Academic literature on the topic 'Major adverse lower limb events'
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Journal articles on the topic "Major adverse lower limb events"
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Bonaca, Marc P., Naomi M. Hamburg, and Mark A. Creager. "Contemporary Medical Management of Peripheral Artery Disease." Circulation Research 128, no. 12 (June 11, 2021): 1868–84. http://dx.doi.org/10.1161/circresaha.121.318258.
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Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke and cardiovascular death. Patients with PAD often have reduced walking capacity and are at risk of acute and chronic critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or amputation. The presence of polyvascular disease identifies the highest risk patient group for major adverse cardiovascular events, and patients with prior critical limb ischemia, prior lower extremity revascularization, or amputation have a heightened risk of major adverse limb events. Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including inflammation, vascular dysfunction, and metabolic disturbances. Treatment with guideline-recommended therapies, including smoking cessation, lipid lowering drugs, optimal glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events. Exercise training and cilostazol improve walking capacity. The heterogeneity of risk profile in patients with PAD supports a personalized approach, with consideration of treatment intensification in those at high risk of adverse events. This review highlights the medical therapies currently available to improve outcomes in patients with PAD.
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Stone, Patrick A., Stephanie N. Thompson, David Williams, Zachary AbuRahma, Luke Grome, Haley Schlarb, and Ali F. AbuRahma. "Biochemical markers in patients with open reconstructions with peripheral arterial disease." Vascular 24, no. 5 (July 10, 2016): 461–68. http://dx.doi.org/10.1177/1708538115611302.
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The purpose of our study was to determine outcome differences as a function of baseline high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) levels in patients receiving lower extremity open reconstructions for the treatment of peripheral arterial occlusive disease. We retrospectively examined patients who underwent surgical reconstructions performed by a single operator during a seven-year time span who received preoperative hsCRP and BNP testing and post-procedure imaging. Outcomes of interest included major adverse limb events, a composite end point of target vessel revascularization, limb amputation, and disease progression, and major adverse cardiovascular events comprised of stroke, myocardial infarction, and death. A total of 89 limbs in 82 patients were included in analysis. Multivariate analysis demonstrated that higher hsCRP levels (>3.0 mg/L) trended toward, but failed to significantly associate with major adverse limb events at 24 months (hazard ratio: 2.2 [1.0–5.2], p = 0.06), however the use of a vein bypass conduit (vs. prosthetic reconstruction) significantly predicted major adverse limb events (hazard ratio: 3.2 [1.5–6.9], p < 0.01). Elevated BNP levels (>100 pg/ml), but not hsCRP, associated with major adverse cardiovascular events (hazard ratio: 3.5 [1.2–10.3], p = 0.03). Preoperative biochemical markers may assist in clinical decision making and stratifying patients regarding adverse events following open reconstructions.
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Guédon, Alexis F., Jean-Baptiste De Freminville, Tristan Mirault, Nassim Mohamedi, Bastien Rance, Natalie Fournier, Jean-Louis Paul, Emmanuel Messas, and Guillaume Goudot. "Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events." JAMA Network Open 5, no. 12 (December 8, 2022): e2245720. http://dx.doi.org/10.1001/jamanetworkopen.2022.45720.
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ImportanceHigh lipoprotein(a) (Lp[a]) levels are involved in the development of cardiovascular events, particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing the Lp(a) levels associated with adverse lower-limb events are lacking.ObjectiveTo assess the association between Lp(a) levels and incidence of major adverse limb events in unselected hospitalized patients.Design, Setting, and ParticipantsThis large retrospective monocentric cohort study was conducted from January 1, 2000, to December 31, 2020. Data were derived from the clinical information system of the Hôpital Européen Georges-Pompidou, a Paris-based university hospital. Patients who underwent at least 1 Lp(a) measurement at the center during the study period were included. Patients who had no follow-up data or who had the first Lp(a) measurement after the study outcome had occurred were excluded. Data analyses were performed from May 2021 to January 2022.Main Outcomes and MeasuresThe primary outcome was the first inpatient major adverse limb event, defined as a major amputation, peripheral endovascular revascularization, or peripheral surgical revascularization, during follow-up. Secondary outcomes included individual components of the primary outcome. Lipoprotein(a) levels were categorized as follows: normal (&lt;50 mg/dL), high (50 to &lt;134 mg/dL), and very high (≥134 mg/dL); to convert Lp(a) values to milligrams per liter, multiply by 0.1.ResultsA total of 16 513 patients (median [IQR] age, 58.2 [49.0-66.7] years; 9774 men [59.2%]) were included in the cohort. The median (IQR) Lp(a) level was 24 (10.0-60.0) mg/dL. The 1-year incidence of major adverse limb event was 2.44% in the overall population and 4.54% among patients with very high Lp(a) levels. High (adjusted accelerated failure time [AFT] exponential estimate: 0.43; 95% CI, 0.24-0.78; Benjamini-Hochberg–corrected P = .01) and very high (adjusted AFT exponential estimate: 0.17; 95% CI, 0.07-0.40; Benjamini-Hochberg–corrected P &lt; .001) Lp(a) levels were independently associated with an increased risk of major adverse limb event.Conclusions and RelevanceResults of this study showed that higher Lp(a) levels were independently associated with an increased risk of a major adverse limb event in hospitalized patients. The Lp(a) measurement needs to be taken into account to improve lower-limb vascular risk assessment.
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Fashandi, Anna Z., J. Hunter Mehaffey, Robert B. Hawkins, Irving L. Kron, Gilbert R. Upchurch, and William P. Robinson. "Major adverse limb events and major adverse cardiac events after contemporary lower extremity bypass and infrainguinal endovascular intervention in patients with claudication." Journal of Vascular Surgery 68, no. 6 (December 2018): 1817–23. http://dx.doi.org/10.1016/j.jvs.2018.06.193.
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Mehaffey, James H., Robert Hawkins, Anna Fashandi, Margret C. Tracci, Kenneth Cherry, Irving Kron, Gilbert Upchurch, and William P. Robinson. "Lower Extremity Bypass Is Associated with Lower Short-Term Major Adverse Limb Events and Equivalent Major Adverse Cardiac Events Compared with Endovascular Intervention in A National Cohort with Critical Limb Ischemia." Journal of Vascular Surgery 65, no. 1 (January 2017): e4-e5. http://dx.doi.org/10.1016/j.jvs.2016.10.018.
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Habib, Salim, Othman Abdul-Malak, Michael Madigan, Karim Salem, and Mohammad Eslami. "Completion Imaging Use After Lower Extremity Bypass and Association With Major Adverse Limb Events." Journal of Vascular Surgery 76, no. 3 (September 2022): e40-e41. http://dx.doi.org/10.1016/j.jvs.2022.06.070.
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Singh, Kuldeep, Amandeep Juneja, Tushar Bajaj, Christian Voto, Jonathan Schor, Saqib Zia, and Jonathan Deitch. "Single Tertiary Care Center Outcomes After Lower Extremity Cadaveric Vein Bypass for Limb Salvage." Vascular and Endovascular Surgery 54, no. 5 (June 3, 2020): 430–35. http://dx.doi.org/10.1177/1538574420925586.
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Objective: Cadaveric saphenous vein (CV) conduits are used in rare instances for limb salvage in patients without autogenous veins although long-term outcome data are scarce. This study was designed to evaluate the outcomes of CV bypass in patients with threatened limbs. Methods: We retrospectively reviewed the charts from 2010 to 2017 of 25 patients who underwent 30 CV allografts for critical limb ischemia and acute limb ischemia. Patient charts were reviewed for demographics, comorbidities, smoking status, indications for bypass, and outcomes. Primary outcomes included graft patency, major amputation rates, and mortality. Secondary outcomes measured included infection rates, 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE). Statistical analysis was performed using time series and Kaplan-Meier survival curves. Results: A total of 30 limbs received CV lower extremity bypasses (20 males, 10 female), and the average age was 68 ± 4 years. Primary patency rates were 71%, 42%, and 28% at 3, 6, and 12 months, respectively. Assisted primary patency rates were 78%, 56%, and 37% at 3, 6, and 12 months, respectively. Secondary patency rates were 77%, 59%, and 28% at 3, 6, and 12 months, respectively. Minor amputations, defined as amputations below the transmetatarsal level occurred in 5 (20%) patients. Wound infection occurred in 8 (32%) patients which was managed with local wound care and no patients required an extraanatomic bypass for limb salvage. Thirty-day MALE occurred in 7 (23.3%) patients. We had no 30-day mortality or MACE. The average graft length was 64.2 ± 8 cm with an average graft diameter of 3.9 ± 2 mm. Amputation-free survival and overall survival at 12 months were 20 (68%) and 21 (84%), respectively. Conclusions: Cadaveric saphenous vein allograft may be used as a bypass conduit as a viable surgical option before limb amputation. Despite the poor patency rates, the limb salvage rates of cadaveric vein grafts demonstrate that this alternate conduit may be considered when no autogenous vein is available.
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Niiranen, Oskari, Juha Virtanen, Ville Rantasalo, Amer Ibrahim, Maarit Venermo, and Harri Hakovirta. "The Association between Major Adverse Cardiovascular Events and Peripheral Artery Disease Burden." Journal of Cardiovascular Development and Disease 11, no. 6 (May 21, 2024): 157. http://dx.doi.org/10.3390/jcdd11060157.
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Objective: The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs). Methods: All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) at Turku University Hospital department of Vascular Surgery between 1 January 2009 and 30 July 2011 were retrospectively analyzed. Angiography due to symptomatic PAD was used as the index date for the inclusion in the study. The segmental burden of atherosclerosis based on DSA was divided into three categories according to the highest disease burden of the defined artery segment: aorto-iliac, femoropopliteal, or tibial segments. The major association for the study was MACEs (defined as a cerebrovascular event, heart failure (HF) and myocardial infarction requiring hospital admission). Demographic data and MACEs were obtained from the hospital electronic medical records system. Results. The lower limb atherosclerosis burden of tibial vessels was related to an increased probability for HF (OR 3.9; 95%CI 2.4–6.5) and for MACEs overall (OR 2.3; 95%CI 1.4–3.6). The probability of both HF and MACEs overall rose with the increasing severity of the atherosclerosis burden. Moreover, the more severe the tibial vessel atherosclerosis, the higher the risk of HF and MACEs. The most extensive tibial atherosclerosis patients had an OR 4.5; 95%CI 2.6–8.0 for HF and an OR 3.1; and 95%CI 1.7–5.6 for MACEs overall. The femoropopliteal disease burden was also associated with an increased risk of HF (OR 2.3; 95%CI 1.6–3.2) and MACE (OR 1.9; 95%CI 1.3–2.7). However, the increasing extent of atherosclerosis of the femoropopliteal segment solely increased the risk of MACEs. Conclusions: PAD patients with severe tibial atherosclerosis are likely to present with MACEs. The risk is further enhanced as the extent of tibial vessel atherosclerosis is increased. An association between MACE and severe atherosclerosis on the aortoiliac segment was not detected. However, when the femoropopliteal segment was the most affected artery segment, the risk of MACEs was increased.
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Mehaffey, J. Hunter, Robert B. Hawkins, Anna Fashandi, Kenneth J. Cherry, John A. Kern, Irving L. Kron, Gilbert R. Upchurch, and William P. Robinson. "Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention." Journal of Vascular Surgery 66, no. 4 (October 2017): 1109–16. http://dx.doi.org/10.1016/j.jvs.2017.04.036.
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Sunitha Therese, S., and N. Gayathri. "LOWER EXTREMITY PHERIPHERALARTERIAL DISEASE - AN UPDATE." International Journal of Advanced Research 10, no. 02 (February 28, 2022): 1049–52. http://dx.doi.org/10.21474/ijar01/14311.
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Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthful to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patient and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes.
Dissertations / Theses on the topic "Major adverse lower limb events"
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Teyssières, Salle Laurence. "Artériopathie des membres inférieurs chez le patient vivant avec un diabète de type 2 : marqueurs du risque et impact des thérapeutiques." Electronic Thesis or Diss., Limoges, 2024. http://www.theses.fr/2024LIMO0031.
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Malgré les avancées diagnostiques et thérapeutiques dans la prise en charge de la maladie cardio-vasculaire, celle-ci reste la première cause de mortalité chez le sujet vivant avec un diabète de type 2 (DT2). Cependant, l’artériopathie des membres inférieurs reste sous-diagnostiquée et sous-traitée alors que le diabète expose à des formes plus atypiques, plus précoces et plus graves. Chez le sujet porteur de DT2, la mesure de l’index de pression systolique (IPS), l’outil de dépistage validé, peut être pris en défaut en raison de la présence de médiacalcose (MAC). Dans une population de 1119 sujets porteurs de DT2 asymptomatiques, nous avons montré que la présence de MAC détectée échographiquement était un facteur associé à la survenue des évènements cardio-vasculaires majeurs (MACE) et des évènements artériels périphériques (MALE) de façon indépendante de l’IPS. Sur l’ensemble de la cohorte, la présence de MAC apparait être un marqueur de risque plus robuste que l’IPS élevé, souvent utilisé comme un équivalent de MAC. Au-delà du dépistage et de l’estimation du risque, nous nous sommes intéressés à l’impact de différentes thérapeutiques sur le risque artériel périphérique du patient vivant avec un DT2. L’arrivée sur le marché de la classe des inhibiteurs du SGLT2 a relancé le débat sur le lien diurétiques et risque artériel périphérique. Notre méta-analyse effectuée sur 5 études a démontré une augmentation significative du risque d’amputation associé à l’utilisation de diurétiques (OR=1,73, p<0,001). Nous avons par la suite effectué une étude rétrospective et observationnelle chez 1309 sujets vivant avec un DT2. En analyse multivariée, les diurétiques étaient significativement associés à la survenue du MALE, après ajustement sur le score de propension (aHR=1,66 ; 1,08-2,56, p=0,020) et pondération inverse de probabilité du traitement (aHR=1,76 ; 1,67-1,84, p<0,001). En analyse en sous-groupe, le risque de MALE sous diurétique était significativement augmenté en cas d’IPS anormal (<0,90 ou 1,40) (aHR=2,29, p d’interaction=0,02), sous diurétiques de l’anse ou thiazidiques mais pas sous diurétiques épargneurs de potassium. La troisième partie du travail a porté sur l’étude du registre XATOA chez le sujet porteur de diabète. L’essai COMPASS a montré le bénéfice d’un traitement combiné anti-agrégation plaquettaire et rivaroxaban (2.5mg 2 fois par jour) sur les MACE et les MALE chez des sujets porteurs de maladie cardio-vasculaire. Ces résultats ont été confirmé par les données de vraie vie du registre XATOA. Les situations d’initiation d’une double inhibition étaient identiques entre les patients diabétiques et non diabétiques. Le bénéfice sur le MACE et le MALE était superposable à celui observé dans l’essai COMPASS. L’ensemble de notre travail a donc mis en lumière la nécessité d’évaluer le risque artériel périphérique chez le sujet vivant avec un DT2, d’utiliser les outils appropriés à son évaluation et de définir les thérapeutiques adaptées au niveau de risqueDespite diagnostic and therapeutic advances in the management of cardiovascular disease, it remains the leading cause of mortality in people living with type 2 diabetes (T2D). While coronary artery disease is increasingly screened for and managed optimally, peripheral artery disease remains underdiagnosed and undertreated, despite diabetes predisposes to more atypical, earlier, and severe forms. In individuals with T2D, the measurement of the ankle-brachial index (ABI), a validated screening tool, may be biased due to the presence of medial arterial calcification (MAC). In a population of 1119 asymptomatic patients with T2D, we demonstrated that the presence of ultrasound-detected MAC was independently associated with the occurrence of Major Adverse Cardiovascular Events (MACE) and Major Adverse Lower limb Events (MALE), regardless of the ABI. In the entire cohort, MAC appears as a better risk predictor than high ABI, often considered as a proxy for MAC. Beyond screening and risk estimation, we investigated the impact of different therapies on the peripheral arterial risk of patients living with T2D. The introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors, with proven cardio-renal protective effects, re-launched the debate on the link between diuretics and peripheral arterial risk. Our group's meta-analysis highlighted the need to expand literature. Among the 5 included studies, we showed a significant increase in the risk of amputation associated with diuretic use (OR=1.73, p<0.001). Subsequently, we conducted a retrospective observational study involving 1309 patients with T2D. In multivariable analysis, diuretics were significantly associated with the occurrence of MALE after adjustment for propensity score (aHR=1.66; 1.08-2.56, p=0.020) and inverse probability of treatment weighting analysis (aHR=1.76; 1.67-1.84, p<0.001). We identified at-risk profiles with diuretics treatment. In subgroup analysis, the risk of MALE with diuretics was significantly increased with abnormal ABI (<0.90 or 1.40) (aHR=2.29, interaction p=0.02). Loop or thiazide diuretics were associated with an increased risk, but not potassium-sparing diuretics. The third part of the work focused on the XATOA registry in patients with diabetes. The COMPASS trial demonstrated the benefit of double antithrombotic therapy (aspirin and rivaroxaban 2.5mg twice daily) on MACE and MALE in patients with stable cardiovascular disease. The results of this randomized controlled trial were confirmed by real-life data from the XATOA registry. The decisions that drive to double antithrombotic therapy prescription werecomparable between diabetic and non diabetic patients. The benefit on MACE and MALE was similar to that observed in the COMPASS trial.Our work highlights the need to assess peripheral arterial risk in people with T2D, use appropriate assessment tools and define therapies suited to the level of risk
Books on the topic "Major adverse lower limb events"
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Sunderkötter, Cord, and Luis Requena. Panniculitides. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0165.
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Panniculitis is an inflammation that originates primarily in the subcutaneous fatty tissue (panniculus adiposus). It is associated with rheumatological diseases and with adverse events to rheumatological therapies (e.g. poststeroid panniculitis, erythema nodosum, infective panniculitis). The panniculitides are classified histopathologically into mostly septal panniculitis and mostly lobular panniculitis, according to the major or denser localization of the infiltrate, and also into those with or without vasculitis. Additional criteria involve the composition of the inflammatory infiltrate, the cause, and an underlying or associated disease. The clinical hallmarks of panniculitis are subcutaneous nodules or plaques, often located on the lower limb. A deep excisional biopsy is often required for a more precise diagnosis, given the often sparse and monotonous clinical symptoms. Erythema nodosum is the most common form and a typical example of septal panniculitis. It occurs in response to many different provoking factors, the most common trigger in children being a 'strep throat', in adults sarcoidosis. Clinically, it presents with a sudden symmetrical appearance of painful, tender, warm, erythematous nodes or plaques, usually on the shins, which resemble bruises. Classical and cutaneous polyarteriitis nodosa present a mostly septal panniculitis associated with vasculitis. Here subcutaneous, partially ulcerating nodules are surrounded by livedo racemosa. The mostly lobular panniculitides not associated with vasculitis include lupus panniculitis (lupus erythematosus profundus, typically with ensuing lipoatrophy and predilection for the upper part of the body), panniculitis in dermatomyositis (often calcifiying), cold panniculitis, pancreatic panniculitis, panniculitis due toα-antitrypsin deficiency, poststeroid panniculitis (in children after rapid withdrawal of corticosteroids), calciphylaxis (with and without renal failure), and factitious panniculitis (after mechanical, physical, or chemical injuries to the subcutaneous tissue, often self-inflicted). Nodular vasculitis (formerly erythema induratum Bazin) is a lobular panniculitis with vasculitis involving mostly the small blood vessels of the fat lobule. It appears to present a (hyper)reactive response to certain infections (tuberculosis, streptococci, candida) or to cold exposure or chronic venous insufficiency in susceptible females. In conclusion, the panniculitides are a heterogenous group of diseases requiring a systematic work-up and knowledge of certain histological or clinical criteria.
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Stolker, Robert Jan, and Felix van Lier. Choice and interpretation of preoperative investigations. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0041.
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Preoperative risk assessment is one of the most important steps in perioperative management. In the last decades, considerable progress has been achieved. However, as more high-risk procedures are performed in more aged patients, suffering more morbidity, this may lead to an increased risk of adverse outcomes. The goal of preoperative assessment is to identify patients at extreme risk and discuss whether they should be operated on, or undergo an alternative procedure with a lower risk profile, or if conservative treatment should be continued. Furthermore, it gives the opportunity to optimize patients prior to surgery, adapt intraoperative anaesthetic management and monitoring, and select patients for postoperative treatment at an intensive care unit or post-anaesthesia care unit. The cornerstone of preoperative assessment is the estimation of functional capacity. Accurate anamnesis and physical examination are crucial. Several procedures have been used to optimize the preoperative risk stratification. In this chapter, the value of these additional preoperative investigations is reviewed. These investigations are to be performed only in patients with considerable co-morbidity undergoing high-risk surgery. As cardiovascular adverse events are a major determinant of postoperative outcome, the chapter focuses on the management of the two most important cardiac risk factors, that is, myocardial ischaemia and impaired left ventricular function.
Book chapters on the topic "Major adverse lower limb events"
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Yli-Ikkelä, Riku, Aki Rintala, Anna Köyhäjoki, Harto Hakonen, Hilkka Korpi, Mirjami Kantola, Sari Honkanen, et al. "Effectiveness of Robot-Assisted Lower Limb Rehabilitation on Balance in People with Stroke: A Systematic Review, Meta-analysis, and Meta-regression." In Communications in Computer and Information Science, 101–16. Cham: Springer Nature Switzerland, 2024. http://dx.doi.org/10.1007/978-3-031-59091-7_7.
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AbstractThe objective of this study was to evaluate the effectiveness of robot-assisted lower-limb rehabilitation on balance in stroke patients and to explore the covariates associated with these effects.A systematic literature search was carried out in four databases (MEDLINE (Ovid), CINAHL, PsycINFO, and ERIC) for studies published from inception to 25th of March 2022. Studies on robot-assisted lower-limb rehabilitation with a randomized controlled trial (RCT) design, participants with stroke, a comparison group with conventional training, and balance-related outcomes were included. Studies were assessed for Cochrane Risk of Bias 2 and quality of evidence. Meta-analysis and meta-regression were performed.A total of 48 (RCT) with 1472 participants were included. The overall risk of bias in the included studies was unclear (n = 32), high (n = 15) or low (n = 1). Compared to conventional rehabilitation, robot-assisted lower-limb rehabilitation interventions were more effective for balance improvement (Hedges’ g = 0.25, 95% CI: 0.10 0.41). In meta-regression, a relationship between the training effect was observed with the time since stroke, explaining 56% of the variance (p = 0.001), and with the ankle robots, explaining 16% of the variance (p = 0.048). No serious adverse events related to robot-assisted training were reported.Robot-assisted lower-limb rehabilitation may improve balance more than conventional training in people with stroke, especially in the acute stage. Robot-assisted lower-limb rehabilitation seems to be a safe rehabilitation method for patients with stroke. To strengthen the evidence, more high-quality RCTs with adequate sample sizes are needed.
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Orrapin, Saritphat. "Cardiovascular Complications Related to Lower Limb Revascularization and Drug-Delivering Technology in Peripheral Arterial Disease." In Cardiovascular Diseases [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.107973.
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The cardiovascular complication related to lower limb revascularization is the common cause of mortality in patients with peripheral arterial disease (PAD). The coexisting multisite atherosclerotic vascular disease is increasing risk of major adverse cardiovascular events (MACE). The minimally invasive approach for revascularization, namely, endovascular-first strategy for decreasing risk of intervention is the modern approach. The novel technology of the drug delivering device by paclitaxel, sirolimus, and other antiproliferative drug coated balloon (DCB) and drug eluting stent (DES) to increase the patency of the target artery are trending to use in patients with CLTI. However, the long-term result and safety of a drug delivering device are still controversial. The paclitaxel related to MACE and major adverse limb events (MALE) need to be investigated. The new drug coating balloon, sirolimus demonstrated the excellent short-term result. However, there are some limitations of previous randomized studies and meta-analyses to conclude the best strategy and device to perform the best result for revascularization without increasing risk of MACE and MALE in CLTI patients who candidate for revascularization. This article is summarized the pathophysiology of MACE and MALE in the patients with PAD during revascularization, paclitaxel related cardiovascular complications and sirolimus coated balloon.
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Little, Michael B. "Anesthesia for Amputation Surgery." In Vascular Anesthesia Procedures, 259–74. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197506073.003.0018.
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This chapter examines the perioperative anesthetic concerns for patients undergoing amputation surgery of the upper or lower extremity. Most amputation surgeries, particularly of the lower extremity, are the result of peripheral artery disease (PAD). This chapter discusses multiple comorbid conditions associated with PAD, such as diabetes mellitus, hypertension, tobacco use, and sepsis and how they impact risk stratification and anesthetic management. It also discusses pertinent anatomical considerations, intraoperative management with general anesthesia, neuraxial anesthesia, and/or regional anesthesia. It also discusses short- and long-term postoperative outcomes, including major adverse cardiac events and chronic phantom limb pain as well as strategies to improve outcomes.
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Shahid, Monica, Nunzio Franco, and Laxmi Sistla. "Voyaging to Safety: Anticoagulation in Peripheral Artery Disease and Limb Revascularisation." In Anticoagulation - An Update [Working Title]. IntechOpen, 2023. http://dx.doi.org/10.5772/intechopen.112773.
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This chapter provides a comprehensive evaluation of the impact of the Vascular Outcomes Study of Acetylsalicylic Acid (ASA) Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for Peripheral Artery Disease (VOYAGER PAD) trial for the use of the direct acting oral anticoagulant (DOAC) rivaroxaban after surgical revascularisation of lower limb peripheral arterial disease (PAD). The VOYAGER PAD trial, a multinational, double-blind, randomized control trial, evidenced the benefits of a combined low-dose rivaroxaban and aspirin therapy over aspirin alone in reducing major limb adverse events such as acute limb ischemia, major amputations, and cardiovascular-related mortality following surgical revascularisation for severe PAD. However, an increased bleeding risk was also associated with this regimen, particularly in females and patients with a history of bleeding, underscoring the need for careful patient selection, risk stratification, and vigilant monitoring. Special attention is therefore needed when considering this treatment for certain population groups at higher risk of bleeding. Despite these considerations, the results of the trial offer significant promise for improving PAD management and limb revascularization and present numerous opportunities for future research. Investigations into patient-specific factors, precise indications, and dosage optimization could further refine the therapeutic strategies involving rivaroxaban.
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Sunderkötter, Cord, and Luis Requena. "Panniculitides." In Oxford Textbook of Rheumatology, 1418–25. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0165_update_003.
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Panniculitis is an inflammation that originates primarily in the subcutaneous fatty tissue (panniculus adiposus). It is associated with rheumatological diseases and with adverse events to rheumatological therapies (e.g. poststeroid panniculitis, erythema nodosum, infective panniculitis). The panniculitides are classified histopathologically into mostly septal panniculitis and mostly lobular panniculitis, according to the major or denser localization of the infiltrate, and also into those with or without vasculitis. Additional criteria involve the composition of the inflammatory infiltrate, the cause, and an underlying or associated disease. The clinical hallmarks of panniculitis are subcutaneous nodules or plaques, often located on the lower limb. A deep excisional biopsy is often required for a more precise diagnosis, given the often sparse and monotonous clinical symptoms. Erythema nodosum is the most common form and a typical example of septal panniculitis. It occurs in response to many different provoking factors, the most common trigger in children being a ’strep throat’, in adults sarcoidosis. Clinically, it presents with a sudden symmetrical appearance of painful, tender, warm, erythematous nodes or plaques, usually on the shins, which resemble bruises. Classical and cutaneous polyarteriitis nodosa present a mostly septal panniculitis associated with vasculitis. Here subcutaneous, partially ulcerating nodules are surrounded by livedo racemosa. The mostly lobular panniculitides not associated with vasculitis include lupus panniculitis (lupus erythematosus profundus, typically with ensuing lipoatrophy and predilection for the upper part of the body), panniculitis in dermatomyositis (often calcifiying), cold panniculitis, pancreatic panniculitis, panniculitis due toα-antitrypsin deficiency, poststeroid panniculitis (in children after rapid withdrawal of corticosteroids), calciphylaxis (with and without renal failure), and factitious panniculitis (after mechanical, physical, or chemical injuries to the subcutaneous tissue, often self-inflicted). Nodular vasculitis (formerly erythema induratum Bazin) is a lobular panniculitis with vasculitis involving mostly the small blood vessels of the fat lobule. It appears to present a (hyper)reactive response to certain infections (tuberculosis, streptococci, candida) or to cold exposure or chronic venous insufficiency in susceptible females. In conclusion, the panniculitides are a heterogenous group of diseases requiring a systematic work-up and knowledge of certain histological or clinical criteria.
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Mazzolai, Lucia, Victor Aboyans, and Marianne Brodmann. "Diabetes and lower extremity arterial disease." In ESC CardioMed, 944–46. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0222.
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The risk of lower extremity arterial disease (LEAD) is markedly increased among patients with diabetes and ischaemic event rates are more frequent in LEAD populations with than among those without diabetes. A multidisciplinary approach to LEAD diabetic patients is essential. Proper diagnosis and management is crucial in this selected group of patients to reduce cardiovascular burden and decrease limb adverse events. This chapter reviews the clinical implications of LEAD in diabetic patients, diagnostic strategies, and management.
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Jimenez, Juan Carlos, and Samuel Eric Wilson. "Major Adverse Limb Events and Mortality in Patients with Peripheral Artery Disease: The COMPASS Trial." In 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 193–97. CRC Press, 2020. http://dx.doi.org/10.1201/9780429434020-39.
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Lane, Giulia I., Colby A. Dixon, M. Louis Moy, and Cynthia S. Fok. "A Midurethral Sling to Reduce Incontinence After Vaginal Prolapse Repair." In 50 Studies Every Urologist Should Know, 227–32. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190655341.003.0040.
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This chapter summarizes the results of the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling (OPUS) trial, in which women without stress urinary incontinence undergoing prolapse surgery were randomized to a midurethral sling or no concomitant midurethral sling. The OPUS trial found that women randomized to undergo prophylactic concomitant midurethral sling at the time of transvaginal repair for pelvic organ prolapse had lower rates of urinary incontinence at 3 and 12 months but also experienced higher rates of adverse events such as bladder perforation, major bleeding, and urinary tract infections.
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Al Shakarchi, Julien. "Rivaroxaban in Peripheral Artery Disease After Revascularization (VOYAGER)." In 50 Studies Every Vascular Surgeon Should Know, edited by Julien Al Shakarchi and Andrew Garnham, 15–20. Oxford University Press, 2023. http://dx.doi.org/10.1093/med/9780197637906.003.0003.
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Abstract This chapter provides a summary of a landmark study in the management of patients with atherosclerotic vascular disease following revascularization. The Rivaroxaban in Peripheral Artery Disease After Revascularization (VOYAGER) trial assessed the role of a combination of low-dose rivaroxaban and aspirin in decreasing major adverse cardiovascular and limb events. The VOYAGER trial demonstrated better efficacy for a combination of low-dose rivaroxaban and aspirin than aspirin alone. This chapter describes the basics of the study, including funding, study location, who was studied, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
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Sousa-Uva, Miguel, and Stuart J. Head. "Special conditions: revascularization." In ESC CardioMed, 935–38. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0219.
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Patient with diabetes mellitus (DM) are at increased risk for adverse cardiovascular events regardless of symptoms, and coronary artery disease (CAD) is the leading cause of death. Approximately one-third of patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) have DM with inferior outcomes of these procedures compared with patients without DM. In patients with stable angina and DM, optimal medical therapy, control of obesity, and lifestyle modifications are key and common to all management strategies. A randomized comparison of prompt revascularization and optimal medical therapy versus optimal medical therapy alone in patients with demonstrated ischaemia and documented CAD showed no benefit in survival or major adverse cardiac events rate with revascularization except in patients with more severe CAD who were deemed best treated with CABG. The decision on whether or not to revascularize a patient with type 2 DM is dependent upon angina class and extent of ischaemia by non-invasive tests and extent of CAD. The Future Revascularization Evaluation in patients with Diabetes Mellitus: Optimal Management of Multivessel disease (FREEDOM) trial, randomized patients with DM to PCI or CABG using first-generation drug-eluting stents and showed better survival and lower combined all-cause death, myocardial infarction, or stroke after 5-year follow-up with CABG. Overall, the benefit of CABG increases with increased disease complexity. As both PCI and CABG are continuously evolving, making trial results rapidly obsolete, decision-making about revascularization strategy for individual patients with DM and CAD require a Heart Team discussion.
Conference papers on the topic "Major adverse lower limb events"
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He, Yongtian, David Eguren, Trieu Phat Luu, and Jose L. Contreras-Vidal. "Risk and adverse events related to lower-limb exoskeletons." In 2017 International Symposium on Wearable & Rehabilitation Robotics (WeRob). IEEE, 2017. http://dx.doi.org/10.1109/werob.2017.8383850.
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Fernandes, Lucca Ferdinando Queiroz, Matheus Procópio Guimarães, Diógenes Emanuel Dantas da Silva, Pedro Henrick Guimarães Carvalho, Iury Hélder Santos Dantas, Daniel Vicente de Siqueira Lima Junior, Luíza Alves Monteiro Torreão Villarim, and Bianca Etelvina Santos de Oliveira. "Multiple sclerosis associated with adalimumab treatment in psoriatic arthritis: a case report." In XIV Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2023. http://dx.doi.org/10.5327/1516-3180.141s1.607.
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Introduction: Tumor necrosis factor (TNF) antagonists have emerged as one of the most effective treatment options for patients with autoimmune diseases, including psoriatic arthritis. However, these agents carry a risk of severe adverse effects, including demyelinating disorders. The aim to report a case of multiple sclerosis associated with the use of adalimumab. This is a case report study. The information of this work was obtained through review of the medical record. Case report: A 40-year-old female with psoriatic arthritis on adalimumab (ADM) treatment. She developed paresthesia in her lower limbs, which was initially attributed to anxiety. Six months later, she presented with decreased visual acuity in her left eye, which was diagnosed as optic neuritis. She received pulse therapy with methylprednisolone and underwent investigation for multiple sclerosis (MS). Magnetic resonance imaging (MRI) of the brain revealed multiple lesions with high signal intensity in T2/FLAIR on periventricular regions bilaterally. Furthermore, MRI of the thoracic spine showed high signal intensity on posterolateral cords at levels T5 to T9. These findings fulfilled the revised McDonald Criteria for MS and suggested a link to ADM treatment. On neurological examination, mild left lower limb paresis, bilateral plantar-cutaneous reflex, hyperreflexia in the lower limbs, and mild hypopalesthesia in her right leg. ADM treatment was discontinued, and although she reported a slight worsening of her skin condition, there were no further signs of psoriatic arthritis. Conclusion: Neurological adverse events associated with TNF antagonists are rare but must be considered. If neurological disorders develop during therapy, prompt discontinuation of the drug is recommended.
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Wang, Yajuan, Antonio Ferreira, Bradley B. Keller, Marc Simon, and James F. Antaki. "Effect of Continuous-Flow Left Ventricular Assist Device on Cardiac Function: Simulation Study With a Biventricular Computer Model." In ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53784.
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Left ventricular assist device (LVAD) therapy has become an established treatment for patients with end-stage heart failure as either a bridge to transplant (BTT) or as permanent support (destination therapy: DT) [1]. For a small portion of patients, LVAD could be used as a bridge to cardiac recovery (BTR). Recent clinical studies have demonstrated the advantages of continuous-flow LVADs over pulsatile-flow counterparts with respect to higher survival rates and lower incidence of major adverse events [2]. However, the control challenge of continuous-flow LVADs has been not fully addressed: most of the devices are driven at a constant speed, which does not take into account changes in patient physiologic demands [3, 4].
Reports on the topic "Major adverse lower limb events"
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Philosoph-Hadas, Sonia, Peter Kaufman, Shimon Meir, and Abraham Halevy. Signal Transduction Pathway of Hormonal Action in Control and Regulation of the Gravitropic Response of Cut Flowering Stems during Storage and Transport. United States Department of Agriculture, October 1999. http://dx.doi.org/10.32747/1999.7695838.bard.
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Original objectives: The basic goal of the present project was to increase our understanding of the cellular mechanisms operating during the gravitropic response of cut flowers, for solving their bending problem without affecting flower quality. Thus, several elements operating at the 3 levels o the gravity-induced signal transduction pathway, were proposed to be examined in snapdragon stems according to the following research goals: 1) Signaling: characterize the signal transduction pathway leading to the gravitropic response, regarding the involvement of [Ca2+]cyt as a mediator of IAA movement and sensitivity to auxin. 2) Transduction by plant hormones: a) Examine the involvement of auxin in the gravitropic response of flower stems with regard to: possible participation of auxin binding protein (ABP), auxin redistribution, auxin mechanism of action (activation of H+-ATPase) mediation by changes in [Ca2+]cyt and possible regulation of auxin-induced Ca2+ action b: calmodulin-activated or Ca2+-activated protein kinases (PK). b) Examine the involvement of ethylene in the gravitropic response of flower stems with regard to auxin-induced ethylene production and sensitivity of the tissue to ethylene. 3) Response: examine the effect of gravistimulation on invertase (associated with growth and elongation) activity and invertase gene expression. 4) Commercial practice: develop practical and simple treatments to prevent bending of cut flowers grown for export. Revisions: 1) Model systems: in addition to snapdragon (Antirrhinum majus L.), 3 other model shoe systems, consisting of oat (Avena sativa) pulvini, Ornithogalun 'Nova' cut flowers and Arabidopsis thaliana inflorescence, were targeted to confirm a more general mechanism for shoot gravitropism. 2 Research topics: the involvement of ABP, auxin action, PK and invertase in the gravitropic response of snapdragon stems could not be demonstrated. Alternatively, the involvement in the gravity signaling cascade of several other physiological mediators apart of [Ca2+]cyt such as: IP3, protein phosphorylation and actin cytoskeleton, was shown. Additional topics introduced: starch statolith reorientation, differential expression of early auxin responsive genes, and differential shoot growth. Background to the topic: The gravitropic bending response of flowering shoots occurring upon their horizontal placement during shipment exhibits a major horticultural problem. In spite of extensive studies in various aboveground organs, the gravitropic response was hardly investigated in flowering shoots. Being a complex multistep process that requires the participation of various cellular components acting in succession or in parallel, analysis of the negative gravitropic response of shoot includes investigation of signal transduction elements and various regulatory physiological mediators. Major achievements: 1) A correlative role for starch statoliths as gravireceptors in flowering shoot was initially established. 2) Differentially phosphorylated proteins and IP3 levels across the oat shoe pulvini, as well as a differential appearance of 2 early auxin-responsive genes in snapdragon stems were all detected within 5-30 minutes following gravistimulation. 3) Unlike in roots, involvement of actin cytoskeleton in early events of the gravitropic response of snapdragon shoots was established. 4) An asymmetric IAA distribution, followed by an asymmetric ethylene production across snapdragon stems was found following gravistimulation. 5) The gravity-induced differential growth in shoots of snapdragon was derived from initial shrinkage of the upper stem side and a subsequent elongation o the lower stem side. 6) Shoot bending could be successfully inhibited by Ca2+ antagonists (that serve as a basis for practical treatments), kinase and phosphatase inhibitors and actin-cytoskeleton modulators. All these agents did not affect vertical growth. The essential characterization of these key events and their sequence led us to the conclusion that blocking gravity perception may be the most powerful means to inhibit bending without hampering shoot and flower growth after harvest. Implications, scientific and agriculture: The innovative results of this project have provided some new insight in the basic understanding of gravitropism in flower stalks, that partially filled the gap in our knowledge, and established useful means for its control. Additionally, our analysis has advanced the understanding of important and fundamental physiological processes involved, thereby leading to new ideas for agriculture. Gravitropism has an important impact on agriculture, particularly for controlling the bending of various important agricultural products with economic value. So far, no safe control of the undesired bending problem of flower stalks has been established. Our results show for the first time that shoot bending of cut flowers can be inhibited without adverse effects by controlling the gravity perception step with Ca2+ antagonists and cytoskeleton modulators. Such a practical benefit resulting from this project is of great economic value for the floriculture industry.
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Financial Markets Report - Second Quarter 2023. Banco de la República, July 2024. http://dx.doi.org/10.32468/rmf.eng2-trim.2023.
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Throughout the second quarter of the year, high inflation levels continued to ease, benefiting both the local public debt and that of counterparts in the region (Brazil, Mexico, Chile, and Peru). Conversely, amid stronger-than-anticipated economic activity in developed economies and expectations of a more contractionary monetary policy path, public debt in these countries depreciated. Riskier assets were favored by an increase in risk appetite. Global inflationary pressures remain high, although showing a downward trend, while economic activity demonstrated greater resilience than expected. Major central banks of developed economies continued their cycle of interest rate hikes, with markets pricing in further increases for the remainder of the year, and public debt securities devalued. Consumer price indices continued to reflect a downward trend in most countries, largely attributed to reduced supply-side pressures. Market inflation expectations also fell. Riskier assets, such as equities, performed favorably due to improved risk appetite, which had been affected in the previous quarter by adverse events in US regional banking and Credit Suisse in Europe, and subsequently by the uncertainty surrounding US debt ceiling negotiations. Locally, market participants anticipate the conclusion of Banco de la República (the Central Bank of Colombia - Banrep) interest rate hiking cycle, and public debt securities appreciated. Local public debt performed favorably, outperforming regional peers, in line with lower inflation expectations and the prospect of concluding the tightening cycle in Banrep's Monetary Policy Rate (MPR), coupled with an increase in local risk appetite. Long-term securities outperformed short-term ones, therefore, flattening the yield curve. Foreign investors accentuated their selling trend of local currency public debt securities. Nevertheless, they remain the second-largest holders of these assets, trailing behind local pension funds, which have made significant purchases of these securities so far this year. The money market continued to operate adequately, and the overnight benchmark interbank rate (IBR in Spanish) closely tracked the MPR established by the Banrep’s Board of Directors (BDBR), partly due to the Banrep’s liquidity provisions to the market. Banrep offered repurchase agreements (repos) at multiple maturities and engage in purchases in the public debt market to provide permanent liquidity to the economy and prevent the IBR from deviating from the MPR. In the foreign exchange market, the Colombian peso appreciated above its regional peers. The exchange rate reached unseen levels since mid-last year, in line with increased local risk appetite and flows that influenced its behavior. Nonetheless, the level remains divergent from those exhibited by currencies of peer countries in the region when considering a longer time horizon. Boxes Box 1: Factors that may influence the Resistance to Inversion of the Yield Curve in Colombia Box 2: Central Bank Asset Purchases in Response to the Covid-19 Crisis