Critical ischemia is the most advanced form of peripheral arterial disease, and it is characterized by ischemic rest pain and ulcers or gangrene. Revascularization is obviously positioned as the first-line treatment, and guidelines recommend both possible strategies (surgery or angioplasty) largely based on the findings of the BASIL trial (British Angioplasty versus Surgery in Ischemic...
Critical Lower Limb Ischemia Should Be Taken into Account in TAVR
Courtesy of Dr. Carlos Fava. Peripheral vascular diseases (PVD) present the same risk factors as aortic stenosis. In consequence, these disorders usually coexist. The frequency and impact of their various stages on patients undergoing TAVR is yet to be thoroughly assessed. Read also: “Peripheral Vascular Disease Is Associated to More Events in TAVR”. This study analyzed...
Diabetics’ Silent Ischemia Myth Busted
Diabetes mellitus patients generally present more diffuse coronary disease, faster lesion progression and higher risk of restenosis after PCI. The way these anatomical differences translate into in a different clinical practice, compared to non-diabetic patients, remains unclear. Prior studies comparing the frequency of angina symptoms in diabetic vs. non-diabetic patients have arrived to contradicting outcomes,...
Successful CTO reduces local and remote residual ischemia
Courtesy of Dr. Carlos Fava. The presence of Chronic Total Occlusion (CTO) is about 30%, with an ischemic threshold between 10% and 12.5% to justify rechannelization. Using the new devices, the new guidelines and with more experience operators, these procedures are successful in 10% to 30% of cases. More often than not these patients are not treated...
Critical ischemia in the lower limbs: Frequent Readmissions show the magnitude of this problem
Readmissions at 6 months in patients with critical ischemia in the lower limbs occur in about 50% of all cases and most of them are unplanned. This truly alarming number is cause for further concern when taking into account that only part of these readmissions are related to vascular problems. Many are caused by comorbidities...
Critical Limb Ischemia: Wound Blush Is the Most Important Objective
The aim of this study was to find the optimal angiographic endpoint for infrapopliteal interventions to be able to predict wound healing. Evidence shows acceptable patency and successful limb salvage in patients with critical limb ischemia after infrapopliteal intervention. However, the optimal angiographic endpoint remains unclear. Is it enough to restore flow in one...
Pedal Artery Angioplasty: Beneficial in Critical Limb Ischemia
Courtesy of Dr. Carlos Fava. Delaying or failing to heal trophic wounds in critical limb ischemia (CLI) changes quality of life, delays rehabilitation and is associated to infections and amputation. Pedal artery revascularization with angioplasty would speed up recovery and improve CLI wound healing. The study analyzed 257 patients with de novo infrapopliteal...
The role of ischemia, complete revascularization and intravascular imaging in contemporaneous PCI
Exhibitor: Ajay Kirtane Recorded by TV Med
Angiosome: Is It Feasible in Critical Limb Ischemia?
Courtesy of Dr. Carlos Fava. Critical limb ischemia (CLI) accompanied by tissue loss entails high risk of amputation. At present, there is substantial evidence in favor of revascularization by PCI according to the angiosome concept, but the feasibility of this treatment remains unclear. 161 compromised limbs were analyzed in 160 patients with foot...
Vorapaxar in Acute Limb Ischemia
Original Title: Acute Limb Ischemia and Outcomes With Vorapaxar in Patients with Peripheral Artery Disease: Results From TRA2°P-TIMI 50. Reference: Marc P. Bonaca et al. Circulation. 2016 Mar 8;133(10):997-1005. Patients with peripheral artery disease have a high risk of acute limb ischemia, an event that may result in the loss of the affected limb. This...