Popliteo–pedal bypass surgery for critical limb ischemia

Good, Daniel W.; Chalabi, Hasanin Al; Hameed, Farooq; Egan, Bridget; Tierney, Sean; Feeley, T. M.

doi:10.1007/s11845-011-0740-2

Cited by 7 publications

(9 citation statements)

References 21 publications

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“…Equivalent to the above-mentioned trans-catheter achievements, the common bypass for distal leg reperfusion still represents a fundamental procedure in CLTI diabetic foot revascularization [10] [43], and up to the plantar or tarsal foot arteries [44] were reported with remarkable clinical results. Other extreme techniques, exploiting even the remote branches of pedal arteries, were equally described, such as the publications of Brochado-Neto and co-workers regarding particular limb salvage bypass variants [45].…”

Section: Bypass Surgery For Distal Foot Revascularizationmentioning

confidence: 99%

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Alexandrescu¹,

Sinatra²,

Maufroy³

2019

WJCD

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Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation, the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro-and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting, a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large-and medium-sized collaterals, and the arterial-arterial communicants, in an intentional "source artery" and "collateral" topographic foot revascularization. However, up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.

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Section: Bypass Surgery For Distal Foot Revascularizationmentioning

confidence: 99%

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Alexandrescu¹,

Sinatra²,

Maufroy³

2019

WJCD

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“…High-skill distal vein bypasses to the tibial [72], to the pedal [77], and up to the plantar or tarsal foot arteries [78] equally by targeting remote branches of pedal arteries in some particular cases [1,76] were successfully documented. We now know that both surgical and endovascular techniques are more likely complementary than competitive techniques since each of them holds major advantages and inherent drawbacks [1,29,30,79].…”

Section: Contemporary Landmarks In Ischemic Wounds Revascularizationmentioning

confidence: 99%

“…Endovascular techniques essentially provide minimal invasiveness, great accessibility, and reproducibility for one or multiple below-the-knee CTO recanalizations [1,29,[73][74][75]. Alternatively, bypass offers a higher pressure on targeted arteries and more physiological and pulsatile flow inside collaterals around the wound zone [35,53,[77][78][79]. This particularity heightens arterial-arterial collateral shear stress and enhances rising arteriogenesis [58][59][60] toward further tissue cicatrization [1,29,35,60,72].…”

Section: Contemporary Landmarks In Ischemic Wounds Revascularizationmentioning

confidence: 99%

“…Beyond striking surgical arterial reconstructions [76][77][78][79], new tapered nitinol [81], drug-eluting stents (DES) [82], and original drugeluting balloon, (DEB) [83] were imagined. Novel or redesigned directional or rotational atherectomy devices [84], together with latest "bioresorbable scaffolds" technologies [85], represent few additional of numerous achievements that challenge today ancient technical barriers [1,29,75,[81][82][83][84][85][86].…”

Section: Contemporary Landmarks In Ischemic Wounds Revascularizationmentioning

confidence: 99%

“…Beyond high-performance techniques in reconstructing arterial flow [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86], new strategies about "when" and "where" to perform appropriate revascularization emerge today [1,27,30,35]. Contemporary practitioners equally avail key data on the molecular mechanisms generating ischemic threat and tissue regeneration [59][60][61].…”

Section: New Strategies For "Wound Targeted Revascularization"mentioning

confidence: 99%

See 2 more Smart Citations

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Alexandrescu¹,

Triffaux²

2016

Wound Healing - New Insights Into Ancient Challenges

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During the recent decades, soaring progresses in vascular disease knowledge, particularly in critical limb ischemia (CLI) treatment, enhanced novel diagnostic and interventional strategies with high serviceableness in patient's selection, arterial recanalization, and dedicated ischemic ulcer follow-up. However, despite undeniable advances in medical technology and clinical judgment, limb salvage, the ambulation recovery, and patient's survival seem only scarcely affected in this heterogeneous CLI group, particularly concerning the diabetic and renal patients. Innovative strategies such as "end artery occlusive disease" treatment or "wound-targeted revascularization" were equally proposed by following the angiosomal anatomical distribution associating individual foot collateral assessment in a unified macro-and micro-circulatory judgment. However, despite encouraging clinical results, prospective evidence still lacks on this concern. It also appears that specific wounds could not always stand for the lowest perfusion areas according to current CLI criteria, since severe neuropathy, inflammatory swelling, local infection, and skin trauma may add complementary hindrances to tissue viability.The present chapter endeavor to summarize main available treatment principles for ischemic ulcer recovery that every modern practitioner eventually disposes in an updated contemporary view."

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The cost utility of a multi-disciplinary foot protection clinic (MDFPC) in an Irish hospital setting

et al. 2012

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Popliteo–pedal bypass surgery for critical limb ischemia

Abstract: Our data supports popliteo-pedal bypass as an effective treatment for distal vascular disease. Comparison with endovascular treatment in a randomised trial needs to be performed.

Cited by 7 publications

References 21 publications

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

The cost utility of a multi-disciplinary foot protection clinic (MDFPC) in an Irish hospital setting

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