No abstract available.
Extremities* ; Limb Salvage* ; Tendons*

No abstract available.
Extremities* ; Limb Salvage* ; Tibia*

No abstract available.
Extremities ; Limb Salvage ; Polytetrafluoroethylene ; Transplants

The small saphenous vein (SSV) is an important graft in limb salvage surgery. It is frequently translocated for bypass surgery. Sometimes, the use of the SSV as an in-situ graft for posterior tibial artery or peroneal artery reconstruction offers the advantages of reduced vein graft injury and improved patency. Recently, saphenous vein mapping through computed tomography (CT) volume rendering technique offers a great quality view to the surgeon. We experienced a patient in whom a CT image with volume rendering technique revealed an aberrant SSV connected with the great saphenous vein at the medial malleolus level. This case indicates that an aberrant SSV may be successfully used as an in-situ conduit for bypass to the dorsalis pedis artery. Here, we present the case of a popliteal-to-dorsalis pedis in-situ vein bypass using a LeMaitre valvulotome (LeMaitre Vascular Inc., USA) under mapping of the aberrant SSV by CT volume rendering technique.
Arteries ; Humans ; Limb Salvage ; Saphenous Vein* ; Tibial Arteries ; Transplants ; Veins

Amputation ; Chronic Limb-Threatening Ischemia ; Fibrinolytic Agents/therapeutic use* ; Humans ; Limb Salvage ; Peripheral Arterial Disease ; Risk Factors ; Singapore ; Treatment Outcome

PURPOSE: Use of a composite graft combining a polytetrafluoroethylene graft with an autogenous vein is an option for limb salvage in the absence of an adequate single segment vein graft. We aimed to investigate the results of infrainguinal bypass with a composite graft. MATERIALS AND METHODS: We retrospectively reviewed 11 infrainguinal arterial bypasses on 11 limbs which underwent surgery from March 2012 to November 2016. RESULTS: Critical limb ischemia was common (63.6%) indication of bypass surgery and most (90.9%) of the patients had history of failed previous treatment including endovascular treatment (36.4%) and bypass surgery (72.7%). At the 2 years after graft implantations, primary patency and amputation-free survival of below-knee bypasses using composite graft were 73% and 76%, respectively. CONCLUSION: Infrainguinal arterial bypasses with composite graft had an acceptable patency. In patients without other alternative conduits for revascularization, bypass with a composite graft can be an option.
Extremities ; Humans ; Ischemia ; Limb Salvage ; Polytetrafluoroethylene* ; Retrospective Studies ; Saphenous Vein* ; Transplants* ; Veins*

PURPOSE: The purpose of this study is to compare and analyze the results of primary and secondary patency rates and limb salvage rates in DM (Diabetes Mellitus) and Non-DM patients with atherosclerosis in the lower extremity after arterial reconstruction. METHODS: A retrospective study was done by reviewing admission notes and follow up records of 95 atherosclerotic limbs which had infrainguinal arterial reconstruction due to claudication induced severe impediment and limb threatening ischemia (reat pain, minor and major tissue loss). Kaplan-Meier survival analysis was used in the comparison of the primary, secondary patency rates and limb salvage rates, and statistical examination was handled by the Log-Rank significance test. RESULTS: 1 and 3 year primary patency rates were 76.0% and 65.6% each in the DM group and 63.9% and 56.5% each in the Non-DM group. 1 and 3 year secondary patency rates were 80.0% and 69.7% in DM patients and 81.1%, 73.9% each in Non-DM patients. The 1 and 3 year limb salvage rates of DM patients were 83.8% and 72.6% while Non-DM patients revealed a 84.9% and 77.8%. CONCLUSION: Aggressive arterial reconstruction is recommended as well, in DM patients with atherosclerosis in the lower extremity, considering the insignificant differences in the risk of surgery as well as the primary, secondary patency rates and limb salvage rates.
Atherosclerosis ; Extremities* ; Follow-Up Studies ; Humans ; Ischemia ; Limb Salvage* ; Lower Extremity ; Retrospective Studies ; Transplants*

PURPOSE: We wanted to define the appropriate treatment modalities for Trans-Atlantic Inter-Society Consensus (TASC) II C and D femoro-popliteal lesions. So we compared the primary patency rate and several clinical factors between percutaneous balloon angioplasty with or without stenting (PTA/S) and bypass surgery (BP). METHODS: We reviewed the medical records of patients who underwent BP or PTA/S for TASC II C (BP-C, PTA/S-C) and D (BP-D, PTA/S-D) femoro-popliteal lesions from March 2001 to May 2009. We analyzed the primary and secondary patency rates, and the major limb salvage rates. RESULTS: Eighty two limbs in 74 patients (mean age: 68.7+/-10.2 years, males: 82.9%) were treated (PTA/S-C: 18, PTA/S-D 19: BP-C 12, BP-D 33). The mean follow-up duration was 30.0+/-19.0 months. The twenty four month primary patency rates was 82.4% for PTA/S-C and 73.3% for BP-C (P=0.876), and 45.3% for PTA/S-D and 66.6% for BP-D (P=0.034). The twenty four month secondary patency rates were 88.2% for PTA/S-C and 73.3% for BP-C (P=0.669), and 54.7% for PTA/S-D and 73.3% for BP-D (P=0.077). The twenty four month major limb salvage rates were 100.0% for PTA/S-C and 75.0% for BP-C (P=0.030) but there were no statistical differences between the TASC II D groups (P=0.377). CONCLUSION: Bypass surgery is a preferred initial therapeutic option for TASC II D femoro-popliteal lesions. However, several clinical factors must be carefully considered when selecting the primary treatment modality for TASC II C lesions.
Angioplasty, Balloon ; Consensus ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Limb Salvage ; Medical Records ; Stents

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.
Amputation ; Angioplasty* ; Consensus ; Extremities ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Humans ; Ischemia ; Limb Salvage ; Male ; Stents

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.
Amputation ; Angioplasty* ; Consensus ; Extremities ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Humans ; Ischemia ; Limb Salvage ; Male ; Stents