BACKGROUND: The purpose of this study was to assess the safety and efficacy of translating into national practice methodology for infrainguinal excimer laser-assisted angioplasty, for the treatment of critical limb ischemia in poor surgical bypass candidates. METHODS: A prospective five centre Belgian registry enrolled 48 patients, who presented with 51 ...

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal ...

OBJECTIVE: To characterize the national epidemiology of adult osteomyelitis (OM) and, using a single institutions' experience, test the hypothesis that early surgical therapy as compared with antibiotics alone results in an improved chance of wound healing and limb salvage. BACKGROUND: Foot and digit OM is a very common problem for ...

HYPOTHESIS: Infragenicular polytetrafluoroethylene (PTFE)-venous cuff bypass grafting provides acceptable graft patency and limb salvage rates for limb salvage. DESIGN: Retrospective clinical review of a consecutive series. SETTING: Vascular surgical practice during the interval October 1, 2000, to September 1, 2004. PATIENTS: Fifty-one male and 49 female patients whose mean age ...

This clinical, retrospective study is evaluated the effect of epidural spinal cord stimulation (SCS) in the treatment of Buerger's disease. The clinical criteria of Shionoya were used to diagnose 29 patients (22 men, 7 women; mean age 33.7 years) with Buerger's disease. The patients underwent SCS. Complete physical examination and ...

In a multivariate retrospective analysis was conducted to examine whether and to what extent PGE1 is therapeutically effective and whether there are predictors of response. The examination included 767 patients (448 women, 319 men) of a mean age of 71.2 years and with peripheral arterial disease (PAD) having existed for ...

Determination of the optimal amputation level is essential for patients, morbidity and rehabilitation. Various non-invasive procedures have been proposed to determine the optimal level of amputation. There is no consensus on the minimal tcPO2 level that is required to predict the healing of the stump. Therefore we aimed to rank ...

OBJECTIVES: To describe the functional outcome of bilateral limb-threatening injuries at 2 years postinjury and to evaluate whether a different decision-making process should be used for these patients as opposed to patients with unilateral limb-threatening injury. DESIGN/SETTING/PATIENTS: This study population of 32 patients is a subset of 601 patients from ...

BACKGROUND: Radio frequency obliteration of the saphenous veins has been introduced as a less invasive alternative to traditional surgery for varicose veins. OBJECTIVE: To report the efficacy of obliteration and clinical outcomes following endovenous obliteration of the saphenous vein with limited follow-up to 3 years. MATERIALS AND METHODS: Radiofrequency obliteration ...

PURPOSE: To predict healing of the stump by assessing the microscopic vascular changes at the amputation site. METHODS: A cohort study was conducted on 39 patients, 18 of them had below-knee amputation (group A) and 21 had ray amputation of a single toe (group B). Biopsies were taken from the ...

This study investigates the effects of early fitting in trans-tibial amputees. The assumption is that compared to elastic bandaging, the use of a rigid dressing in early fitting will result in quicker wound healing and earlier ambulation. A retrospective file search was carried out in three different hospitals, analysing the ...

PURPOSE: To review the feasibility of infra-inguinal angioplasty in the management of critical limb ischemia (CLI). MATERIAL AND METHODS: Data on 221 patients with 230 critically ischemic limbs, treated with consecutive percutaneous transluminal angioplasty (PTA) at Helsinki University Central Hospital between January 2000 and December 2002 were collected and analyzed ...

OBJECTIVES: This study was performed in order to assess morbidity and mortality associated with major lower extremity amputation according to an extensive complication registration system used in our hospital. METHODS: All consecutive patients who underwent lower limb major extremity amputation were included from January 1996 until December 2002. Complications were ...

The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all ...

OBJECTIVE: This study describes a new technique for treatment of Buerger's disease, developed to stimulate angiogenesis, using a Kirschner wire placed in the medullary canal of the tibia. The aim of the study was to evaluate clinical and radiological effects of this technique in patients where medical and surgical therapy ...

AIM: Iloprost, usually administered through intravenous infusion for 6 hours per day for at least 21 days, is the main medical treatment for critical limb ischemia in patients unsuitable for surgical or endovascular approach. We evaluated the tolerance and the short-term and long-term effects of a single 1-week treatment in ...

PURPOSE: To report the preliminary 3-month follow-up of a recently developed absorbable metal stent (AMS) for treatment of infrapopliteal lesions in patients with critical limb ischemia (CLI). METHODS: Between December 2003 and January 2004, 20 patients (10 men; mean age 76 years, range 59-96) with symptomatic critical limb ischemia (CLI) ...

Transmetatarsal amputation (TMA) for peripheral vascular disease has the reputation of being an operation with a poor outcome. This retrospective study reviewed a 3-year consecutive series of TMA in diabetic and nondiabetic patients. All amputations performed for peripheral vascular disease at Groote Schuur Hospital from January 1999 to December 2002 ...

Patients with chronic venous disease (CVD) often ask whether elective vein surgery could be delayed without consequences. Because the natural history of CVD is not well known, this study was designed to determine its progression in such patients. One hundred and sixteen limbs in 90 patients who had at least ...

Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial. We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of ...

As microsurgery advances, microsurgical free-tissue transfers have become the reconstructive method of choice over staged or primary amputation, and enabling independent ambulation in difficult lower-extremity wounds. In this report, we present our experiences with free-tissue transfer for the reconstruction of soft-tissue defects in 13 diabetic foot ulcers. Following radical debridement, ...

This study compares the development of reflux, recanalization, and clinical outcomes of patients with femoral-popliteal and iliofemoral deep venous thrombosis (DVT). Emphasis is placed on the relationship between early lysis of clot through thrombolysis and the development of reflux and post-thrombotic syndrome (PTS) for iliofemoral patients. A retrospective chart review ...

BACKGROUND: It has been shown that long limb gastric bypass in the super-obese (BMI >50) results in increased weight loss in comparison with conventional gastric bypass. The purpose of this study was to compare the effect of short and long limb lengths in patients with BMI<50. METHODS: 48 patients with ...

BACKGROUND: Little has been written about the functional outcome of patients treated with bone transport to reconstruct a distal tibial defect. The aim of this study was to investigate the functional capabilities of patients who had undergone reconstruction with distraction osteogenesis for the treatment of a distal tibial defect in ...

OBJECTIVES: The objective of this study was an investigation of the safety and efficacy of primary below-knee stent-supported angioplasty (BKSSA) for restoring straight inline arterial flow in patients with critical limb ischemia (CLI) or lifestyle-limiting claudication (LLC). BACKGROUND: Surgical tibial bypass for CLI and severe LLC is associated with significant ...

BACKGROUND/AIMS: Limb-threatening ischemia in patients with end-stage renal disease (ESRD) represents a challenging therapeutic problem. Furthermore, diabetes mellitus is frequently associated with ischemic gangrene, persistent infection and impaired wound healing. The present study was undertaken to examine graft patency, limb salvage and survival in patients with ESRD and diabetes following ...

Thumb amputation is a relatively frequent injury in industrial accidents, producing a significant effect on hand function. The long-term results of 18 first metacarpal elongations in patients who had had a non-replantable thumb amputation at the metacarpophalangeal level are reported. Lengthening was performed using a unilateral external fixator. After a ...

Venous disease was evaluated in relation to post-thrombotic syndrome 5 years after deep venous thrombosis (DVT) in patients treated with a regimen of low-molecular-weight heparin (LMWH) and warfarin in a Hospital-in-the-Home program. The presence of flow, reflux and compressibility in 51 patients (102 limbs, 54 with DVT and 48 without ...

OBJECTIVES: To evaluate short- and long-term mortality and morbidity in patients that were treated for acute upper extremity ischemia. DESIGN: Single center retrospective study. PATIENTS: A consecutive series of 148 patients who were admitted with a diagnosis of acute ischemia of the upper extremity during an 11-year period. METHODS: All ...

While decision analysis and treatment algorithms have repeatedly been shown to improve quality of care in many areas of medicine, no such algorithm has emerged for the invasive management of lower extremity peripheral arterial disease. Using the best available evidence-based outcomes data, our group designed a standardization tool, the Lower ...

AIMS: Stewart-Treves syndrome is an angiosarcoma associated with long-standing lymphoedema, most commonly seen as a rare complication of breast cancer treatment, and is associated with a poor outcome. We present results from six patients supporting the use of early radical surgery to improve prognosis. METHODS: Six patients with Stewart-Treves syndrome ...

When a transmetatarsal amputation (TMA) is required, successful long-term limb salvage is questioned. We evaluated the influence of TMA on limb salvage in patients undergoing lower extremity revascularization. Patients who had distal bypasses extending to the infrapopliteal arterial tree and adjunctive TMA were retrospectively reviewed. Limb salvage was determined with ...

This is a prospective study of 10 cases, 14 lower extremities lymphedema were treated by microsurgical lymphonodovenous implantation from October 2001 to July 2003. All of the presented patients suffered from filariasis with obstructive lymphedema of the lower limbs. The surgical technique is described. The results have been satisfactory. The ...

PURPOSE: To evaluate a continuous-infusion protocol for peripheral arterial thrombolysis using tenecteplase (TNK), with regard to the technique, dosing, infusion times, and clinical outcomes. METHODS: Between November 1999 and July 2002, 48 patients (30 men; mean age 68.5+/-11.9 years) presented with acute limb ischemia (ALI) owing to iliofemoral arterial thrombosis, ...

PURPOSE: To report a comprehensive literature review focused on comparing the risk of complications with urokinase versus recombinant tissue plasminogen activator (rtPA) for thrombolytic treatment of peripheral arterial occlusions. METHODS: The English-language literature between 1985 and 2002 was searched for studies that used tissue-derived urokinase or rtPA in the treatment ...

OBJECTIVE: Meningococcal disease causes septic shock with associated disseminated intravascular coagulation and hemorrhagic skin necrosis. In severe cases, widespread vascular thrombosis leads to gangrene of limbs and digits and contributes to morbidity and mortality. Uncontrolled case reports have suggested that thrombolytic therapy may prevent some complications, and the use of ...

The purpose of this study was to examine the outcome of the application of the high density polyethylene (HDPE)-Jaipur prosthetic construction in fitting trans-femoral amputees in a number of projects throughout the developing world. Projects in Honduras, Uganda and India were included. One hundred and fifty eight (158) patients had ...

BACKGROUND AND AIM: The aim of this study was to compare the effects of a pharmacological and a surgical vasodilatatory therapy in the treatment of chronic arterial diseases of the lower limbs. METHODS AND RESULTS: After giving their informed consent, 40 patients were randomised to receive a slow (approximately 2-hour) ...

BACKGROUND: The principal aims of this study were to examine functional outcomes following trauma-related lower-extremity amputation and to compare outcomes according to the amputation levels. We hypothesized that above-the-knee amputations would result in less favorable outcomes than would through-the-knee or below-the-knee amputations. A secondary aim was to examine the factors, ...

PURPOSE: To review percutaneous intentional extraluminal recanalization (PIER) for treatment of patients who are poor candidates for infrainguinal arterial bypass surgery (IABS) and have arterial occlusions and chronic critical limb ischemia (CCLI). MATERIALS AND METHODS: Patients with CCLI who were poor candidates for IABS were candidates for PIER. PIER was ...

Barrier techniques have been proposed to improve the results of repeat surgery to treat recurrent saphenofemoral junction incompetence. We hypothesized that interposition of a silicone implant would contain postoperative neovascularization and thus reduce the incidence of clinical recurrence at 5-year follow-up. We compared the results of repeat interventions with use ...

Complex Regional Pain Syndrome (CRPS) associated with herpes zoster (HZ) was first reported by Sudeck in 1901 (Sudeck, 1901) and is recognized clinically. However, only 13 cases have been published in the literature, and nothing is known about the incidence, prevalence, or natural history (Chester, 1992; Foster et al., 1989; ...

The subject of ischemia-reperfusion has commonly been studied in rat hindlimb models. Unfortunately, in these experiments, the ischemia procedures lack standardization. For this reason, the authors evaluated the reliability of rat ischemia models described in the literature using scintigraphy. The study comprised six groups. Each consisted of ten male Wistar ...

Subintimal recanalization is a percutaneous technique that allows revascularization in patients with limb-threatening ischemia. It was first described by Bolia (Cardiovasc Intervent Radiol 13;357-63:1990) but has not gained widespread use in the United States. Twenty-five patients with 32 threatened limbs were referred from a single surgeon's practice over a 23-month ...

We report a case of jellyfish envenomation in a 39 year old male. He was stung extensively on both lower limbs by an unidentified jellyfish. This occurred in shallow waters of a beach in the vicinity of Labuan Island, Malaysia. The patient received ambulatory treatment with parenteral and oral ascorbate ...

We analyzed clinicopathologic and imaging features of chronic peripheral lymphedema to identify imaging findings indicative of its exact etiopathogenesis and to establish the optimal treatment strategy. One of the main problems of microsurgery for lymphedema is the discrepancy between the excellent technical possibilities and the subsequently insufficient reduction of the ...

PURPOSE: Fibrotic sequelae remain the most important dose-limiting toxicity of radiation therapy to soft tissue. Functionally, this is reflected in loss of range of motion and muscle strength and the development of limb edema and pain. Tumor necrosis factor alpha and fibroblast growth factor 2 (FGF2), which are abnormally elevated ...

PURPOSE: To evaluate an approach to the treatment of iliofemoral deep vein thrombosis (DVT) that included pharmacomechanical catheter-directed thrombolysis with reteplase and the Helix mechanical thrombectomy device, followed by early stent placement. MATERIALS AND METHODS: During 3-year period, 23 symptomatic limbs in 18 patients with iliofemoral DVT were treated with ...

To highlight the indication, level of amputation and the problem associated with lower extremity amputations including rehabilitation in this environment and compare them with results from other centers. The setting is Nnamdi Azikiwe University Teaching Hospital Nnewi, and Holy Cross Hospital Nnewi. Hospital records of 46 patients (32 males; 14 ...

There is continuing controversy as to whether surgical bypass or angioplasty should be first-line treatment of severe limb ischemia. We undertook this study to examine angiographic and clinical factors that influence the treatment of severe limb ischemia by vascular surgeons and interventional radiologists. Twenty consultant vascular surgeons and 17 consultant ...