Long-Term Prognosis of Diabetic Patients With Critical Limb Ischemia: A population-based cohort study

OBJECTIVE\u2014 To evaluate the long-term prognosis of critical limb ischemia (CLI) in diabetic patients. RESEARCH DESIGN AND METHODS\u2014 A total of 564 consecutive diabetic patients were hospitalized for CLI from January 1999 to December 2003; 554 were followed until December 2007. RESULTS\u2014 The mean follow-up was 5.93 1.28 years. Peripheral angioplasty (PTA) was performed in 420 (74.5%) and bypass graft (BPG) in 117 (20.6%) patients. Neither PTA nor BPG were possible in 27 (4.9%) patients. Major amputations were performed in 74 (13.4%) patients: 34 (8.2%) in PTA, 24 (21.1%) in BPG, and 16 (59.2%) in a group that received no revascularization. Restenosis occurred in 94 patients, bypass failures in 36 patients, and recurrent ulcers in 71 patients. CLI was observed in the contralateral limb of 225 (39.9%) patients; of these, 15 (6.7%) required major amputations (rate in contralateral compared with initial limb, P 0.007). At total of 276 (49.82%) patients died. The Cox model showed significant hazard ratios (HRs) for mortality with age (1.05 for 1 year [95% CI 1.03\u20131.07]), unfeasible revascularization (3.06 [1.40\u20136.70]), dialysis (3.00 [1.63\u20135.53]), cardiac disease history (1.37 [1.05\u20131.79]), and impaired ejection fraction (1.08 for 1% point [1.05\u20131.09]). CONCLUSIONS\u2014 Diabetic patients with CLI have high risks of amputation and death. In a dedicated diabetic foot center, the major amputation, ulcer recurrence, and major contralateral limb amputation rates were low. Coronary artery disease (CAD) is the leading cause of death, and in patients with CAD history the impaired ejection fraction is the major independent prognostic factor

Emergency stent grafting after unsuccessful surgical repair of a mycotic common femoral artery pseudoaneurysm in a drug abuser

Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement

Protists within corals : the hidden diversity

Previous observations suggested that microbial communities contribute to coral health and the ecological resilience of coral reefs. However, most studies of coral microbiology focused on prokaryotes and the endosymbiotic algae Symbiodinium. In contrast, knowledge concerning diversity of other protists is still lacking, possibly due to methodological constraints. As most eukaryotic DNA in coral samples was derived from hosts, protist diversity was missed in metagenome analyses. To tackle this issue, we designed blocking primers for Scleractinia sequences amplified with two primer sets that targeted variable loops of the 18S rRNA gene (18SV1V2 and 18SV4). These blocking primers were used on environmental colonies of Pocillopora damicornis sensu lato from two regions with contrasting thermal regimes (Djibouti and New Caledonia). In addition to Symbiodinium clades A/C/D, Licnophora and unidentified coccidia genera were found in many samples. In particular, coccidian sequences formed a robust monophyletic clade with other protists identified in Agaricia, Favia, Montastraea, Mycetophyllia, Porites, and Siderastrea coral colonies. Moreover, Licnophora and coccidians had different distributions between the two geographic regions. A similar pattern was observed between Symbiodinium clades C and A/D. Although we were unable to identify factors responsible for this pattern, nor were we able to confirm that these taxa were closely associated with corals, we believe that these primer sets and the associated blocking primers offer new possibilities to describe the hidden diversity of protists within different coral species

PTA del distretto iliaco: studio clinico controllato

Percutaneous transluminal angioplasty CPTA) is a frequently applied technique in the treatment of peripheral occlusive arterial disease (PAOD) espe- cially when it affects large and medium caliber ves- sels. Iliac vessels PTA is preferably associated with arterial stenting in particular in the presence of vascular occlusion. This study evaluates the efficacy of PTA and stenting treatment in 75 patients with occlusion of iliac axes. The immediate results show over 98 of success rate, and the follow-up shows patency of treated segments and a significant impro- vement hi periferal symptoms. There were no major complications in the treatment of iliac PTA and sten- ting

When is a technically successful peripheral angioplasty effective in preventing above-the-ankle amputation in diabetic patients with critical limb ischaemia?

To determine parameters predictive of avoidance of major (above-the-ankle) amputation after a technically successful peripheral angioplasty (PTA) in patients with diabetes with critical limb ischaemia. METHODS: From January 1999 to December 2003, 420 consecutive patients with diabetes admitted to hospital because of critical limb ischaemia underwent peripheral angiography and concomitant technically successful PTA. Transcutaneous oxygen tension (TcPO(2)) was measured before and after PTA. Major amputation at 30 days was recorded. RESULTS: After PTA, the iliac-femoral-popliteal axis was patent in all patients. In 67 patients, all three crural arteries were patent, in 143 patients 2 crural arteries were patent, and in 186 patients one crural artery was patent (104 peroneal, 62 anterior tibial, 20 posterior tibial). In 24 patients, all three crural arteries were occluded. Twenty-two major amputations were performed. Of these, 15 were performed in the 24 patients with occlusion of all the infrapopliteal arteries. Seven of the 186 patients in whom only the peroneal artery was patent required amputation. In patients not requiring amputation, TcPO(2) increased from 15.5 +/- 11.9 to 45.0 +/- 12.0 mmHg (P = 0.000), while in those requiring amputation, TcPO(2) increased from 9.6 +/- 7.7 to 18.6 +/- 8.1 mmHg (P < 0.082). Multivariate analysis indicated an independent role of occlusion of infrapopliteal arteries after PTA (OR 8.20 for every crural obstructed artery, P = 0.022, CI 1.35-49.6) and TcPO(2) after PTA (OR 0.80 for increase of 1 mmHg, P < 0.001, CI 0.74-0.88). CONCLUSIONS: In patients with diabetes, PTA is effective in avoiding major amputation, provided recanalization occurs in at least one tibial artery down to the foot. In a few patients, re-canalization of the peroneal artery alone is not sufficient to avoid major amputatio

PTA dei tronchi tibiali nei pazienti diabetici

Diabetes increases the incidence and severity of limb ischemia approximately from 50 to 100. Diabetic peripheral arterial disease often affects distal limb vessels, such as the tibial and peroneal arteries, limiting the potential for collateral vessel development and reducing options for revasculari- zation. As such, patients with diabetes are more likely to develop symptomatic forms of the disease, such as intermittent claudication and critical limb ischemia, and undergo amputation. For patients aged 65 to 74 years, diabetes heightens the risk of amputation more than 20-fold, putting these patients at great risk for limb loss. We report the results of our center on a case relating to diabe- tic patients in critical ischemia of lower vessels trea- ted by PTA of distal arteries in the prospective of saving the limb from amputation

ANGIO-SEAL: analisi su 1889 procedure per via femorale anterograda

Traditionally manual compression is the most fre- quent method to achieve hemostasis in percutaneus arterial access site after angiographic and interven- tional procedures. Using this technique complica- tions detected at the access site are <5 including: bleeding, pseudoaneurysm formation, occlusion of the vessel. Alternative method to traditional manual compression for hemostasis is a new system called Angio-Seal vascular device. The literature of the past 10 years is rich in contributions on the use of Angio- Seal system in the femoral artery, the majority rela- ting to its employment with retrograde arterial access. On the contrary just a few studies exist about this device usage after an antegrade access in the common femoral artery. The purpose of this study is to evaluate the efficacy and safety of the use of Angio-Seal device after endovascular antegrade puncture of common femoral artery, performed in diabetic patients in critical ischemia