gangrene persisting and it is also associated with excessively high risk for cardiovascular events including myocardial infarction and death. 2,5 PGE1, known pharmaceutically as Alprastodil. Although widely used, the exact mechanism of the known beneficial effects is not completely understood.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and starting of intervention early is a key to successful outcome. 1,2 The goals in treating CLI are to relieve claudication pain and rest pain, to heal ulcer, to prevent amputation of limbs, to improve quality of life and to prolong survival. 1,2 Increase of blood flow in the ischemic leg is believed to represent the main action of PGE1 in the therapy of POVD.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 The goals in treating CLI are to relieve claudication pain and rest pain, to heal ulcer, to prevent amputation of limbs, to improve quality of life and to prolong survival. 1,2 Increase of blood flow in the ischemic leg is believed to represent the main action of PGE1 in the therapy of POVD. Though PGE1 is used for treatment of advanced Critical Limb ischaemia (CLI) by Indian doctors, studies have so far not been published about the effects of PGE1 on the improvements in peripheral pulsations, ulcer healing, or amputation levels after administration of PGE1 amongst Indian population.…”

Section: Introductionmentioning

confidence: 99%

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A study on prostaglandin E1 therapy in critical limb ischaemia patients to evaluate the improvement in vascularity

Kurien¹,

Sansho²,

Varghese³

et al. 2017

Int Surg J

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Background: Diffuse peripheral arterial disease or peripheral occlusive vascular disease (POVD) involving the lower limb is a debilitating illness with high incidence of morbidity and mortality. The objective of this study was to assess the improvement of ulcer healing and improvement of the level of amputation in patients with diffuse peripheral arterial disease after administration of prostaglandin E1.Methods: From June 2013 to November 2014, a total of 45 patients having critical limb ischaemia (Fontaine’s grade III and IV) not suitable for angioplasty and stenting or bypass procedures received different courses of Prostaglandin E1 (PGE1). 20 patients (44.44%) received 6 full courses of PGE1, 3 patients (6.66%) received 5 courses, 5 patients (11.11%) received 4 courses, 4 patients (8.8%) received 3 courses, 4 patients (8.8%) received 2 courses and 9 patients (20%) received one course. PGE1 was administered through intravenous infusion (Alprastodil 100mcg) over 10 hours a day for 5 days in one month (1course). They were followed up for 3 years till June 2017.The improvement in level of amputation, ulcer healing and complications were assessed.Results: 14 patients (31.1%) did not require amputation of limbs/ toes, 24 patients (53.3%) have the same amputated status while 7 patients (15.6%) required higher amputation. This study justifies the role of PGE1 therapy in improving the peripheral arterial pulsations and thereby augmenting ulcer healing and improving the level of amputation.Conclusions: After diagnosing a patient with advanced CLI where angioplasty and stenting or bypass procedures are not possible, aggressive treatment for the non-healing ulcer, amputation of gangrenous limbs or toes and starting the PGE1 therapy early not only arrest the progression of POVD but even reverses it to some extent.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A study on prostaglandin E1 therapy in critical limb ischaemia patients to evaluate the improvement in vascularity

Kurien¹,

Sansho²,

Varghese³

et al. 2017

Int Surg J

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“…Required are a multidisciplinary approach, risk-benefi t analysis, and treatment of comorbid conditions. However, besides atherosclerosis, CLI is also frequently observed in patients with lower limb arteritis of various types [2].…”

Section: Introductionmentioning

confidence: 99%

Conservative treatment of patients with thromboangiitis obliterans or cannabis-associated arteritis presenting with critical lower limb ischaemia

Galyfos

Kerasidis

Kastrisios

et al. 2017

Vasa

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Summary: Background:Proper management of patients with thromboangiitis obliterans (TAO) or cannabis-associated arteritis (CAA), presenting with critical lower limb ischaemia (CLI) remains controversial, and data are limited. Patients and methods: Patients with TAO or CAA presenting with CLI between 2011 and 2016 were retrospectively evaluated. Patients requiring primary intervention were excluded. Conservative treatment included: (a) weight-adjusted bemiparin plus six hours/day intravenous iloprost for 28 days, (b) aspirin (100 mg/day) plus cilostazol (100 mg twice/day) after discharge, and (c) strict recommendations/monitoring for smoking cessation. Main outcomes included symptom recession, ankle-brachial index (ABI) improvement, and healing of lesions at the time of discharge as well as amputation, revascularization, and abstinence rate during follow-up. Results: Overall, 23 patients (TAO: 15; CAA: 8) were included within six years, none of the patients reported any other factor than smoking. All patients presented with rest pain and 12 patients with ulcer or necrotic lesions. Mean ABI measurement at presentation was 0.46 ± 0.2, after 28 days of treatment, all patients showed improvement regarding clinical picture and ABI measurement (0.54 ± 0.1; p < 0.05). During follow-up, only three patients underwent bypass surgery and two patients underwent major amputation, although the smoking abstinence rate was very low (13 %). Conclusions: Intravenous iloprost plus bemiparin for 28 days together with per os aspirin plus cilostazol seem to produce promising results in patients with TAO/CAA, treated for CLI, even with a low smoking abstinence rate. However, larger series are needed to further evaluate inter-group differences and potential prognostic factors.

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“…(1,2) CLI with multifocal atherosclerotic lesions and concomitant diseases is an urgent problem of vascular surgery. (3)(4)(5)(6) Recently, the number of patients with MFA and CLI has increased, largely the result of an increase in the number of elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Results of Surgical Treatment of Patients with Critical Limb Ischemia and Stenotic Lesions of the Brachiocephalic Arteries

Чарышкин¹,

Максин²,

Матвеева³

et al. 2017

IJBM

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The aim of our study was to evaluate the results of the surgical treatment for patients with critical limb ischemia (CLI) and stenotic lesions of the brachiocephalic arteries. Methods and Results:We examined 72 patients (68/87.2% men and 4/7.3% women) aged from 46 to 78 years (mean age, 62.2±4.3 years) with CLI and stenotic lesions of the brachiocephalic arteries. Conservative treatment was performed in 17(23.6%) patients and surgical treatment in 55(76.4%). It has been carried out 73 surgical operations: femoral popliteal bypass (5/6.8%), lumbar sympathectomy (4/5.5%), thrombectomy of occluded aortofemoral graft (2/2.7%), limb amputation (4/5.5%), iliofemoral bypass (4/5.5%), aortofemoral bifurcation bypass (10/13.1%), endovascular surgery (1/1.6%), limb amputation at thigh level -4(5.5%), thrombectomy of occluded distal arteries (4/5.5%), femoro-femoral cross-over bypass (1/1.6%), resection of popliteal artery aneurysm and prosthesis of the popliteal artery (1/1.6%), semi-closed loop endarterectomy of occluded arteries of the lower limbs (8/10.9%), carotid endarterectomy (23/31.5%), and carotid-subclavian bypass (2/2.7%). After the surgical intervention, we observed the disappearance or reduction of pain, restoration of sensitivity and motor activity, and healing of trophic ulcers in 75% of patients. In the late postoperative period, we detected the progression of limb ischemia in 4(5.5%) patients; in connection with that, we performed limb amputation at thigh level. Ischemic stroke with a lethal outcome developed in one patient (1.4%).Conclusion: In patients with multifocal atherosclerosis, multilevel reconstructive surgical interventions must be performed in stages, due to the high operational risk, and risk of complications, secondary amputations and lethality in the postoperative period.

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Critical Limb Ischemia: Current Trends and Future Directions

Cited by 197 publications

References 89 publications

A study on prostaglandin E1 therapy in critical limb ischaemia patients to evaluate the improvement in vascularity

A study on prostaglandin E1 therapy in critical limb ischaemia patients to evaluate the improvement in vascularity

Conservative treatment of patients with thromboangiitis obliterans or cannabis-associated arteritis presenting with critical lower limb ischaemia

Results of Surgical Treatment of Patients with Critical Limb Ischemia and Stenotic Lesions of the Brachiocephalic Arteries

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