Vascular Involvement in Diabetic Subjects with Ischemic Foot Ulcer: A New Morphologic Categorization of Disease Severity

Graziani, Lanfroi; Silvestro, Antonio; Bertone, Vittorio; Manara, E; Andreini, Roberto; Sigala, A.; Mingardi, R.; Giglio, Roberto De

doi:10.1016/j.ejvs.2006.11.022

Cited by 287 publications

(104 citation statements)

References 21 publications

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“…Although reasons for this are unclear, rest pain is often caused by multilevel obstruction to arterial flow rather than discrete blockage (as is more commonly observed in patients with wounds) 19, 20. Furthermore, the occurrence of wound healing suggests response to therapy and adequate tissue perfusion, which may infer better outcomes than patients with persistent rest pain.…”

Section: Discussionmentioning

confidence: 99%

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Reed

Raeisi‐Giglou

Kafa

et al. 2016

JAHA

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BackgroundThe significance of hospital readmission after endovascular therapy for critical limb ischemia (CLI) is not well established. We sought to investigate the incidence, timing, and causes of readmissions after endovascular therapy for CLI and whether readmission is associated with major adverse limb events (MALE) or mortality.Methods and ResultsThis was a retrospective study of 252 patients treated with endovascular therapy for CLI. During median follow‐up of 381 days (interquartile range [IQR], 115–718), 140 (56%) were readmitted, with median time to readmission of 83 days (IQR, 33–190). Readmission within 30 days occurred in 14% of patients (n=35; 25% of readmissions). Most readmissions occurred between 30 and 180 days (n=67; 48% of readmissions). The most frequent reason for readmission was unhealed wounds (n=63; 45% of readmissions). Independent predictors of readmission by Cox proportional hazards analysis were unhealed wounds, presence of multiple wounds, age ≥70, female sex, hemodialysis, and history of heart failure (P<0.05 for each). By Kaplan–Meier analysis, readmission was greatest in patients with unhealed wounds, followed by patients who never had a wound, and lowest in patients whose wounds completely healed (P<0.0001 overall, and P<0.01 between groups). After multivariable adjustment, readmission remained an independent predictor of composite MALE (major amputation, bypass, or endarterectomy) or mortality (adjusted hazard ratio, 3.1; 95% CI, 1.5–6.5; P=0.002).ConclusionsMost readmissions occur 30 and 180 days after endovascular therapy for nonprocedural reasons. Unhealed wounds are an independent risk factor for readmission. Readmission is associated with increased MALE and mortality after endovascular therapy for CLI.

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Section: Discussionmentioning

confidence: 99%

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Reed

Raeisi‐Giglou

Kafa

et al. 2016

JAHA

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“…5,6 The success rates are also lower in the case of endovascular techniques for bypass salvaged78.9% for Mofidi et al 1 In these patients, the surgical alternative through a distal bypass is not a feasible option owing to their elevated comorbidities, the absence of an adequate vein, or the absence of an adequate runoff flow. 7,8 In our patient, the decision was made to try every possible endovascular treatment modality, given the type of lesion, the comorbidities, and the absence of an autologous vein for a sequential bypass. After an unsuccessful attempt at crossing the lesion through an anterograde access, the retrograde access was considered the best option, as the patient had a patent distal vessel (posterior tibial artery) that entered the foot.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Approach for Endovascular Salvage of an Infrapopliteal Vein Bypass

Revuelta¹,

Gastambide²,

San-Norberto³

et al. 2012

Annals of Vascular Surgery

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“…Infrainguinal disease (FP and IP) can be further subdivided into those with predominantly isolated IP disease ( 33%) and those with both FP and IP disease ( 67%) [4][5][6][7].…”

Section: Anatomic Considerationsmentioning

confidence: 99%

SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use

Gray

Díaz‐Sandoval

Dieter

et al. 2014

Cathet Cardio Intervent

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Intervention to treat infrapopliteal arterial disease can be challenging because the patients' comorbidities, the anatomic variables, and the limitations of our techniques. Clinical scenarios based on anatomic and clinical variables are presented. Recommendations regarding intervention (appropriate care, may be appropriate care, rarely appropriate care) are made based on best evidence. V C 2014 Wiley Periodicals, Inc.Key words: peripheral intervention; appropriate use; peripheral arterial disease INTRODUCTION Infrapopliteal (IP) arterial disease or "below the knee" arterial disease is commonly seen in patients with long-standing diabetes mellitus, chronic kidney disease, or the elderly. The most concerning manifestation of peripheral arterial disease (PAD) in these high risk patients is the development of critical limb ischemia (CLI: ischemic rest pain or ischemic ulcers). This arterial bed consists of relatively small caliber vessels, which are often calcified and associated with diffuse, multilevel disease. Due to the complexity of this patient population, their co-morbidities, and severity of vascular disease, there is a paucity of scientific evidence for the generalizability of percutaneous revascularization.In general, non-ambulatory patients with a short life expectancy and extensive necrosis or gangrene should undergo primary amputation. Ambulatory patients who are acceptable surgical candidates, expected to survive more than two years with a patent IP artery that provides direct flow to the foot (considered to be a good distal target), and an adequate autologous venous conduit should be considered for surgical bypass. Patients with significant medical co-morbidities that limit life expectancy, those at increased risk for surgery, those without an adequate distal target for bypass, or with poor venous conduit should be considered for an endovascular-first approach.This document was developed to guide physicians in clinical decision-making in the modern practical application of endovascular intervention for patients with IP arterial disease. ANATOMIC CONSIDERATIONSPatients with CLI typically have disease involving multiple levels (i.e., aorto-iliac, femoropopliteal (FP) and IP), but less than 10% of patients with CLI have hemodynamically significant disease in all three levels [1][2][3] (Table I). Infrainguinal disease (FP and IP) can be further subdivided into those with predominantly isolated IP disease ( 33%) and those with both FP and IP disease ( 67%) [4][5][6][7].Additional Supporting Information may be found in the online version of this article. Catheterization and Cardiovascular Interventions 84:539-545 (2014) Isolated IP disease is mainly seen in the elderly (>80-years old), diabetic, or dialysis-dependent patients [5]. These patients are at higher risk for amputation and have a shorter amputation-free survival compared to those with FP and IP disease (median amputation-free survival: 17 months (95% CI ¼ 9-24 m) versus 37 months (95% CI ¼ 28-44 m), P ¼ 0.001) [6]. Clinical and non-invasive cr...

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Vascular Involvement in Diabetic Subjects with Ischemic Foot Ulcer: A New Morphologic Categorization of Disease Severity

Abstract: In CLI diabetic subjects with ischemic foot ulcer, the vascular involvement is extremely diffuse and particularly severe in tibial arteries, with high prevalence of long occlusions. A new morphologic categorization of these patients is proposed.

Cited by 287 publications

References 21 publications

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Retrograde Approach for Endovascular Salvage of an Infrapopliteal Vein Bypass

SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use

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