Extreme distal bypass to improve wound healing in Buerger's disease

Caridi, Giovanni De; Massara, Mafalda; Villari, Simona; Martelli, Eugenio; Spinelli, Francesco; Grande, Raffaele; Butrico, Lucia; Franciscis, Stefano de; Serra, Raffaele

doi:10.1111/iwj.12241

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…This experience is confi rmed by previous reports from other authors who fi nd the use of a tourniquet very helpful in distal bypasses [26][27][28][29]. Our concept of surgical revascularization for TAO in selected cases is supported by a recent positive report from an Italian author describing a distal bypass in a case of extensive gangrene in a patient with TO [30]. He emphasized the dramatic effect on the wound healing in his patient.…”

Section: Discussionsupporting

confidence: 77%

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

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Summary:Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex fi ndings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin confi guration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superfi cial femoral artery was used for infl ow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identifi ed graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after defi nitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.Keywords: Thromboangiitis obliterans, bypass, limb salvage, human, vascular patency ease frequently involves the small distal arteries of the calf and the foot with complete obliteration of the vessel lumen and absence of a suitable distal artery for bypass. The angiographic pattern of TAO is characterized by occlusions of the tibial and pedal arteries and the presence of typical corkscrew collaterals with normal proximal arteries [2,3]. Surgical revascularization with autologous vein bypass is rarely regarded as feasible due to the absence of healthy distal arterial segments or because of the small calibre of patent arteries and recent advances in conservative treatment. Superfi cial veins may become aff ected by the disease in form of phlebitis migrans with consecutive infl ammatory changes [4]. Hence previous infl ammation of the superfi cial veins often limits their availability as bypass grafts. However surgical vein bypass was recommended by Asian groups and a few European groups as an eff ective therapy for critical ischaemia [5][6][7][8][9]. The results of a contemporar...

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Section: Discussionsupporting

confidence: 77%

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

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“…Severe ischaemic pain, claudication, tissue loss and finally limb amputation are common complications of peripheral arterial disease (PAD), especially among patients affected by diabetes mellitus and end‐stage renal disease and on haemodialysis . The common treatment of PAD includes correction of risk factors, medical therapy and revascularisation through endovascular treatment or distal bypass, in order to restore a pulsatile flow as distal as possible .…”

Section: Introductionmentioning

confidence: 99%

Spinal cord stimulation to achieve wound healing in a primary lower limb critical ischaemia referral centre

Caridi

Massara

David

et al. 2014

International Wound Journal

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Critical lower limb ischaemia is a diffuse pathology that could cause claudication, severe ischaemic pain and tissue loss. The common treatment includes modification of risk factors, pharmacological therapy and endovascular or surgical revascularisation of the lower limb to restore a pulsatile flow distally. Spinal cord stimulator is seen as a valid alternative in patients unsuitable for revascularisation after endovascular or surgical revascularisation failure and as adjuvant therapy in the presence of a functioning bypass in patients with extensive tissue loss and gangrene presenting a slow and difficult wound healing. We report our experience on spinal cord stimulation (SCS) indication and implantation in patients with critical lower limb ischaemia, at a high-volume centre for the treatment of peripheral arterial disease.

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“…With such aims, predictive indices and risk‐stratification of patients with CLI can guide the physician in choosing and tailoring the treatment of PAD. This is even more valiant when newer and ancillary approaches to PAD such as angiosome‐targeted revascularisation , extreme distal bypass , gene therapy , vacuum‐assisted closure (VAC) therapy , spinal cord stimulation and prostaglandin E1 infusions are considered.…”

Section: Discussionmentioning

confidence: 99%

Matrix metalloproteinases and risk stratification in patients undergoing surgical revascularisation for critical limb ischaemia

Caridi

Massara

Spinelli

et al. 2015

International Wound Journal

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Critical limb ischaemia (CLI) is the most advanced form of peripheral artery disease (PAD) and it is often associated with foot gangrene, which may lead to major amputation of lower limbs, and also with a higher risk of death due to fatal cardiovascular events. Matrix metalloproteinases (MMPs) seem to be involved in atherosclerosis, PAD and CLI. Aim of this study was to evaluate variations in MMP serum levels in patients affected by CLI, before and after lower limb surgical revascularisation through prosthetic or venous bypass. A total of 29 patients (7 females and 22 males, mean age 73·4 years, range 65-83 years) suffering from CLI and submitted to lower extremity bypass (LEB) in our Institution were recruited. Seven patients (group I) underwent LEB using synthetic polytetrafluoroethylene (PTFE) graft material and 22 patients (group II) underwent LEB using autogenous veins. Moreover, 30 healthy age-sex-matched subjects were also enrolled as controls (group III). We documented significantly higher serum MMPs levels (P < 0·01) in patients with CLI (groups I and II) with respect to control group (group III). Finally, five patients with CLI (17·2%) showed poor outcomes (major amputations or death), and enzyme-linked immunosorbent assay (ELISA) test showed very high levels of MMP-1 and MMP-8. MMP serum levels seem to be able to predict the clinical outcomes of patients with CLI.

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Extreme distal bypass to improve wound healing in Buerger's disease

Cited by 12 publications

References 12 publications

Very distal vein bypass in patients with thromboangiitis obliterans

Very distal vein bypass in patients with thromboangiitis obliterans

Spinal cord stimulation to achieve wound healing in a primary lower limb critical ischaemia referral centre

Matrix metalloproteinases and risk stratification in patients undergoing surgical revascularisation for critical limb ischaemia

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