“The Renal Foot” - Angiographic Pattern of Patients with Chronic Limb Threatening Ischemia and End-Stage Renal Disease

Baghdasaryan, Patrick; Bae, Jun Ho; Yu, Wendy; Rowe, Vincent L.; Armstrong, David G.; Shavelle, David M.; Clavijo, Leonardo

doi:10.1016/j.carrev.2019.09.001

Cited by 14 publications

(18 citation statements)

References 13 publications

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“…These interesting reports would confirm our findings related to the predominant and diffuse involvement of the FP, IP, and P segments with high GLASS scores (20.3%; HR, 197.5; 95% IC, 97.33–400.8; p < 0.0001 ). 32 Baghdasaryan et al 20 described similar figures for MALE (29.2%) in a North American population; however, we report values lower than those described (16.30%). 20…”

Section: Discussioncontrasting

confidence: 57%

“…Dyslipidemia, which includes hypercholesterolemia (OR, 1.86; 95% CI, 1.43–2.41; p < 0.05 ) and triglyceridemia (OR 2.05, 95% CI, 1.58–2.66; p < 0.05 ), is a factor that has been gaining much ground during the PAD study. 15,25 Approximately 59% of the population with PAD has a history of dyslipidemia, 20 in our case, with a lower value (35.63%). However, the distribution of atherosclerotic lesions is similar to that of hypertension, with aortoiliac predominance (RR, 1.15; 95% CI, 0.98–1.36; p < 0.05 ) followed by FP (RR, 1.0; 95% CI, 0.99–1.18; p < 0.05 ).…”

Section: Discussionmentioning

confidence: 61%

“…Various studies carried out by the University of Wisconsin Hospital and the PARTNERS study highlighted among their conclusions that 16–40% of the population with PAD also had chronic coronary heart disease 28,29 ; however, despite the age of its dissemination, recently, Baghdasaryan et al reported figures close to those described and similar to ours (24.8 vs 26.55%). 20 On the other hand, the association between chronic coronary heart disease and PAD is frequent (OR, 1.90; 95% CI, 1.23–2.93; p < 0.001 ). 15 Furthermore, it should be mentioned that currently, a typical pattern of atherosclerosis involvement of this association has not been found in any published series, and we believe that ours would provide evidence of predominantly IF and P involvement (GLASS 4 and P2, p < 0.05 ).…”

Section: Discussionmentioning

confidence: 99%

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Arteriographic patterns of peripheral arterial disease in lower limbs in a Peruvian cohort of patients

et al. 2022

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Introduction There is currently no universal and uniform pattern of peripheral arterial disease (PAD) in the lower limbs; however, it is influenced by various cardiovascular factors of the individual. The objective of this study was to identify the arteriographic patterns of PAD in the lower limbs according to cardiovascular factors in a Peruvian cohort of patients. Methods This is an analytical, observational, and retrospective study. The arteriographic patterns of PAD in the aortoiliac segment were analyzed with the TransAtlantic InterSociety Consensus (TASC-II) score and the Global Anatomic Staging System (GLASS) for the femoropopliteal (FP), infraopopliteal (IP), and pedial (P) segments in a Peruvian cohort from January 2018 to May 2021. Results 595 patients (833 extremities) were analyzed with a mean age of 67.54 ± 16.39 years, and the main cardiovascular factor was diabetes (65.04%). The patients older than 65 years with GLASS FP 4 (p = 0.042), IP 0 (p = 0.004), and P2 ( p = 0.047) presented significant findings: in men and women with GLASS IP 4 ( p = 0.031) and P 2 ( p = 0.045); diabetes with TASC-II A ( p = 0.031), GLASS FP 4 ( p = 0.038), IP 4 ( p = 0.009), and P2 ( p = 0.003); dyslipidemia with TASC-II D ( p = 0.027), GLASS FP 4 ( p = 0.038), IP 0 ( p = 0.009), and P0 ( p = 0.003); smoking with TASC-II D ( p = 0.001), GLASS FP 4 ( p = 0.049) and IP 0 ( p = 0.008); chronic coronary disease with GLASS IP 4 ( p = 0.049) and P2 ( p = 0.037); chronic kidney disease with GLASS FP 4 ( p=0.047), IP 4 ( p = 0.004), and P2 ( p = 0.016); and previous amputation history with GLASS IP 4 ( p = 0.015) and P2 ( p = 0.039). The most frequent arteriographic pattern of PAD in the lower limbs of our cohort was TASC-II A, GLASS FP 0 and 4, IP 0, and P2 ( p = 0.047). Conclusion Our work will allow the limb salvage teams to understand the behavior of PAD affectation in the population of our environment, allowing a timely control of cardiovascular risk factors, adequate revascularization planning, and a significant reduction in the risk of loss of limb.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Arteriographic patterns of peripheral arterial disease in lower limbs in a Peruvian cohort of patients

et al. 2022

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“…46 These patients have high rates of tibial and pedal disease, and revascularization of the pedal arch may be of value due to compartmentalized pedal perfusion. 47,48 The pedal-plantar loop technique has been described as a method to recanalize occluded pedal vessels and plantar arch. Wire access is obtained in either the anterior tibial or posterior tibial artery and advanced through the plantar arch with sequential balloon angioplasty until retrograde access is obtained in the opposite artery of the foot.…”

Section: Btk Angioplastymentioning

confidence: 99%

New Innovations and Devices in the Management of Chronic Limb-Threatening Ischemia

Kim

Schneider

2020

J Endovasc Ther

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As the number of patients afflicted by chronic limb-threatening ischemia (CLTI) continues to grow, new solutions are necessary to provide effective, durable treatment options that will lead to improved outcomes. The diagnosis of CLTI remains mostly clinical, and endovascular revascularization remains mostly balloon-based. Multiple innovative techniques and technologies are in development or in early usage that may provide new solutions. This review categorizes areas of advancement, highlights recent developments in the management of CLTI and looks forward to novel devices that are currently under investigation.

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“…9,46 This angiographic finding, which occurs in up to 20% of CLTI patients, may be suggested by a low toe pressure despite a higher ABI and is more common among elderly patients with diabetes and end-stage renal disease (ESRD). 47,48 Ferraresi et al 5 reviewed 1915 angiograms of patients with symptomatic PAD and found that 20% had evidence of significant disease in 3 pedal vessels. Diabetes is strongly associated with small vessel disease, and up to 84% of patients have an absent or incomplete pedal arch.…”

Section: Classification Of the No-option Patientmentioning

confidence: 99%

A Review and Proposed Classification System for the No-Option Patient With Chronic Limb-Threatening Ischemia

2020

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A growing, but poorly defined subset of patients with chronic limb-threatening ischemia (CLTI) have “no option” for revascularization. One notable subgroup includes patients with severe ischemia and advanced pedal artery occlusive disease, termed “desert foot,” who are at high risk for major amputation due to a lack of conventional revascularization options. Although new therapies are being developed for no-option patients with desert foot anatomy, this subgroup and the broader group of no-option patients are not well defined, limiting the ability to evaluate outcomes. Based on a systematic review, a classification of the no-option CLTI patient was constructed for use in clinical practice and studies. Several no-option conditions were identified, including type I—severe and pedal occlusive disease (desert foot anatomy) for which there is no accepted method of repair; type II—lack of suitable venous conduit for bypass in the setting of an acceptable target for bypass; type III—extensive tissue loss with exposure of vital structures that renders salvage impossible; type IV—advanced medical comorbidities for which available revascularization options would pose a prohibitive risk; and type V—presence of a nonfunctional limb. While type I and type II patients may have no option for revascularization, type III and type V patients have wounds, infection, comorbidities, or functional status that may leave them with few options for revascularization. As treatment strategies continue to evolve and novel methods of revascularization are developed, the ability to identify no-option patients in a standardized fashion will aid in treatment selection and assessment of outcomes.

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“The Renal Foot” - Angiographic Pattern of Patients with Chronic Limb Threatening Ischemia and End-Stage Renal Disease

Cited by 14 publications

References 13 publications

Arteriographic patterns of peripheral arterial disease in lower limbs in a Peruvian cohort of patients

Arteriographic patterns of peripheral arterial disease in lower limbs in a Peruvian cohort of patients

New Innovations and Devices in the Management of Chronic Limb-Threatening Ischemia

A Review and Proposed Classification System for the No-Option Patient With Chronic Limb-Threatening Ischemia

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