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

Below the knee (BTK) interventions are increasing in patients with rest pain or critical limb ischemia, and these interventions are frequently successful in facilitating limb salvage. New intervention techniques and devices allow successful recanalization of occluded BTK arteries. Here, we report a case of successful recanalization of BTK arteries using multidisciplinary methods, including an antegrade approach and retrograde approach without the use of a sheath, but with simple balloon angioplasty, and plaque excision using Silverhawk atherectomy device.
Angioplasty ; Angioplasty, Balloon ; Arteries ; Atherectomy ; Extremities ; Humans ; Ischemia ; Knee ; Limb Salvage

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: 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*

Phlegmasia cerulea dolens (PCD) is a medical emergency that can lead to venous gangrene of the lower extremity. Early diagnosis and prompt treatment is crucial for limb salvage. There are two treatment options (endovascular or surgical). In the endovascular era, catheter-directed thrombolysis is the treatment of choice to achieve venous outflow. However, surgical thrombectomy is indicated in certain cases. The authors report successful surgical thrombectomy in a 75-year-old man with PCD and review the treatment of PCD.
Aged ; Early Diagnosis ; Emergencies ; Gangrene ; Humans ; Limb Salvage ; Lower Extremity ; Thrombectomy* ; Venous Thrombosis

PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) below the knee as a treatment in diabetic foot gangrene. MATERIALS AND METHODS: Between May 2003 and May 2006, angiography was performed in 35 diabetic foot gangrene classified as either Wagner grade IV or V. Infrapopliteal PTA was performed in 10 patients among them. Clinical success was defined as prevention of major amputation. RESULTS: Among 25 patients who did not receive infrapopliteal PTA, the major amputation rate is 22% (in one arterial occlusion cases), 50% (in two arterial occlusion cases), 63% (in three arterial occlusion cases), respectively. Infrapopliteal PTA was successfully performed in 8 among 10 patients. Two patients were failed and undergone below-knee amputation. Toe amputation were performed in 2 patients with one arterial occlusion. Out of 6 patients with three arterial occlusions, toe amputations were performed in 4 patients and the other 2 patients were healed through debridement. CONCLUSION: As a first choice revascularization procedure for limb salvage in diabetic foot gangrene, infrapopliteal PTA can be one of treatment options.
Amputation ; Angiography ; Angioplasty* ; Debridement ; Diabetic Foot ; Gangrene* ; Humans ; Knee ; Limb Salvage ; Toes