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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024:S0735-1097(24)00381-4. [PMID: 38752899 DOI: 10.1016/j.jacc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Monami M, Silverii A, Miranda C, Monge L, Uccioli L, Scevola G, Stabile E, Gargiulo M, Scatena A, Ragghianti B, Vermigli C. Prostanoids in patients with diabetes and chronic limb-threatening ischemia: a meta-analysis of randomized clinical trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 2024:10.1007/s00592-024-02260-x. [PMID: 38563995 DOI: 10.1007/s00592-024-02260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/11/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Matteo Monami
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy.
- Diabetology, Careggi Hospital, Largo Brambilla 3, 50141, Florence, Italy.
| | - Antonio Silverii
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | | | - Luca Monge
- AMD - Italian Association of Clinical Diabetologists, Rome, Italy
| | - Luigi Uccioli
- Diabetes Section CTO Hospital and Dept of Biomedicine and Prevention Tor Vergata, University of Rome, Rome, Italy
| | | | | | - Mauro Gargiulo
- Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy
- Vascular Surgery Unit, IRCCS, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Alessia Scatena
- San Donato Hospital, Health Authorities South East Tuscany, Arezzo, Italy
| | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
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Alhewy MA, Abdo EM, Abd Elmoneim Ghazala E, Atef Khamis A, Gado H, Abdo Abd-Elgawad WA, Abdelhafez AA, El Sayed A, Khedr AM, Mahmoud Mosaed HA. Outcomes of Alprostadil as an Adjuvant Therapy with Indirect Angiosomal Revascularization in Patients with Critical Limb Ischemia after Failure of Direct Revascularization. Ann Vasc Surg 2024:S0890-5096(24)00056-6. [PMID: 38431199 DOI: 10.1016/j.avsg.2023.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES this study was carried out to assess the effectiveness of Alprostadil (Prostaglandin E1) when used as an adjuvant therapy with indirect revascularization in patients with critical limb ischemia after the failure of direct revascularization. PATIENTS AND METHODS At our centers, 120 patients suffering from infrainguinal peripheral arterial disease with critical limb ischemia underwent a failed trial of direct revascularization procedure, all revascularization procedures were endovascular. Median follow-up was two years and 2.5 years for patients with and without DM. In the Alprostadil group mean age was 63.41±12.52; 36 (60%) for males and 24 (40%) for females. Post-endovascular intervention Alprostadil was administrated immediately postoperatively by intravenous infusion of 40μg Alprostadil diluted in 100 ml of normal saline, over 2 hours every 12 hours for six days. RESULTS In Alprostadil group, the mean ± SD of the baseline ABI was 0.45±0.175, while the Mean ± SD of ABI at the end of our study was 0.65±0.216 with a difference from the baseline of 0.2±0.041 (P-Value = 0.08, <0.05 meaning that it is significant). Our 1-month primary patency rate was 93.3%, while our 3 and 6-month patency rate was 92.9%. In the control group, the mean ± SD of the baseline ABI was 0.68±0.22, while the Mean ± SD of ABI at the end of our study was 0.69±0.23 with a difference from the baseline of 0.01±0.01 (P-Value > 0.05 meaning that it is non-significant) 1-month patency rate was 89%, while 3-month and 6-month patency rate was 75%. When we compared the patient's leg vessels before and after our intervention, we found that the percentage of the no-runoff-vessels group decreased from 10 (16.7%) to 4 (6.67%). One-runoff-vessel group percentage dropped from 40 (66.7%) to 36 (60%), whereas, in the two-runoff-vessel group, the percentage increased from 10 (16.7%) to 20 (33.3%). We evaluate leg arteries; we do no pedal arch intervention. in the Alpostradil group. Out of the total of 60 patients, limb salvage occurred in 58 (96.7%) patients, and 2 (3.3%) patients underwent below-the-knee amputation (BKA) before the study ended. CONCLUSION Our results show the efficacy and safety of Alprostadil as an adjuvant therapy with indirect angiosomal revascularization in patients with tissue loss due to critical limb ischemia.
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Affiliation(s)
- Mohammed Alsagheer Alhewy
- vascular and endovascular surgery department, faculty of Medicine, Assiut, Al-Azhar University, Egypt.
| | - Ehab M Abdo
- vascular and endovascular surgery department, faculty of Medicine (girls), Cairo, Al-Azhar University, Egypt
| | - Ehab Abd Elmoneim Ghazala
- vascular and endovascular surgery department, faculty of Medicine, Assiut, Al-Azhar University, Egypt
| | - Ahmed Atef Khamis
- vascular and endovascular surgery department, faculty of Medicine, Assiut, Al-Azhar University, Egypt
| | - Hassan Gado
- vascular and endovascular surgery department, faculty of Medicine, Assiut, Al-Azhar University, Egypt
| | | | | | - Abdullah El Sayed
- vascular and endovascular surgery department, faculty of Medicine, Cairo, Al-Azhar University, Egypt
| | - Alhussein M Khedr
- vascular and endovascular surgery department, faculty of Medicine (girls), Cairo, Al-Azhar University, Egypt
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Troisi N, Bertagna G, Juszczak M, Canovaro F, Torri L, Adami D, Berchiolli R. Emergent management of diabetic foot problems in the modern era: Improving outcomes. Semin Vasc Surg 2023; 36:224-233. [PMID: 37330236 DOI: 10.1053/j.semvascsurg.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 06/19/2023]
Abstract
Limb amputation is a consequence, and the leading complication, of diabetic foot ulcers. Prevention depends on prompt diagnosis and management. Patients should be managed by multidisciplinary teams and efforts should be focused on limb salvage ("time is tissue"). The diabetic foot service should be organized in a way to meet the patient's clinical needs, with the diabetic foot centers at the highest level of this structure. Surgical management should be multimodal and include not only revascularization, but also surgical and biological debridement, minor amputations, and advanced wound therapy. Medical treatment, including an adequate antimicrobial therapy, has a key role in the eradication of infection and should be guided by microbiologists and infection disease physicians with special interest in bone infection. Input from diabetologists, radiologists, orthopedic teams (foot and ankle), orthotists, podiatrists, physiotherapists, and prosthetics, as well as psychological counseling, is required to make the service comprehensive. After the acute phase, a well-structured, pragmatic follow-up program is necessary to adequately manage the patients with the aim to detect earlier potential failures of the revascularization or antimicrobial therapy. Considering the cost and societal impact of diabetic foot problems, health care providers should provide resources to manage the burden of diabetic foot problems in the modern era.
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Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Maciej Juszczak
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesco Canovaro
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Lorenzo Torri
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
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Abu Deiab GI, Croatt MP. Prostacyclin (PGI2) scaffolds in medicinal chemistry: current and emerging drugs. Med Chem Res. [DOI: 10.1007/s00044-022-02914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abola MTB, Golledge J, Miyata T, Rha SW, Yan BP, Dy TC, Ganzon MSV, Handa PK, Harris S, Zhisheng J, Pinjala R, Robless PA, Yokoi H, Alajar EB, Bermudez-delos Santos AA, Llanes EJB, Obrado-Nabablit GM, Pestaño NS, Punzalan FE, Tumanan-Mendoza B. Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee. J Atheroscler Thromb 2020; 27:809-907. [PMID: 32624554 PMCID: PMC7458790 DOI: 10.5551/jat.53660] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic modalities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD. OBJECTIVES The APSAVD aimed to accomplish the following: 1) determine the applicability of the 2016 AHA/ACC guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease to the Asia-Pacific region; 2) review Asia-Pacific literature; and 3) increase the awareness of PAD. METHODOLOGY A Steering Committee was organized to oversee development of the APCS, appoint a Technical Working Group (TWG) and Consensus Panel (CP). The TWG appraised the relevance of the 2016 AHA/ACC PAD Guideline and proposed recommendations which were reviewed by the CP using a modified Delphi technique. RESULTS A total of 91 recommendations were generated covering history and physical examination, diagnosis, and treatment of PAD-3 new recommendations, 31 adaptations and 57 adopted statements. This Asia-Pacific Consensus Statement on the Management of PAD constitutes the first for the Asia-Pacific Region. It is intended for use by health practitioners involved in preventing, diagnosing and treating patients with PAD and ultimately the patients and their families themselves.
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Affiliation(s)
- Maria Teresa B Abola
- Department of Clinical Research, Philippine Heart Center and University of the Philippines College of Medicine, Metro Manila, Philippines
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan
| | - Seung-Woon Rha
- Dept of Cardiology, Internal Medicine, College of Medicine, Korea University; Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Timothy C Dy
- The Heart Institute, Chinese General Hospital and Medical Center, Manila, Philippines
| | | | | | - Salim Harris
- Neurovascular and Neurosonology Division, Neurology Department, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | | | | | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital; International University of Health and Welfare, Fukuoka, Japan
| | - Elaine B Alajar
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital; University of the Philippines College of Medicine, Manila, Philippines
| | | | - Elmer Jasper B Llanes
- Division of Cardiology, Department of Medicine, College of Medicine, University of the Philippines Philippine General Hospital, Manila, Philippines
| | | | - Noemi S Pestaño
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital, Manila, Philippines
| | - Felix Eduardo Punzalan
- Division of Cardiology, Department of Medicine, College of Medicine, University of the Philippines; Philippine General Hospital, Manila, Philippines
| | - Bernadette Tumanan-Mendoza
- Department of Clinical Epidemiology, University of the Philippines College of Medicine, Manila, Philippines
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Meini S, Dentali F, Melillo E, de Donato G, Mumoli N, Mazzone A. Prostanoids for Critical Limb Ischemia: A Clinical Review and Consideration of Current Guideline Recommendations. Angiology 2019; 71:226-234. [PMID: 31769315 DOI: 10.1177/0003319719889273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For many years, the only pharmacological option for patients with critical limb ischemia (CLI) unsuitable for revascularization has been prostanoids; however, some recent guidelines have become very restrictive regarding their use. We review the available evidence on the use of prostanoids and analyze the guideline positions as well as the possible reasons for changes over time. In most placebo-controlled trials and meta-analyses, prostanoids showed a significant effect in improving rest pain, promoting ulcer healing and reducing major amputations. Results for iloprost were especially consistent. Different prostanoid drugs have different evidence of efficacy, thus using a generic term "prostanoids" is misleading. Unfortunately, the available evidence is often of low quality and probably not sufficient to support an extensive use of prostanoids in all patients, and further high-quality randomized trials are needed. Consequently, some recent guidelines do not recommend treatment with prostanoids in this setting. However, in our opinion, pending definitive evidence, patients with CLI who have a viable limb in whom revascularization is unfeasible or has a poor chance of success, without alternative to amputation, may benefit from treatment with iloprost, balancing harms and benefits in each case.
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Affiliation(s)
- Simone Meini
- Internal Medicine Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Elio Melillo
- Cardiothoracic and Vascular Department, Angiology Unit, University of Pisa, Pisa, Italy
| | | | - Nicola Mumoli
- Internal Medicine Department, ASST Ovest Milanese Magenta, Legnano, Italy
| | - Antonino Mazzone
- Internal Medicine Department, ASST Ovest Milanese Magenta, Legnano, Italy
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Borisov AS, Malov AA, Kolesnikov SV, Lomivorotov VV. Renal Replacement Therapy in Adult Patients After Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:2273-2286. [PMID: 30871949 DOI: 10.1053/j.jvca.2019.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Alexander S Borisov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Andrey A Malov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Sergey V Kolesnikov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Vladimir V Lomivorotov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia.
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Cherviakov IV, Kha KN, Klimov AE, Gavrilenko AV. [Immediate results of conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes]. Angiol Sosud Khir 2019; 25:11-15. [PMID: 31149986 DOI: 10.33529/angio2019201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of the study was to comparatively assess efficacy of using agents belonging to the group of prostaglandin E1 in comprehensive conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes by the frequency of major amputation, amputation-free survival, and total mortality by combinations of the WIfI classification during a 6-month follow up period. Our retrospective multicentre study enrolled a total of 109 patients, including 60 men and 49 women, with a mean age of 70±7.3 years. The patients were subdivided into 2 groups. Group 1 patients (n=58) received standard conservative therapy without prostaglandin E1 and group 2 patients (n=51) received similar treatment with the use of prostaglandin E1. The statistical analysis (chi-squared test, Fisher criterion, log-rank test) was carried out with regard to stratification of the patients in the groups by the WIfI component combinations. No statistically significant differences between the groups in the frequency of amputation and total mortality were revealed (p=0.094 and p=0.925, respectively). The use of the WIfI classification system made it possible to single out a cohort of patients (with a WIfI combination of 130) for whom the results of administering prostaglandin E1 statistically significantly differed by the frequency of amputation (p=0.042) and by amputation-free survival (p=0.017). No significant differences by these outcomes were obtained for other combinations analysed. A conclusion was drawn that using prostaglandin E1 in comprehensive conservative treatment decreased the frequency of amputation and increased amputation-free survival in patients presenting with unreconstructable critical limb ischaemia and referred to the category with a combination of 130 according to the WIfI classification.
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Affiliation(s)
- Iu V Cherviakov
- Yaroslavl State Medical University of the FR Ministry of Public Health, Yaroslavl, Russia
| | - Kh N Kha
- Russian University of Friendship of Peoples, Moscow, Russia
| | - A E Klimov
- Russian University of Friendship of Peoples, Moscow, Russia
| | - A V Gavrilenko
- Russian Research Centre of Surgery named after Academician B.V. Petrovsky, Moscow, Russia; First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
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Abstract
OBJECTIVES To determine the indications for the use, potential benefits, and adverse reactions of alprostadil in a group of Colombian patients. METHODS A retrospective cross-sectional study was conducted in patients diagnosed with critical limb ischemia who received alprostadil in five hospitals in Colombia between September 2011 and July 2017. We reviewed the clinical records of each patient to obtain the sociodemographic and pharmacological variables, clinical stages, complications, comorbidities, reported effectiveness and adverse reactions. RESULTS Sixty-one patients treated with alprostadil were evaluated; 50.8% of patients were men, and the average age of 72.5 ± 10.7 years. A total of 86.9% of patients were hypertensive, and 65.6% were diabetic. A total of 77.0% presented ulceration, and this condition was considered as a diabetic foot in 57.4% of patients. A total of 81.9% of patients were classified as Fontaine stage 4; 60.7% received therapy as initially indicated, with an average of 19 days of alprostadil use. Regarding the therapy results, 58.0% of the patients with ulcers or trophic lesions showed improvement, 86.2% showed improvement of pain, and the limb was saved in 72.1% of patients. CONCLUSIONS Critical limb ischemia was presented by patients with advanced age and high cardiovascular risk who were treated during severe and advanced stages where therapeutic options are limited. Treatment with alprostadil achieved satisfactory results with improvement in ulcers, pain, and limb salvage rates in this series of patients.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- 1 Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia, South America.,2 Fundacion Universitaria Autonoma de las Americas. Pereira, Colombia
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Andrade-Lima A, Chehuen M, Silva Junior N, Fecchio RY, Peçanha T, Brito LC, Miyasato R, Leicht AS, Forjaz CLM. Reproducibility of Hemodynamic, Cardiac Autonomic Modulation, and Blood Flow Assessments in Patients with Intermittent Claudication. Ann Vasc Surg 2018; 57:144-151. [PMID: 30476599 DOI: 10.1016/j.avsg.2018.08.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/18/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study is to identify, in patients with peripheral artery disease and intermittent claudication (IC), the reproducibility of heart rate (HR), blood pressure (BP), rate pressure product, heart rate variability (HRV), and forearm and calf blood flow (BF) and vasodilatory assessments. METHODS Twenty-nine patients with IC underwent test and retest sessions, 8-12 days apart. During each session, HR, BP, HRV, BF, and vasodilatory responses were measured by electrocardiogram, auscultation, spectral analysis of HRV (low frequency, LFR-R; high frequency, HFR-R), and strain gauge plethysmography (baseline BF, post-occlusion BF, post-occlusion area under the curve). Reproducibility was determined by intra-class correlation coefficient (ICC), typical error, coefficient of variation (CV), and limits of agreement. RESULTS The ICC for HR and BP was >0.8 with CV <9%. For most HRV measures, ICC was >0.9 while CV was <7%, except for LF/HF (ICC = 0.737, CV = 93.8%). The ICC for forearm and calf baseline BF assessments was >0.9 while CV was <19%; variable ICC and CV for vasodilatory responses were exhibited for calf (0.653-0.770, 35.2-37.7%) and forearm (0.169-0.265, 46.2-55.5%). CONCLUSIONS In male patients with IC, systemic hemodynamics (HR and BP), cardiac autonomic modulation (LFR-R and HFR-R), and forearm and calf baseline BF assessments exhibited excellent reproducibility, whereas the level of reproducibility for vasodilatory responses were moderate to poor. Assessment reproducibility has highlighted appropriate clinical tools for the regular monitoring of disease/intervention progression in patients with IC.
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Affiliation(s)
- Aluísio Andrade-Lima
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | - Marcel Chehuen
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Natan Silva Junior
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Rafael Y Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Leandro C Brito
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Roberto Miyasato
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Anthony S Leicht
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Cláudia L M Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Pandey P, Vadlamudi R, Pradhan R, Pandey KR, Kumar A, Hackett P. Case Report: Severe Frostbite in Extreme Altitude Climbers—The Kathmandu Iloprost Experience. Wilderness Environ Med 2018; 29:366-74. [DOI: 10.1016/j.wem.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/12/2018] [Accepted: 03/13/2018] [Indexed: 11/17/2022]
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Rammos C, Burghardt A, Lortz J, Azizy O, Jánosi RA, Steinmetz M, Rassaf T. Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case-control study. Eur J Med Res 2018; 23:25. [PMID: 29788990 PMCID: PMC5964909 DOI: 10.1186/s40001-018-0324-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/14/2018] [Indexed: 01/10/2023] Open
Abstract
Background Radial artery access is the primary approach for coronary interventions due to higher safety profile in comparison to femoral access. Radial artery occlusion (RAO) is the main complication of transradial catheterization that can lead to severe symptoms and a permanent artery occlusion. The incidence of RAO after transradial access ranges from 5 to 38% and data regarding treatment is scarce. Whether anticoagulation and vasoactive medication provides an additional benefit in recovery of radial artery patency (RAP) after catheterization has not been investigated in detail. Aim The objective was to investigate the impact of anticoagulation and vasoactive medication on regained patency after documented RAO following transradial catheterization. Patients and methods Overall 2635 patients were screened. 2215 (84%) catheterizations were performed by femoral and 420 (16%) by radial access. In 30 patients RAO was observed. In case of RAO patients were classified in three groups: Anticoagulation, anticoagulation added with alprostadil and controls. Follow-up was conducted after 3 months with ultrasound and clinical examination. Results Eight patients received anticoagulation and 11 patients anticoagulation together with alprostadil. Eleven patients served as controls. Recovery of RAP after catheterization was higher following either treatment (79.5%) compared to controls (0%, p = 0.006). Subgroup analysis yielded a higher RAP recovery in patients treated with anticoagulation (62.5%) as compared to controls (0%, p = 0.002). No effect on regained RAP was found with additional alprostadil therapy (33.3%) compared to anticoagulation therapy (62.5%, p = 0.229). Conclusion RAO should be treated with anticoagulation to regain patency. Addition of vasoactive medication does not lead to further beneficial effects. Further research is needed regarding preventive and therapeutic strategies following RAO.
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Affiliation(s)
- C Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - A Burghardt
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J Lortz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - O Azizy
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - R A Jánosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - M Steinmetz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - T Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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Abstract
BACKGROUND Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity and mortality due to cardiovascular disease in the general population. Although numerous treatments have been adopted for patients at different disease stages, no option other than amputation is available for patients presenting with critical limb ischaemia (CLI) unsuitable for rescue or reconstructive intervention. In this regard, prostanoids have been proposed as a therapeutic alternative, with the aim of increasing blood supply to the limb with occluded arteries through their vasodilatory, antithrombotic, and anti-inflammatory effects. This is an update of a review first published in 2010. OBJECTIVES To determine the effectiveness and safety of prostanoids in patients with CLI unsuitable for rescue or reconstructive intervention. SEARCH METHODS For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (January 2017) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1). In addition, we searched trials registries (January 2017) and contacted pharmaceutical manufacturers, in our efforts to identify unpublished data and ongoing trials. SELECTION CRITERIA Randomised controlled trials describing the efficacy and safety of prostanoids compared with placebo or other pharmacological control treatments for patients presenting with CLI without chance of rescue or reconstructive intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. We resolved disagreements by consensus or by consultation with a third review author. MAIN RESULTS For this update, 15 additional studies fulfilled selection criteria. We included in this review 33 randomised controlled trials with 4477 participants; 21 compared different prostanoids versus placebo, seven compared prostanoids versus other agents, and five conducted head-to-head comparisons using two different prostanoids.We found low-quality evidence that suggests no clear difference in the incidence of cardiovascular mortality between patients receiving prostanoids and those given placebo (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.41 to 1.58). We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared with placebo (RR 0.97, 95% CI 0.86 to 1.09). Adverse events were more frequent with prostanoids than with placebo (RR 2.11, 95% CI 1.79 to 2.50; moderate-quality evidence). The most commonly reported adverse events were headache, nausea, vomiting, diarrhoea, flushing, and hypotension. We found moderate-quality evidence showing that prostanoids reduced rest-pain (RR 1.30, 95% CI 1.06 to 1.59) and promoted ulcer healing (RR 1.24, 95% CI 1.04 to 1.48) when compared with placebo, although these small beneficial effects were diluted when we performed a sensitivity analysis that excluded studies at high risk of bias. Additionally, we found evidence of low to very low quality suggesting the effects of prostanoids versus other active agents or versus other prostanoids because studies conducting these comparisons were few and we judged them to be at high risk of bias. None of the included studies assessed quality of life. AUTHORS' CONCLUSIONS We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared against placebo. Moderate-quality evidence showed small beneficial effects of prostanoids for rest-pain relief and ulcer healing when compared with placebo. Additionally, moderate-quality evidence showed a greater incidence of adverse effects with the use of prostanoids, and low-quality evidence suggests that prostanoids have no effect on cardiovascular mortality when compared with placebo. None of the included studies reported quality of life measurements. The balance between benefits and harms associated with use of prostanoids in patients with critical limb ischaemia with no chance of reconstructive intervention is uncertain; therefore careful assessment of therapeutic alternatives should be considered. Main reasons for downgrading the quality of evidence were high risk of attrition bias and imprecision of effect estimates.
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Affiliation(s)
- Valeria Vietto
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceBuenos AiresArgentina
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentreBuenos AiresArgentina
| | - Juan VA Franco
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentreBuenos AiresArgentina
| | - Victoria Saenz
- Unidad Asistencial Dr. César MilsteinInternal MedicineLa Rioja 951Ciudad Autónoma de Buenos AiresBuenos AiresArgentinaC1221ACI
| | - Denise Cytryn
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceBuenos AiresArgentina
| | - Jose Chas
- Hospital Italiano de Buenos AiresCardiovascular Surgery DepartmentBuenos AiresArgentinaPerón 4190
| | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
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Megías-Vericat JE, Ricart JM, Ribes-Artero H, Poveda JL. Prostaglandin Injection After Arterial Compromise Related to Hyaluronic Acid Filler. Dermatol Surg 2017; 43:975-7. [PMID: 28178006 DOI: 10.1097/DSS.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nuzzo A, Soudan D, Billiauws L, Bataille J, Maggiori L, Ronot M, Stocco J, Bouhnik Y, Castier Y, Corcos O, Corcos O, Bouhnik Y, Nuzzo A, Stefanescu C, Treton X, Joly F, Billiauws L, Panis Y, Maggiori L, Prost à la Denise J, Tribillon E, Laforêt A, Lakkis Z, Sibert A, Zappa M, Garcia-alba C, Abdel-rehim M, Vilgrain V, Bertin C, Kerbaol A, Allaham W, Lagadec M, Benzimra J, Ronot M, Paugam C, Weiss E, Abback P, Delefosse D, Enriquez I, Janny S, Toussaint A, Iserentant J, Bout H, Pease S, Ear LK, Castier Y, Pellenc Q, Roussel A, Cerceau P, Mordant P, Deblic R, Boulitrop C, Curac S, Cachier A, Plessier A, Rautou P, Valla D, Soubrane O, Sauvanet A, Dokmak S, Dondero F, Sepulveda A, Farges O, Aussilhou B, Palazzo M, Cazals-hatem D, De Raucourt E, Boudaoud L, Peoc'h K, Puy H, Pons-kerjean N, Stocco J, Bataille J, Bouton V, Diop A, Gault N, Montravers P, Augustin P, Jacob BL. Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization. Ann Vasc Surg 2017; 42:128-35. [DOI: 10.1016/j.avsg.2016.10.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/06/2016] [Accepted: 10/17/2016] [Indexed: 01/27/2023]
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Shirai Y, Kuwana M. Complex Pathophysiology of Pulmonary Hypertension Associated with Systemic Sclerosis: Potential Unfavorable Effects of Vasodilators. Journal of Scleroderma and Related Disorders 2017; 2:92-9. [DOI: 10.5301/jsrd.5000235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Therapeutic advance by pulmonary vasodilators has provided huge impacts on prognosis in patients with pulmonary arterial hypertension (PAH), but outcomes of systemic sclerosis (SSc)-associated PAH still remain unsatisfactory. One of the major reasons is a series of potential unfavorable effects triggered by pulmonary vasodilators, which result from the complex pathophysiology of SSc-PAH. We herein present and discuss five representative conditions potentially induced by pulmonary vasodilators, including (i) emergence of latent pulmonary veno-occlusive disease, (ii) emergence of latent left-heart disease, (iii) worsening of pulmonary gas change in the presence of interstitial lung disease, (iv) ischemic limb gangrene by stealing of blood flow, and (v) uncontrolled hemorrhage from gastrointestinal telangiectasia. The former three conditions are common causes for worsening of dyspnea or oxygenation during treatment with pulmonary vasodilators, whereas the latter two are rare, but have significant negative impacts on patients’ quality of life and survival. These unfavorable conditions are pitfalls in clinical practice, and interfere with optimizing therapies in patients with SSc-PAH. Therefore, pre-assessment of pathophysiology of pulmonary hypertension and cautious monitoring during the treatment are necessary to achieve better outcomes in patients with SSc-PAH.
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Abstract
OPINION STATEMENT Peripheral artery disease (PAD) comprises atherosclerosis of the aorta and lower extremities. Many patients with PAD are asymptomatic, while others present with intermittent claudication (IC) or critical limb ischemia (CLI). Defined as rest pain or tissue loss that persists for >2 weeks, CLI represents the most severe clinical manifestation of PAD and is associated with an increased risk of limb loss and death. Patients with PAD, including those with CLI, are underdiagnosed and undertreated. In addition to smoking cessation, medical therapy with an antiplatelet agent and statin is recommended for all patients with PAD. Regular exercise has been shown to improve walking distance and quality of life in patients with symptomatic PAD and should be incorporated into each patient's treatment plan. In patients who have CLI and in those with persistent lifestyle-limiting claudication despite optimal medical therapy and an exercise program, revascularization is indicated for limb salvage and symptom relief, respectively. Consensus guidelines currently support an endovascular first approach to revascularization in the majority of cases. Surgical procedures provide an alternative to endovascular therapy in select cases.
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Affiliation(s)
- T Raymond Foley
- VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
| | - Stephen W Waldo
- VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
| | - Ehrin J Armstrong
- VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA.
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