Press Release:
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Loss of protective heart failure protein linked to critical limb ischemia
S100A1 could be a potential therapeutic target in critical limb ischemiato promote revascularization, say Thomas Jefferson University researchers from the Center for Translational Medicine
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Press Release:
Covidien Announces Final Results from Landmark DEFINITIVE LE Study in Patients with Peripheral Arterial Disease
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Related threads:
Other threads tagged with peripheral vascular disease -
Outcomes of angiosome and non-angiosome targeted revascularization in critical lower limb ischemia.
Kabra A, Suresh KR, Vivekanand V, Vishnu M, Sumanth R, Nekkanti M.
J Vasc Surg. 2012 Oct 8.
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I have found 4 abstracts of articles proving that increasing circulation using a pneumatic compression device increase wound healing amongst diabetic patients.
The links are
http://1.usa.gov/19bas8
http://1.usa.gov/ndrMLV
http://1.usa.gov/QX4At9
http://1.usa.gov/WAerJi.
It seems that since circulation is a major factor in wound healing then any device which increases it should have a similar effect. There is but one battery powered portable device on the market and it has shown some remarkable success so far.
If anyone wishes to find out more they can find me on twitter.
Selwyn Firth -
Endovascular Revascularization for Patients with Critical Limb Ischemia: Impact on Wound Healing and Long Term Clinical Results in 189 Limbs.
Bae JI, Won JH, Han SH, Lim SH, Hong YS, Kim JY, Kim JD, Kim JS.
Korean J Radiol. 2013 May;14(3):430-438.
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If the protein is so effective, it might be quicker and more effective to just make copies and give injections similar to insulin for the treatment of Type 1 diabetes. Cost of gene therapy may be too expensive and not cost effective based on expected extension of lifetimes.The researchers should try making and using the protein before moving into gene therapy.
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Press Release:
Procedures saving limbs of more peripheral arterial disease patients, Mayo Clinic finds
Amputation study among several being presented at Society for Vascular Surgery conference
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Growing Impact of Restenosis on the Surgical Treatment of Peripheral Arterial Disease
Douglas W. Jones, MD; Andres Schanzer, MD; Yuanyuan Zhao, MA; Todd A. MacKenzie, PhD; Brian W. Nolan, MD; Michael S. Conte, MD; Philip P. Goodney, MD, MS, The Vascular Study Group of New England
J Am Heart Assoc. 2013; 2: e000345 -
Our treatment strategy for critical limb ischemia.
Yamada T, Onishi K, Utsunomiya M, Nakamura M.
Int J Vasc Med. 2013;2013:437471. doi: 10.1155/2013/437471.
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Peripheral Arterial Testing Before Lower Extremity Amputation Among Medicare Beneficiaries, 2000 to 2010.
Vemulapalli S, Greiner MA, Jones WS, Patel MR, Hernandez AF, Curtis LH.
Circ Cardiovasc Qual Outcomes. 2014 Jan 14
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Multidisciplinary approach to treatment of patients with lower limb critical ischaemia.
Maksimov AV, Koreĭba KA, Nuretdinov RM, Usmanov MA, Glinkin VV.
Angiol Sosud Khir. 2013;19(4):122-126.
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Press Release:
THE SAGE GROUP LLC Announces Publication of an Article Titled “Cost-Benefit Analysis of Amputation in the Era of the Affordable Care Act. Is it Fiscally Responsible to Perform Primary Amputation as Treatment?” in the May Issue of Endovascular Today
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Urgent endovascular revascularization in acute on chronic critical limb ischemia.
Troisi N, Ercolini L, Chisci E, Barbanti E, Peretti E, Setti M, Pitì A, Michelagnoli S.
J Cardiovasc Surg (Torino). 2014 Sep 12.
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Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis.
Sano, Hitomi MD, PhD; Ichioka, Shigeru MD, PhD
Plastic and Reconstructive Surgery; September 22, 2014
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A systematic review of intermittent pneumatic compression for critical limb ischaemia.
Moran PS, Teljeur C, Harrington P, Ryan M.
Vasc Med. 2014 Sep 30.
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An early validation of the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System.
Cull DL, Manos G, Hartley MC, Taylor SM, Langan EM, Eidt JF, Johnson BL.
J Vasc Surg. 2014 Oct 1
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Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease: Consensus Definitions From Peripheral Academic Research Consortium (PARC).
Patel MR et al
J Am Coll Cardiol. 2015 Mar 10;65(9):931-941. doi: 10.1016/j.jacc.2014.12.036.
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Predictors of Delayed Wound Healing after Endovascular Therapy of Isolated Infrapopliteal Lesions Underlying Critical Limb Ischemia in Patients with High Prevalence of Diabetes Mellitus and Hemodialysis.
Shiraki T et al
Eur J Vasc Endovasc Surg. 2015 Mar 3
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Press Release:
Lower extremity revascularization not effective in majority of nursing home residents
UCSF researchers find most patients still alive gain little, if any, function
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Prognosis of critical limb ischemia: Minor vs major amputation comparison.
Matsuzaki K et al
Wound Repair Regen. 2015 Jun 17
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Outcomes of One straight-line flow with and without pedal arch in patients with critical limb ischemia.
Higashimori A et al
Catheter Cardiovasc Interv. 2015 Oct 22
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Functional Imaging of the Foot with Perfusion Angiography in Critical Limb Ischemia.
Reekers JA et al
Cardiovasc Intervent Radiol. 2015 Dec 1
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Below-the-Knee Angioplasty for Critical Limb Ischemia: Results of a series of 157 procedures and impact of the Angiosome Concept
Marie Pave et al
Annals of Vascular Surgery; 15 July 2016
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Determining End Points for Critical Limb Ischemia Interventions.
Cooper KJ, Pe?a C, Benenati J
Tech Vasc Interv Radiol. 2016 Jun;19(2):104-112. doi: 10.1053/j.tvir.2016.04.003. Epub 2016 Apr 22.
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Lumbar sympathectomy techniques for critical lower limb ischaemia due to non-reconstructable peripheral arterial disease.
Karanth VK, Karanth TK, Karanth L.
Cochrane Database Syst Rev. 2016 Dec 13;12:CD01151
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Risk Factors for Mortality Among Individuals With Peripheral Arterial Disease
S.M. Amrock, C.Z. Abraham, E. Jung, P.B. Morris, M.D. Shapiro
Am J Cardiol 2017;120:862-7.
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Recurrence of Critical Limb Ischemia After Endovascular Intervention in Patients with Diabetic Foot Ulcers.
Meloni M et al
Adv Wound Care (New Rochelle). 2018 Jun 1;7(6):171-176. doi: 10.1089/wound.2017.0778.
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The impact of foot infection on infrainguinal bypass outcomes in patients with chronic limb-threatening ischemia.
Mayor JM et al
Vasc Surg. 2018 Jul 28. pii: S0741-5214(18)31068-1
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Clinical characteristics of Japanese diabetic patients with critical limb ischemia presenting Fontaine stage IV
Mitsuyoshi TakaharaOsamu IidaYukihiro FujitaMasakazu Haneda
Diabetology International: 08 December 2018
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A Review and Proposed Classification System for the No-Option Patient With Chronic Limb-Threatening Ischemia
Tanner I. Kim, MD, Shant S. Vartanian, MD, Peter A. Schneider, MD
Journal of Endovascular Therapy October 9, 2020
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Research priorities for lower limb amputation in patients with vascular disease
DC Bosanquet et al
Source
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Continuous peripheral nerve block for in-patients with lower limb ischemic pain
Hermann Dos Santos Fernandes et al
Clinics (Sao Paulo). 2021;76:e2805
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Hospital Payer Mix and Amputation Rates Among Patients with Peripheral Artery Disease Complications
Deeksha Bidare, Neal R Barshes
Ann Vasc Surg. 2022 Apr 25
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Management of the no-option foot: Deep vein arterialization
Sadia Ilyas, Richard J Powell
Semin Vasc Surg. 2022 Jun;35(2):210-218
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Press release:
Insights from largest chronic limb-threatening ischemia study to inform quality of care improvements
Data from a cohort of one million patients with chronic limb-threatening ischemia (CLTI) were presented today as late-breaking clinical research at the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 Scientific Sessions. Using data from Medicare, the cohort, Chronic Limb threatening Ischemia Process PERformance (CLIPPER), found one out of six patients with CLTI died within their first year of diagnosis and 50% survived at five years.
CLTI is a serious condition in which blood flow to the feet or legs is severely limited by atherosclerotic plaque. Patients with CLTI are at high risk of lower extremity amputation and death without prompt diagnosis and treatment. Though CLTI is common and highly morbid, there are no established process measures to guide high-quality care. Using data from Medicare, the CLIPPER cohort was created to develop and test process measures for CLTI, which could ultimately be used to measure and improve quality of care.
Using inpatient and outpatient claims data from patients with fee-for-service Medicare from 2010 to 2019, a coding algorithm was used to identify patients with CLTI. To qualify for a CLTI diagnosis, patients had either 1) one diagnostic code for peripheral artery disease and one diagnostic code for ulceration, infection, or gangrene on the same inpatient or outpatient claim, or 2) one CLTI-specific diagnostic code, as well as a procedure code indicating arterial vascular testing within six months before or after the qualifying CLTI diagnostic code(s).
The cohort comprised 1,130,065 patients diagnosed with CLTI between 2010 and 2019. Mean age of the cohort was 75 ± 5.8 years; 48.4% were women and 14.6% were Black. Within 30 days of CLTI diagnosis, 20.4% of patients underwent percutaneous or surgical revascularization. Within 6 months, 3.3% of patients underwent major amputation; 16.7% of patients died at 1-year follow-up and 50.3% at 5-year follow-up.
“CLTI is an incredibly deadly disease if not treated quickly after diagnosis, but we know very little about how hospitals perform with respect to treatment,” said Alexander Fanaroff, MD, MHS and Assistant Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and lead author. “Comprehensive process measures are needed for patients in order to advance care and improve the chance of survival. Our hope is that this study is a first step toward developing better process measures.” -
Lower extremity Allen test in critical limb ischemia
Khurram H Khan et al
Source
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Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
Eleanor Atkins, Ian Kellar, Panagiota Birmpili, Jonathan R. Boyle, Arun D. Pherwani, Ian Chetter & David A. Cromwell
Journal of Foot and Ankle Research volume 16, Article number: 62 (2023)
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News Release 10-Apr-2024
Revascularization enhances quality of life for patients with chronic limb threatening ischemia
Study reveals diminished quality of life among patients with chronic limb-threatening ischemia, a severe form of peripheral artery disease, and emphasizes the benefits of revascularization on wellbeing
Over 200 million people around the world experience peripheral artery disease (PAD) – a condition caused by the narrowing of the blood vessels from the heart to the lower limbs that leads to pain when walking – and for roughly 1-in-10 this advances to chronic limb-threatening ischemia (CLTI), an advanced form of PAD. Those with CLTI often suffer severe pain even at rest, caused by fatty plaque buildup obstructing blood flow, typically to the leg or foot. Those with CLTI face elevated risks of amputation, cardiovascular disease and premature death, yet research on the condition’s impact on quality of life remains limited.
Investigators from both of Mass General Brigham’s founding members, Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH), as well as Boston Medical Center (BMC), sought to address this problem. Following their previous study highlighting the clinical results of the BEST-CLI trial – Best Endovascular versus Best Surgical Therapy for Patients with Critical Limb Ischemia – published in the New England Journal of Medicine (NEJM), the team assessed patient health-related quality of life before and after revascularization treatment. Results are published in Circulation.
“Our study indicates that patients with CLTI have a notably poor quality of life – substantially lower than with many other chronic conditions,” said Matthew Menard, MD, co-director of the Endovascular Surgery Program at BWH and co-principal investigator of BEST-CLI. “Our findings show that revascularization, which restores sufficient blood flow back into the legs, significantly improves quality of life. This confirms the critical role that revascularization plays not just in extending the length of patients’ lives but also its importance in optimizing their wellbeing.”
Among patients with CLTI, those eligible for surgical treatment often have two options: surgical bypass (Bypass), where surgeons restore blood and oxygen to the lower limb by reconstructing the blocked vessel, or endovascular therapy (Endo), which involves placing a stent or catheter inside an artery and opening it up to bring blood flow through a blockage.
Funded by the National Heart, Lung, and Blood Institute, with ongoing post-enrollment support from the Novo Nordisk Foundation, the BEST-CLI trial enrolled over 1,800 patients with CLTI from 150 research sites in the U.S., Canada, Finland, Italy, and New Zealand between August of 2014 and October of 2019. Investigators assessed how clinical outcomes (previously reported in NEJM) and quality of life metrics varied between revascularization techniques.
“Medicine is generally moving towards a more patient-centric model of care. That means looking at what’s best for each patient, taking into account an evidence-based approach. Quality of life is one important element in this determination,” said co-principal investigator Kenneth Rosenfield, MD, head of the Section of Vascular Medicine and Intervention in the Division of Cardiology at MGH.
Investigators sorted 1,528 participants into two cohorts. The first cohort was made up of 1,193 patients, all of whom had an available, good-quality, single-segment great saphenous vein (SSGSV), which previous studies have shown is optimal for Bypass. The second cohort was made up of 335 patients who did not have an available SSGSV. Patients in both cohorts were randomized to undergo Bypass or Endo procedures. Researchers assessed quality of life by administering voluntary surveys asking participants about pain levels, activities of daily living, disease symptoms and severity, physical activity, and mental health (anxiety and depression). Surveys were collected at baseline, 30 days post-procedure, at three months, 12 months, then once yearly until the end of the study.
“Patient-reported outcome measures are essential to our understanding of the patient experience,” said co-principal investigator Alik Farber, MD, MBA, interim chair of the Department of Surgery, chief of the Division of Vascular and Endovascular Surgery at BMC and professor of Surgery and Radiology at Boston University Chobanian & Avedisian School of Medicine. “Yet these metrics are not often used and sometimes ignored. Here we found an opportunity to hear our patients’ voices and use them to improve CLTI outcomes.”
While the trial’s previously published clinical outcomes revealed that patients treated with Bypass had fewer major amputations and less need for repeat procedures than those treated with Endo, quality of life did not significantly differ between treatments. Survey results instead revealed that participants generally experienced significant improvements in quality of life after treatment, regardless of their cohort or whether they underwent Bypass or Endo. They further highlighted that patients with CLTI overwhelmingly conveyed that their quality of life was low upon entering the trial, before receiving treatment.
This study is limited in that patients filled out quality-of-life questionnaires at distinct periods throughout the trial, but these time points did not necessarily line up with significant health events such as additional revascularization procedures or amputations. Further, there remains a dearth of quality-of-life research for patients with PAD, and there are no specific metrics to assess the quality of life for patients with PAD or CLTI.
Going forward, the team aims to assess differences in the cost-effectiveness of these procedures, and how cost, among other factors, affects patient quality of life and overall health outcomes.
“The next step is to integrate quality-of-life measures into a more sophisticated care plan to account for the clinical status of the patient and the cost-effectiveness of treatment options, both for the patient and the viability of the healthcare system,” said Farber.
Authorship: Additional authors include Richard J. Powell, Michael S. Conte, Taye H. Hamza, John A. Kaufman, Mark J. Cziraky, Mark A. Creager, Michael D. Dake, Michael R. Jaff, Diane Reid, George Sopko, Christopher J. White, Michael B. Strong, Max van Over, Emiliano Chisci, Philip P. Goodney, Bruce Gray, Ahmed Kayssi, Jeffrey J. Siracuse (BWH), Niteesh K. Choudhry (BWH).
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