Thematische Bibliographien / Critical limb threatening ischemia

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Auswahl der wissenschaftlichen Literatur zum Thema „Critical limb threatening ischemia“

Autor: Grafiati

Veröffentlicht am 25. Juni 2021

Zuletzt aktualisiert am 1. Februar 2022

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Zeitschriftenartikel zum Thema "Critical limb threatening ischemia"

Suresh, KalkunteR. „What Ails Diagnosis of Peripheral Arterial Disease/Critical Limb Ischemia/Critical Limb-threatening Ischemia in India?“ Indian Journal of Vascular and Endovascular Surgery 4, Nr. 4 (2017): 139. http://dx.doi.org/10.4103/ijves.ijves_59_17.

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Azab, Sandi, Philip Britz-McKibbin, Abdelrahman Zamzam, Rawand Abdin und Mohammad Qadura. „Serum Metabolomic Profile of Critical Limb-Threatening Ischemia Patients“. Journal of Vascular Surgery 72, Nr. 1 (Juli 2020): e214. http://dx.doi.org/10.1016/j.jvs.2020.04.362.

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Chandra, Ankur, und Niren Angle. „Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli“. Vascular 14, Nr. 3 (01.05.2006): 156–60. http://dx.doi.org/10.2310/6670.2006.00029.

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Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.

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krisnasari, Imelda, Novi Kurnianingsih, Mohammad Saifur Rohman und Budi Satrijo. „Limb Preservation with Balloon Angioplasty in Critical Limb Threatening Ischemia: A Case Report“. Heart Science Journal 2, Nr. 2 (01.04.2021): 25–30. http://dx.doi.org/10.21776/ub.hsj.2021.002.02.6.

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Introduction: Chronic limb-threatening ischemia (CLTI) is a syndrome that represents the end-stage of peripheral artery disease (PAD) that increased the risk of major amputation and cardiovascular events. The initial treatment for CLTI may significantly impact the risk of major amputation or death. Objective: This case report aims to describe limb preservation with balloon angioplasty in a Critical Limb Ischemia patient. Case Presentation: A hypertensive 72-years old female complained of left leg pain followed by a wound on her left toe four months ago. Her toe was amputated, but the wound persists. On physical examination, the pulsation was diminished in her left foot. Duplex ultrasound showed monophasic spectral doppler from left popliteal artery to distal left anterior tibial artery (ATA) and distal posterior tibial artery (PTA). CT-Angiography showed short total occlusion (2cm) at the distal left Superficial Femoral artery (SFA), multiple stenoses with maximal 90% stenosis at the left ATA, and chronic total occlusion at the proximal-mid left posterior tibial artery (PTA). She was diagnosed with CLTI left inferior extremity Fontaine IV Rutherford 5. The angiography result was similar to the CT-angiography result. The patient was successfully treated with plain balloon angioplasty from distal left SFA to distal left ATA and drug-coated balloon angioplasty from the distal left SFA to the popliteal artery. Her wound was also consulted to the surgical department. Conclusion: Appropriate revascularization is fundamental to limb preservation. We successfully perform endovas- cular strategy with TIMI flow 3 from left SFA to distal left ATA and distal PTA in our patient, but we still need further holistic CLTI management.

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Silva, J. „Mechanical Thrombectomy in the Treatment of Acute Critical Limb Threatening Ischemia“. Journal of the American College of Cardiology 31, Nr. 2 (Februar 1998): 521A. http://dx.doi.org/10.1016/s0735-1097(97)88271-x.

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Silva, J. A., E. Ramee, S. Y. Zhang, T. J. Collins, J. S. Jenkins, C. J. White und S. R. Ramee. „Mechanical thrombectomy in the treatment of acute critical limb threatening ischemia“. Journal of the American College of Cardiology 31 (Februar 1998): 521. http://dx.doi.org/10.1016/s0735-1097(98)80622-0.

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Dhillon, Ashwat S., Jorge Caro, Han Tun, David G. Armstrong, Vincent Rowe, David M. Shavelle und Leonardo C. Clavijo. „Therapeutic Window of Clopidogrel and Ticagrelor in Patients With Critical Limb-Threatening Ischemia“. Journal of Cardiovascular Pharmacology and Therapeutics 25, Nr. 2 (24.09.2019): 158–63. http://dx.doi.org/10.1177/1074248419877411.

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Background: Critical limb-threatening ischemia (CLTI) is associated with an increased risk of major adverse limb events and mortality. High on-treatment platelet reactivity (HPR) is associated with an increased risk of ischemic events, while low on-treatment platelet reactivity (LPR) is associated with an increased risk of bleeding. This study investigates the frequency with which patients with CLTI on clopidogrel or ticagrelor achieve a “therapeutic window” (TW) of platelet inhibition. Methods: Data from the “Switch To Ticagrelor in Critical Limb Ischemia Anti-Platelet Study” were assessed retrospectively to determine the incidence of TW of on-treatment platelet reactivity in 50 consecutive patients with CLTI (mean age: 65.2 ± 10.5 years, 54% male). The data included 4 measurements of patients’ platelet reactivity using the VerifyNow P2Y12 Assay: baseline and steady state platelet reactivity on clopidogrel 75 mg daily and on ticagrelor 90 mg twice daily. Results: At baseline, 46% of patients on clopidogrel were within TW of on-treatment platelet reactivity compared to 10% of patients on ticagrelor ( P < .0001). At steady state, 42% of patients on clopidogrel were within the TW compared to 10% of patients on ticagrelor ( P < .0001). Patients on ticagrelor exhibited higher rates of LPR compared to those on clopidogrel at baseline as well as at steady state (baseline 88% vs 18%, steady state 88% vs 28%; P < .0001). Conclusion: Although ticagrelor has been proposed as an alternative for patients with HPR on clopidogrel, the current study observes an excess of platelet inhibition with ticagrelor in most patients with CLTI at a dose of 90 mg twice daily.

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Hage, Anthony, Joseph McDevitt, Jeffrey Chick und Venu Vadlamudi. „Acute Limb Ischemia Therapies: When and How to Treat Endovascularly“. Seminars in Interventional Radiology 35, Nr. 05 (Dezember 2018): 453–60. http://dx.doi.org/10.1055/s-0038-1676321.

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AbstractAcute limb ischemia is an emergent limb and life-threatening condition with high morbidity and mortality. An understanding of the presentation, clinical evaluation, and initial workup, including noninvasive imaging evaluation, is critical to determine an appropriate management strategy. Modern series have shown endovascular revascularization for acute limb ischemia to be safe and effective with success rates approaching surgical series and with similar, or even decreased, perioperative morbidity and mortality. A thorough understanding of endovascular techniques, associated pharmacology, and perioperative care is paramount to the endovascular management of patients presenting with acute limb ischemia. This article discusses the diagnosis and strategies for endovascular treatment of acute limb ischemia.

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Amann, Lüdemann, Rückert, Lawall, Liesenfeld, Schneider und Schmidt-Lucke. „Design and rationale of a randomized, double-blind, placebo-controlled phase III study for autologous bone marrow cell transplantation in critical limb ischemia: the BONe Marrow Outcomes Trial in Critical Limb Ischemia (BONMOT-CLI)“. Vasa 37, Nr. 4 (01.11.2008): 319–25. http://dx.doi.org/10.1024/0301-1526.37.4.319.

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Background: Critical limb ischemia (CLI) is the end-stage of peripheral artery disease. Only about two thirds of patients with CLI can be revascularised, one third progresses to leg amputation with high associated morbidity and mortality. Therapeutic angiogenesis with bone marrow cells has shown promising improvement in less severe stages of peripheral ischemia. Our study evaluates the therapeutic value of bone marrow cell induced angiogenesis and arteriogenesis in severe, limb-threatening ischemia. Patients and methods: the BONe Marrow Outcome Trial in Critical Limb Ischemia (BONMOT-CLI) is a investigator-initiated, double-blinded, 1:1 randomized, placebo-controlled multi-centre study at 4 sites in Germany. Only patients with no option for revascularisation or after failed revascularisation will be included. A total of 90 patients is to be included. One arm with 45 subjects will be treated with a concentrate of autologous bone marrow cells which will be injected at 40 sites into the ischemic limb. In the placebo arm, study subjects will undergo a sham bone marrow punction and 40 saline injections. At three months, a combined primary endpoint of major amputation or persisting critical limb ischemia (no clinical or perfusion improvement) will be evaluated. Secondary endpoints are death, changes in perfusion, quality of life, walking distance, minor amputations, wound healing, collateral density and cancer incidence. Post-study follow-up is up to two years. Conclusions: The results of this first randomized placebo-controlled trial for autologous bone marrow cell therapy in CLI will clarify the value of this new therapeutic modality in a patient population with no other alternatives except major amputation.

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Armstrong, Ehrin J., Syed Alam, Steve Henao, Arthur C. Lee, Brian G. DeRubertis, Miguel Montero-Baker, Carlos Mena et al. „Multidisciplinary Care for Critical Limb Ischemia: Current Gaps and Opportunities for Improvement“. Journal of Endovascular Therapy 26, Nr. 2 (01.02.2019): 199–212. http://dx.doi.org/10.1177/1526602819826593.

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Critical limb ischemia (CLI), defined as ischemic rest pain or nonhealing ulceration due to arterial insufficiency, represents the most severe and limb-threatening manifestation of peripheral artery disease. A major challenge in the optimal treatment of CLI is that multiple specialties participate in the care of this complex patient population. As a result, the care of patients with CLI is often fragmented, and multidisciplinary societal guidelines have not focused specifically on the care of patients with CLI. Furthermore, multidisciplinary care has the potential to improve patient outcomes, as no single medical specialty addresses all the facets of care necessary to reduce cardiovascular and limb-related morbidity in this complex patient population. This review identifies current gaps in the multidisciplinary care of patients with CLI, with a goal toward increasing disease recognition and timely referral, defining important components of CLI treatment teams, establishing options for revascularization strategies, and identifying best practices for wound care post-revascularization.

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Mehr Quellen

Dissertationen zum Thema "Critical limb threatening ischemia"

Öberg, Andreas, und Martin Hulterström. „Semantic segmentation using convolutional neural networks to facilitate motion tracking of feet : For real-time analysis of perioperative microcirculation images in patients with critical limb thretening ischemia“. Thesis, Linköpings universitet, Avdelningen för medicinsk teknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-176795.

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This thesis investigates the use of Convolutional Neural Networks (CNNs) toperform semantic segmentation of feet during endovascular surgery in patientswith Critical Limb Threatening Ischemia (CLTI). It is currently being investigatedwhether objective assessment of perfusion can aid surgeons during endovascularsurgery. By segmenting feet, it is possible to perform automatic analysis of perfusion data which could give information about the impact of the surgery in specificRegions of Interest (ROIs). The CNN was developed in Python with a U-net architecture which has shownto be state of the art when it comes to medical image segmentation. An imageset containing approximately 78 000 images of feet and their ground truth segmentation was manually created from 11 videos taken during surgery, and onevideo taken on three healthy test subjects. All videos were captured with a MultiExposure Laser Speckle Contrast Imaging (MELSCI) camera developed by Hultman et al. [1]. The best performing CNN was an ensemble model consisting of10 sub-models, each trained with different sets of training data. An ROI tracking algorithm was developed based on the Unet output, by takingadvantage of the simplicity of edge detection in binary images. The algorithmconverts images into point clouds and calculates a transformation between twopoint clouds with the use of the Iterative Closest Point (ICP) algorithm. The resultis a system that perform automatic tracking of manually selected ROIs whichenables continuous measurement of perfusion in the ROIs during endovascularsurgery.

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Knaus, Juerg Peter Andrew. „Intraoperative catheter thrombolysis as an adjunct to surgicall revascularisation for infraingquinal limb-threatening ischemia /“. [S.l : s.n.], 1994. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.

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Gómez, Jabalera Efrem. „Clinical application of 2D perfusion angiography in critical limb ischemia revascularization“. Doctoral thesis, Universitat Autònoma de Barcelona, 2020. http://hdl.handle.net/10803/670534.

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El tractament endovascular de la malaltia arterial perifèrica està basat en les imatges angiogràfiques. La interpretació subjectiva feta a partir d’elles és com més habitualment s’avalua l’èxit del tractament durant la revascularització. L’angiografia de perfusió 2D (AP) és un software de processat de la imatge que podria donar peu a la quantificació de la perfusió distal. Endemés, un sistema de classificació anatòmic més senzill, capaç de descriure la càrrega de malaltia arterial per sota de l’engonal, és necessari per poder triar el millor tractament per un pacient concret. La intenció d’aquesta tesis és identificar una mesura objectiva per avaluar l’èxit del tractament endovascular basant-se en la quantificació de la perfusió del teixit amb l’AP; i per consegüent tenir la capacitat de predir amb major precisió la curació de les úlceres isquèmiques. Secundàriament, hem buscat adaptar un sistema de classificació que pugui ser aplicat amb facilitat a la pràctica clínica diària i que permeti la comparació entre pacients a assajosi estudis clínics. La investigació del projecte present es va realitzar amb un estudi de cohorts retrospectiu amb pacients consecutius sotmesos a tractament endovascular en un únic centre especialitzat en tractament de la isquèmia crítica de l’extremitat. Als pacients se’ls va realitzar una AP abans i després del tractament, i també es van classificar d’acord amb els sistemes de classificació més utilitzats (Rutherford, TASC i WIfI) i amb una nova classificació proposta: l’score d’Abano Terme (ATS). Les dades demogràfiques i clíniques es van recollir i es va realitzar un seguiment clínic al mes i als 6 mesos. Els paràmetres de l’AP van ser el temps d’arribada (AT), el temps de pic (PT), la velocitat del rentat (WS), l’amplada (W), l’àrea sota la corba (AUC) i el temps de trànsit mig (MTT). Les dos cohorts es van definir en base a un temps de curació major o menor a 30 dies. Des del gener de 2015 fins al juliol de 2016, 580 pacients consecutius van ser tractats endovascularment i van ser estudiats amb AP. D’entre ells, 332 complien els criteris d’inclusió, dels quals 123 van ser exclosos posteriorment de l’anàlisi per la curació de les úlceres (en 34 casos la imatge de l’AP tenia mala qualitat, 50 pacients no presentaven úlceres, 20 van finar i 19 no van completar el seguiment). L’edat mitja va ser de 72 anys i el 67,5% eren homes. 133 pacients presentaven lesions Rutherford 5 i en 76 les lesions eren Rutherford 6. El risc WIfI d’amputació va ser baix en un 24%, moderat en un 14% i alt en un 62%. Vam trobar taxa de curació als 30 dies, amb diferències estadísticament significatives entre els grups, per als següents punts de tall dels paràmetres de l’AP: AT > 6 segons i MTT > 4.1 23 segons o un increment del mateix MTT > 1,7 segons. L’ATS, sent un sistema de classificació més senzill que es existents actualment, no només es va correlacionar millor que amb la TcPO2 i amb l’AP; sinó que en un posterior anàlisis va demostrar millor correlació amb la curació de les úlceres i la supervivència lliure d’amputació en pacients amb lesions Rutherford 5.
El tratamiento endovascular de la enfermedad arterial periférica está basado en las imágenes angiográficas. La interpretación subjetiva hecha a partir de ellas es el modo más habitual de evaluar el éxito del tratamiento durante la revascularización. La angiografía de perfusión 2D (AP) es un software de procesado de la imagen que podría permitir la cuantificación de la perfusión distal. Además, un sistema de clasificación anatómico más sencillo, capaz de describir la carga de enfermedad arterial por debajo de la ingle, es necesario para decidir el mejor tratamiento para un paciente dado. La intención de esta tesis es identificar una medida objetiva para evaluar el éxito del tratamiento endovascular basado en la cuantificación de la perfusión del tejido con la angiografía de perfusión; y por ende ser capaz de predecir con mayor precisión la curación de las úlceras isquémicas. Secundariamente, hemos tratado de adaptar un sistema de clasificación que pueda ser aplicada fácilmente a la práctica clínica diaria y que permita comparaciones entre pacientes en ensayos clínicos y estudios. La investigación de este proyecto se basó en un estudio de cohortes retrospectivo con pacientes consecutivos sometidos a tratamiento endovascular en un único centro especializado para el tratamiento de la isquemia crítica de la extremidad. Los pacientes fueron analizados con AP antes y después del tratamiento, y también se clasificaron de acuerdo con los sistemas más utilizados (Rutherford, TASC y WIfI) y con una nueva clasificación propuesta: el score de Abano Terme (ATS). Los datos demográficos y clínicos se recogieron y se realizó un seguimiento clínico a al primer mes y a los 6 meses. Los parámetros de la AP fueron tiempo de llegada (AT), el tiempo de pico (PT), la velocidad de lavado (WS), la amplitud (W), el área bajo la curva (AUC) y el tiempo de tránsito medio (MTT). Las dos cohortes se definieron en base a un tiempo de curación de menor o mayor a 30 días. De enero de 2015 a julio de 2016, 580 pacientes consecutivos se sometieron a un tratamiento endovascular, realizándose en ellos un análisis con AP. Entre ellos, 332 cumplieron los criterios de inclusión, de los cuales 123 se excluyeron del análisis de curación de úlceras (34 debido a la mala calidad de la imagen de AP, 50 pacientes no presentaban úlceras, 20 fallecieron y 19 no completaron el seguimiento). La edad media fue de 72 años y el 67,5% eran hombres. 133 pacientes presentaban lesiones Rutherford 5 y en 76 las lesiones eran Rutherford 6. El riesgo WIfI de amputación fue bajo en 24%, moderado en 14% y alto en 62%. Encontramos una tasa curación a los 30 días , con diferencias estadísticamente significativas entre los grupos, para los siguientes valores de corte de los parámetros de la AP: 25 AT > 6 segundos y MTT> 4.1 segundos o un incremento del mismo MTT > 1.7 segundos. El ATS, siendo un sistema de clasificación más simple que los actualmente empleados, no sólo se correlacionó mejor con la TcPO2 y la angiografía de perfusión; sino que en un posterior análisis demostró una mejor correlación con la curación de las úlceras y la supervivencia libre de amputación en pacientes con lesiones Rutherford 5.
The endovascular treatment (EVT) of Peripheral Arterial Disease (PAD) is based on angiographic imaging and post-revascularization treatment success is based on the subjective interpretation of this visual assessment. 2D perfusion angiography (PA) is an image- processing software which may allow for the quantification of perfusion. In addition, a simpler anatomic classification system, able to describe the arterial disease burden below the groin, needs to be designed to determine the best therapy for any given patient.(1) The aim of this thesis is to create an objective system to assess the success of EVT based on the quantification of tissue perfusion through PA, capable of accurately predicting the healing probability of ischemic ulcers. Secondly, we seek to describe a classification system of easy application during daily clinical practice that will also facilitate comparison of patients among clinical trials. The Project was designed as a retrospective cohort study with consecutive patients undergoing EVT at a single specialized center for critical limb ischemia (CLI). The cases were analyzed with PA before and after treatment, and also ranked according to current classification systems (Rutherford, TASC and WIfI) and a new proposed classification: the Abano Terme Score (ATS). Demographic and clinical data were recorded and clinical follow- up was performed (at 1 and 6 months). The PA parameters were Arrival Time (AT), Peak Time (PT), Wash-in Rate, Width, Area Under Curve and Mean Transit Time (MTT). Two cohorts were defined based upon a time to heal of less or longer than 30 days. From January 2015 to July 2016, PA analysis was performed on 580 consecutive patients that underwent EVT. Among them, 332 met the inclusion criteria to be studied, from which 123 were excluded for ulcer healing analysis (34 because of poor image quality, 50 patients had no ulcer, 20 died and 19 were lost at follow-up). Mean age was 72 years and 67.5% were men; 133 patients had Rutherford 5 and 76 had Rutherford 6 lesions, with similar distribution in both groups. The WIfI risk for amputation was also similar for both groups, and it was low in 24%, moderate in 14% and high in 62%. We found significant differences between groups in the healing time for the following cut-off values of PA parameters: AT>6 seconds and improvement of MTT>1.7 seconds or the MTT>4.1 seconds after the treatment. The ATS, while being a simpler classification than current used system, not only showed a better correlation with parameters such as the transcutaneous pressure of oxygen (TcPO2) and PA; but also demonstrated, in a subsequent analysis, a better correlation with ulcer healing and amputation free-survival in patients with Rutherford 5 lesions.

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Magri, Dania. „Diminished circulating monocytes after peripheral bypass surgery for critical limb ischemia“. [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-133251/.

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Gaddam, Sathvika, Momani Laith Al, Ali Bokhari und Melania Bochis. „CRITICAL UPPER LIMB ISCHEMIA IN A PATIENT WITH NEW-ONSET ATRIAL FIBRILLATION“. Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/70.

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Atrial fibrillation is the most common type of serious dysrhythmia, with increasing prevalence in older age groups. Thromboembolism is a serious complication seen with atrial fibrillation and can range from ischemic stroke, mesenteric ischemia to acute limb ischemia. The annual incidence of acute limb ischemia secondary to atrial fibrillation is 0.14%[1]. Here we report a case of critical limb ischemia with brachial artery occlusion due to an embolus in a patient with new onset atrial fibrillation. A 90 year-old female patient presented to the hospital with complaints of shortness of breath on exertion, orthopnea and palpitations of one week duration. She denied any chest pain, dizziness, or syncope. Past medical history was significant for longstanding hypertension well controlled with amlodipine and a provoked deep vein thrombosis of the leg 40 years prior to presentation complicated by heparin-induced thrombocytopenia. On examination, she had an irregularly irregular rhythm and an HR in 120s, no murmurs or gallops were appreciated. 12 lead EKG was suggestive of atrial fibrillation with rapid ventricular response. She was started on metoprolol tartrate for rate control and Apixaban for anticoagulation. TSH was normal and serial troponins returned negative. A Transthoracic echocardiogram was obtained and showed an ejection fraction of 55-60%, mildly dilated left atrium, mild MR, there was no evidence of a thrombus or patent foramen ovale. Three hours after the first dose of Apixaban, and right prior to discharge, the patient started complainig of sudden onset sharp pain and paresthesia of the left upper extremity below the elbow. On Inspection, the left upper extremity was pale and cold to touch. Radial and ulnar pulses were absent, confirmed by doppler ultrasound. A stat computed tomography angiography of the left upper extremity showed complete occlusion of the brachial artery at the level of the elbow joint. She was started on Argatroban drip en route for emergent brachial embolectomy after Vascular Surgery consultation. Blood circulation to the arm was fully restored. Apixaban was resumed post-operatively and with clinical improvement, the patient was safely discharged home. Atrial fibrillation, irrespective of the type (persistent, paroxysmal, permanent or silent) leads to increased risk of thromboembolism owing to atrial clot formation[2]. However, the timing of initiation of antithrombotic therapy has been widely discussed and needs to be individualized based on the presence of risk factors for thromboembolism and bleeding. Acute limb ischemia may be defined as sudden loss of blood flow to the limb. The cause being either thrombotic (60%) or embolic (30%). It has been noted that 80% of peripheral emboli originate in the heart secondary to atrial fibrillation[3]. A timely diagnosis and treatment is of utmost importance to decrease morbidity and mortality and to salvage the limb’s functionality. References 1.Thromboembolism in atrial fibrillation Menke J1, Lüthje L, Kastrup A, Larsen J. 2.Writing Committee Members, January CT, Wann LS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-e267. doi:10.1161/CIR.0000000000000041. 3.Callum K, Bradbury A. Acute limb ischaemia. BMJ : British Medical Journal. 2000;320(7237):764-767.

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Coetzee, Andreas Retief. „Global and regional myocardial and circulatory function during anaesthesia in the normal heart and in the presence of threatening or overt myocardial ischemia“. Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85584.

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Thesis (DSc)--Stellenbosch University, 2013.
AFRIKAANSE OPSOMMING: Hierdie DSc is fundeer op ‘n aantal aspekte rondom ‘n sentrale tema naamlik die algemene en streeksfunksie van die normale hart of die hart blootgestel aan die risiko van miokardiale isgemie. Die werk is oor ‘n bestek van 25 jaar gedoen en sluit in eksperimentele werk in groot en kleindiere sowel as data verkry in pasiënte. Hoofstuk 1 handel met globale en streeksfunksie in die normale hart met die klem op die meer moderne benadering tot die koppeling van die hart met die sirkulasie en effek van middels op die twee komponente. Hierdie hoofstuk het waardevolle inligting gegee t.o.v. fisiologie maar ook gehelp om die middels te kies vir daaropvolgende studies. Hoofstuk 2 bevat navorsing wat verwys na die hart met kroonaarstenose. Onder andere word gesteun op ‘n dieremodel van kroonaarstenose. Die hoofstuk sluit data in wat , as eerste en unieke bydrae, gewys het dat inhalasie narkose middels die reperfusie besering van die hart kan verminder. Hierdie data het spesifiek bygedra om die kliniese praktyk van narkose vir hierdie pasiënte te verander. Hoofstuk 3 verwys na werk gedoen om die hart gedurende elektiewe chirurgiese arres te oksigeneer. Die effektiwiteit van verskillende kardioplegiese vloeistofsamestellings is ook krities ontleed. Die vierde hoofstuk handel met ‘n ernstige kliniese probleem naamlik akute pulmonêre hipertensie. By pasiënte met akute long besering is hierdie verskynsel baiemaal die oorsaak van dood en of moeitevolle oksigenasie. Die werk het gelei tot beter insigte t.o.v. pasiënt hantering tot die punt dat baie van die pasiënte vandag gered kan word.
ENGLISH ABSTRACT: This thesis is based on a number of aspects with a central theme of global and regional cardiac function in the normal heart and the heart at risk of ischemia. It summarizes work done over 25 years and includes experimental work in large and small animals as well as data obtained from human clinical practice. Chapter one deals with global and regional heart function and especially the physiological concept of ventriculo-arterial coupling as a mechanism to explain and understand the effects of inter alia commonly used drugs. Chapter 2 summarizes work done in hearts with a coronary artery stenosis. One of the interesting ,and at that time, unique findings was that inhalation anesthetic drugs are effective in limiting the reperfusion injury of the heart. This insight helped to redirect techniques used to anaesthetize patients with coronary artery disease. The third chapter examines methods to improve myocardial oxygenation during elective surgical cardiac arrest. It also includes data showing that not all the cardioplegic solutions are equally effective. Chapter four deals with a significant clinical problem i.e. acute pulmonary artery hypertension. This condition is often responsible for patient death, or contributes to, difficult oxygenation in patients with acute lung injury. The work in this chapter assisted in understanding the pathophysiology of the condition and improved the management thererof. This insight, combined with progress in other areas in the pathology or acute lung injury, has led to many of the patients today surviving their illness.

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Bunte, Matthew C. „RELATIONSHIP OF INFRAGENICULAR ARTERIAL PATENCY WITH ANKLE-BRACHIAL INDEX AND TOE-BRACHIAL INDEX IN CRITICAL LIMB ISCHEMIA“. Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1396547589.

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Motsumi, Mpapho. „Pattern and distribution of peripheral arterial disease in diabetic patients with critical limb ischemia (Rutherford Clinical Category 4-6)“. Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20964.

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Background: The literature tends to support the notion that diabetic patients typically suffer from tibio-peroneal artery occlusive disease (1) (2) (11) (5) (10) (8) with relative sparing of the foot arteries (1). This study seeks to investigate the pattern and distribution of peripheral artery occlusive disease and the arterial foot arch status in diabetic patients with critical limb ischaemia Methods: This is a one year prospective study -(January 2014 to December 2014) carried out on consecutive patients seen at Groote Schuur Hospital, Vascular Department. The inclusion criteria is: diabetic patients ≥18 years of age with critical limb ischemia who had pre- and post-intervention vascular imaging. The calculated minimum sample size of 63 limbs [756 patency levels (63x12)] was needed to achieve a power of 86% to detect a difference of 0.1900 (19%) with a target significance level of 0.05 (using PASS 11 software). The equality of distribution of categories was analyzed using the One sample Chi-square test (SPSS 22) with our Null hypothesis (N0) assuming that categories occur with equal proportions. In this case categories refers to the 5 patency levels used in this study. All 12 main arteries from infra-renal aorta to crural arteries had their patency levels graded from category 1 to category 5 (widely patent to occluded). The findings were then stratified according to gender, age group ( <40 years, 40-54 years and ≥ 55 years) and risk factor combinations [ Group1 = (DM, HPT, Dyslipidemia); Group 2= (DM, HPT, dyslipidemia, exsmoker); Group 3 = (DM, HPT, dyslipidemia, smoker)]. The three risk combination groups formed the majority of our study group (79%).

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Sarlon-Bartoli, Gabrielle. „Outils diagnostique et thérapeutique innovants de la dysfonction vasculaire au cours des maladies artérielles périphériques“. Thesis, Aix-Marseille, 2012. http://www.theses.fr/2012AIXM5510/document.

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Les maladies artérielles périphériques athéromateuses sont graves : l'atteinte des troncs supra-aortiques est à risque d'accident vasculaire cérébral et l'atteinte des artères des membres inférieurs est à risque d'amputation et de décès cardiovasculaire. Le développement de stratégies innovantes capables d'optimiser le diagnostic précoce et le traitement de ces maladies est un enjeu considérable.Nous montrons une corrélation entre deux biomarqueurs inflammatoires, les microparticules leucocytaires (MPL) et la lipoprotéine phospholipase A2, et l'instabilité de la plaque carotidienne définie histologiquement, dans une population de patients porteurs d'une sténose carotidienne serrée. Les MPL sont élevées de façon significative et indépendante y compris chez les patients asymptomatiques porteurs d'une sténose carotidienne serrée instable. Ainsi, le taux circulant de MPL aider à sélectionner les meilleurs candidats à une chirurgie carotidienne préventive parmi les patients ayant une sténose carotidienne serrée asymptomatique. Deuxièmement, nous montrons que l'administration ex vivo d'érythropoïétine (EPO) améliore les capacités proangiogéniques des progéniteurs endothéliaux circulants tardifs in vitro et in vivo sur un modèle d'ischémie de patte de souris nude. Ces effets semblent médiés par la sous-unité CD131 du récepteur à l'EPO. Si ces résultats se confirment chez l'homme, l'EPO pourrait être utilisée pour améliorer les capacités de revascularisation des progéniteurs endothéliaux circulants tardifs circulants humains avant réinjection autologue comme produit de thérapie cellulaire chez des patients atteints d'ischémie critique des membres inférieurs
Atherosclerotic peripheral arterial diseases are frequent and severe. They undertake the functional and vital prognosis of patients: lesions of supra-aortic trunks are at risk of stroke and lesions of lower limb arteries are at risk of amputation and cardiovascular death. The development of innovative strategies that optimize early diagnosis and therapeutic management of these diseases is thus a considerable challenge.In this work, we show a correlation between inflammatory biomarkers, leukocyte microparticles and lipoprotein phospholipase A2, and carotid plaque instability defined histologically, in a population of patients with tight carotid stenosis with or without neurological symptoms. Leukocyte microparticles are elevated significantly and independently including asymptomatic patients with tight unstable carotid stenosis. Thus, the circulating levels of leukocyte microparticles could be a tool in the future to select the best candidates for carotid surgery among patients with asymptomatic carotid stenosis tight.Second, we show that ex vivo administration of erythropoietin improves the proangiogenic capacity of late circulating endothelial progenitor in vitro and in vivo in a mouse model of hindlimb ischemia. These effects appear mediated by CD131 subunit of the receptor for erythropoietin. If these results are confirmed in humans, erythropoietin could be used to improve the revascularization capacity of late circulating endothelial progenitor before reinjection as autologous cell therapy product in patients with critical ischemia of the lower limbs

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Layman, Hans Richard William. „Tissue Engineering Strategies for the Treatment of Peripheral Vascular Diseases“. Scholarly Repository, 2010. http://scholarlyrepository.miami.edu/oa_dissertations/461.

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Peripheral vascular diseases such as peripheral artery disease (PAD) and critical limb ischemia (CLI) are growing at an ever-increasing rate in the Western world due to an aging population and the incidence of type II diabetes. A growing economic burden continues because these diseases are common indicators of future heart attack or stroke. Common therapies are generally limited to pharmacologic agents or endovascular therapies which have had mixed results still ending in necrosis or limb loss. Therapeutic angiogenic strategies have become welcome options for patients suffering from PAD due to the restoration of blood flow in the extremities. Capillary sprouting and a return to normoxic tissue states are also demonstrated by the use of angiogenic cytokines in conjunction with bone marrow cell populations. To this point, it has been determined that spatial and temporal controlled release of growth factors from vehicles provides a greater therapeutic and angiogenic effect than growth factors delivered intramuscularly, intravenously, or intraarterialy due to rapid metabolization of the cytokine, and non-targeted release. Furthermore, bone marrow cells have been implicated to enhance angiogenesis in numerous ischemic diseases due to their ability to secrete angiogenic cytokines and their numerous cell fractions present which are implicated to promote mature vessel formation. Use of angiogenic peptides, in conjunction with bone marrow cells, has been hypothesized in EPC mobilization from the periphery and marrow tissues to facilitate neovessel formation. For this purpose, controlled release of angiogenic peptides basic fibroblast growth factor (FGF-2) and granulocyte-colony stimulating factor (G-CSF) was performed using tunable ionic gelatin hydrogels or fibrin scaffolds with ionic albumin microspheres. The proliferation of endothelial cell culture was determined to have an enhanced effect based on altering concentrations of growth factors and method of release: co-delivery versus sequential. Scaffolds with these angiogenic peptides were implanted in young balb/c mice that underwent unilateral hindlimb ischemia by ligation and excision of the femoral artery. Endpoints for hindlimb reperfusion and angiogenesis were determined by Laser Doppler Perfusion Imaging and immunohistochemical staining for capillaries (CD-31) and smooth muscle cells (alpha-SMA). In addition to controlled release of angiogenic peptides, further studies combined the use of a fibrin co-delivery scaffold with FGF-2 and G-CSF with bone marrow stem cell transplantation to enhance vessel formation following CLI. Endpoints also included lipophilic vascular painting to evaluate the extent of angiogenesis and arteriogenesis in an ischemic hindlimb. Tissue engineering strategies utilizing bone marrow cells and angiogenic peptides demonstrate improved hindlimb blood flow compared to BM cells or cytokines alone, as well as enhanced angiogenesis based on immunohistochemical staining and vessel densities.

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Bücher zum Thema "Critical limb threatening ischemia"

Horsch, Svante, und Luc Claeys, Hrsg. Critical Limb Ischemia. Heidelberg: Steinkopff, 1995. http://dx.doi.org/10.1007/978-3-642-72515-9.

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Dieter, Robert S., Raymond A. Dieter, Jr, Raymond A. Dieter, III und Aravinda Nanjundappa, Hrsg. Critical Limb Ischemia. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-31991-9.

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Horsch, Svante, und Kiriakos Ktenidis, Hrsg. Critical Limb Ischemia Carotid Surgery. Heidelberg: Steinkopff, 1998. http://dx.doi.org/10.1007/978-3-642-53788-2.

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Jacobs, Michael. Critical Limb Ischemia. Blackwell Publishing Limited, 1999.

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Marc, Bosiers, und Schneider Peter A, Hrsg. Critical limb ischemia. New York: Informa Healthcare, 2009.

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Bosiers, Marc, und Peter Schneider, Hrsg. Critical Limb Ischemia. CRC Press, 2016. http://dx.doi.org/10.3109/9781420081909.

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Dieter, Robert S., Raymond A. Dieter Jr, Raymond A. Dieter III und Aravinda Nanjundappa. Critical Limb Ischemia: Acute and Chronic. Springer, 2016.

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(Editor), Svante Horsch, und Luc Claeys (Editor), Hrsg. Critical Limb Ischemia: Diagnosis and Treatment: An Interdisciplinary Approach. Steinkopff-Verlag Darmstadt, 1995.

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Horsch, S. Critical Limb Ischemia Carotid Surgery (Current Aspects in Vascular Surgery). Herausgegeben von S. Horsch. Springer, 1998.

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Spinal Cord Stimulation: An Innovative Method for Critical Limb Ischemia. Steinkopff-Verlag Darmstadt, 1994.

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Buchteile zum Thema "Critical limb threatening ischemia"

Pasqualini, Leonella, und Elmo Mannarino. „Critical Limb Ischemia“. In Textbook of Angiology, 508–31. New York, NY: Springer New York, 2000. http://dx.doi.org/10.1007/978-1-4612-1190-7_42.

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Allie, David E., Raghotham R. Patlola, Elena V. Mitran, Agostino Ingraldi und Craig M. Walker. „Critical Limb Ischemia“. In Peripheral Endovascular Interventions, 305–18. New York, NY: Springer New York, 2009. http://dx.doi.org/10.1007/978-1-4419-1387-6_21.

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Debus, E. Sebastian, und Reinhart T. Grundmann. „Critical Limb Ischemia“. In Evidence-based Therapy in Vascular Surgery, 159–80. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-47148-8_9.

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Patlola, Raghotham, und Craig Walker. „Critical Limb Ischemia“. In Peripheral and Cerebrovascular Intervention, 41–78. Totowa, NJ: Humana Press, 2011. http://dx.doi.org/10.1007/978-1-60327-965-9_3.

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Golden, Michael A., und Brant W. Ullery. „Critical Limb Ischemia“. In Essentials of Vascular Surgery for the General Surgeon, 101–18. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1326-8_7.

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Diaz-Sandoval, Larry J. „The Long-Term Care of Patients with Critical Limb Ischemia (CLI)“. In Critical Limb Ischemia, 641–50. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-31991-9_58.

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Fonteyne, W., und D. Duprez. „Definition, incidence and epidemiology of critical limb ischemia“. In Critical Limb Ischemia, 2–6. Heidelberg: Steinkopff, 1995. http://dx.doi.org/10.1007/978-3-642-72515-9_1.

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Beyer, D., Ch Kaiser, M. Kress und S. Horsch. „Complications during and after percutaneous transluminal angioplasty (PTA) of iliac and peripheral arteries“. In Critical Limb Ischemia, 81–86. Heidelberg: Steinkopff, 1995. http://dx.doi.org/10.1007/978-3-642-72515-9_10.

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Spengel, F. A., G. Küffer und H. Stiegler. „Efficacy and tolerance of recombinant tissue-type plasminogen activator in patients with thrombotic or embolic occlusions of leg-arteries“. In Critical Limb Ischemia, 87–91. Heidelberg: Steinkopff, 1995. http://dx.doi.org/10.1007/978-3-642-72515-9_11.

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Nigbur, H., K. Ktenidis, L. Claeys und S. Horsch. „Below-knee excimer laser angioplasty associated with femoro-popliteal bypass grafting“. In Critical Limb Ischemia, 95–97. Heidelberg: Steinkopff, 1995. http://dx.doi.org/10.1007/978-3-642-72515-9_12.

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Konferenzberichte zum Thema "Critical limb threatening ischemia"

Chauhan, Z., H. Asif, M. Iguina und M. Danckers. „Delayed Type-II Endoleak Causing Critical Limb Ischemia“. In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3485.

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Alvi, Abdulrahman, Zahra Assiri, Asma Bin Habjar und Muhammad Al Moaqil. „The Utility of Two-Dimensional Perfusion Angiography in Critical Limb Ischemia: A Single Center Experience“. In PAIRS Annual Meeting. Thieme Medical and Scientific Publishers Pvt. Ltd., 2019. http://dx.doi.org/10.1055/s-0041-1730619.

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Drescher, Peter, John F. Kispert und Phillip Zalog. „Treatment of Femoropopliteal Arterial Disease in Critical Limb Ischemia with Drug Eluting Stents: A Real World Experience“. In PAIRS Annual Meeting. Thieme Medical and Scientific Publishers Pvt. Ltd., 2019. http://dx.doi.org/10.1055/s-0041-1730532.

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Alghamdi, Ibrahim Abulaziz, Zia Zergham, Donald John Bain, Hany Mohammed Hafez, Salah Saleh Kary und Majed Ahmed Ashour. „In situ Arterialization of the Posterior Tibial Vein for Management of Critical Limb Ischemia Using Outback Re-Entry Catheter-Technical Report“. In PAIRS Annual Meeting. Thieme Medical and Scientific Publishers Pvt. Ltd., 2018. http://dx.doi.org/10.1055/s-0041-1730692.

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Septiani, Anissa Eka, Bhisma Murti, Setyo Sri Rahardjo und Hanung Prasetya. „Meta-Anaylsis: Gender and the Risk of Lower Extremity Amputation in Patients with Type 2 Diabetes Mellitus and Foot Ulcer“. In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.01.37.

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ABSTRACT Background: Diabetes is an independent predictor of limb amputation (versus revascularization) for the treatment of critical limb ischemia. Much of the cost related to diabetes results from macrovascular and microvascular complications, such as myocardial infarctions, end-stage renal disease, and lower extremity amputations (LEAs). This study aimed to examine the associations between gender and the risk of lower extremity amputation in patients with type 2 diabetes mellitus and foot ulcer. Subjects and Method: A meta-analysis and systematic review was conducted by collected published articles from Pubmed, Scopus, Google Scholar, and Springer Link databases. Lower limb amputation, lower extremity amputation, diabetic foot, and diabetic ulcer keywords were used to collect the articles. The inclusion criteria were full text, cohort study, and reporting adjusted odds ratio. The selected articles were analyzed by PRISMA flow chart and revman 5.3. Results: 9 articles were reported that male increased the risk of lower extremity amputation in type 2 DM patients (aOR= 1.60; 95% CI= 1.32 to 1.94; p<0.001). Conclusion: Male increases the risk of lower extremity amputation in type 2 DM patients. Keywords: lower extremity amputation, type 2 diabetes mellitus, foot ulcer Correspondence: Anissa Eka Septiani. Masters Program in Public Heath, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: sanissaeka@gmail.com. Mobile: 089514646458. DOI: https://doi.org/10.26911/the7thicph.01.37

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