Khamin Chinsakchai - Academia.edu (original) (raw)

Papers by Khamin Chinsakchai

Annals of Vascular Surgery, Nov 1, 2022

Background: Abdominal aortic aneurysm with severe infrarenal neck angle (>60) has long been thoug... more Background: Abdominal aortic aneurysm with severe infrarenal neck angle (>60) has long been thought to be an obstacle to endovascular aneurysm repair. However, some previous studies reported endovascular aneurysm repair to be safe and efficacious for treating abdominal aortic aneurysm in patients with severe neck angulation. The aim of this study was to investigate the early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between patients with severe and non-severe infrarenal neck angulation. Methods: Fifty-four severe and 144 non-severe neck angulation patients who were treated at Siriraj Hospital (Bangkok, Thailand) during January 2010-October 2013 were recruited. The primary endpoints were intraoperative neck complications (e.g., type 1A endoleak or proximal graft migration) and immediate adjunct aortic neck procedures. The secondary endpoints included perioperative mortality, overall survival, and the proportion of patients that were reintervention-free at five years compared between the severe and non-severe groups. Results: Severe angulation patients were significantly older than non-severe angulation patients (77 AE 6.3 vs. 74 AE 7.9 years; p ¼ 0.021). The median proximal angle was significantly greater in the severe group (82 vs. 13.5 ; p < 0.001). Intraoperative proximal neck complications developed in 29.6% of patients in the severe angulation group compared with 9.0% in the non-severe group (p < 0.001). Significantly more patients in the severe group required intraoperative adjunct procedures (29.6% vs. 7.6%; p < 0.001). There was no significant difference in perioperative mortality between groups. At the five-year follow-up, there was no significant difference between groups for overall survival or the proportion of patients that remained reintervention-free. Conclusions: Endovascular aneurysm repair to treat abdominal aortic aneurysm in patients with severe proximal neck angulation is technically feasible and safe Although the severe angulation group had a higher rate of intraoperative neck complications and immediate adjunct neck procedures than the non-severe group, there was no significant difference between groups for 30-day mortality, overall survival or the proportion of patients who remained reintervention-free at five years.

Journal of vascular surgery. Venous and lymphatic disorders, May 1, 2023

PubMed, Jun 1, 2013

Objective: To evaluate the efficiency and complications of catheter-directed thrombolysis (CDT) o... more Objective: To evaluate the efficiency and complications of catheter-directed thrombolysis (CDT) of acute limb ischemia (ALI) resulting from thromboembolic occlusion. Material and method: A retrospective study of CDT was carried out in patients with acute thromboembolic arterial occlusion and marginally threatened ischemia of the extremities between February 2006 and December 2011. After the tip of the angiographic catheter was placed within the blood clot, recombinant tissue plasminogen activator (rt-PA) was used for thrombolysis. The CDT procedure included an initial bolus injection of high dose rt-PA (5-15 mg) followed by a tapering of infusion rate (1-2 mg/hour) through the catheter Primary outcome was 1-year amputation free survival rate and mortality rate. Secondary outcome included technical and clinical success rates, time to lysis, and complication rate. The complete reestablishment of the occluded arteries without major amputation and death was considered successful treatment. Results: Thirty-seven patients (30 males and 7 females) with the mean age of 55.6 years (range, 27-86 years) were enrolled in the present study. The number of acute arterial occlusion was 23 (62.2%) of acute arterial embolism and 14 (37.8%) of acute arterial thrombosis. Embolism involved two aortic bifurcations, two iliac arteries, five femoral arteries, 13 popliteal arteries, and one both popliteal arteries. The sites of thrombosis were one of aorto-iliac segment, three of iliac artery, five of femoral artery, three of popliteal artery, one of bilateral popliteal, and one of tibio-peroneal artery. The mean duration of completed infusions was 21.29 hours (range, 2-58 hours). Successful adjunctive percutaneous intervention or arterial bypass was performed in seven patients (18.9%) whose stenotic lesions were disclosed following CDT The 30-day perioperative mortality and 30-day amputation-free survival rates of the patients treated by CDT were 10.8% (4 of 37 patients) and 86.5% (32 of 37 patients) respectively. Both 6-month and 1-year amputation free survival rate were 78.4% (29/37). Technical success rate was 75.7% (28/37) whereas clinical success was 86.5% (32/37). Technical success rate was 80.0% (28/35) if ischemic symptom onset was no longer than six weeks. The 30-day major complications included two patients (5.4%) requiring more than four units of blood transfusion for access site hematoma, two (5.4%) large fatal intracerebral hemorrhages, one (2.7%) small intracerebral hemorrhage, one (2.7%) acute embolic stroke, and one (2.7%) death of multiple organ failure following conversion to surgical revascularization. Minor complications were distal thromboembolization in one patient (2.7%), small hematoma in seven patients (18.9%), and pseudoaneurysm in one patient (2.7%). Conclusion: CDT is an effective armamentarium to salvage the ischemic limb resulting from acute embolism and acute thrombosis of native artery. However bleeding complication is a major problem of this treatment. Although CDT is usually applied for ALI patients with ischemic symptom onset less than 14 days, it also provides technical success for those with the symptom onset between the second and the sixth weeks.

Background: Quality and Quantity (QQ) culture media was shown a promising effect in enhancing the... more Background: Quality and Quantity (QQ) culture media was shown a promising effect in enhancing the vasculogenesis of mononuclear cells (MNCs) of healthy volunteers and chronic limb-threatening ischemia (CLTI) patients. In this study, the MNCs from CLTI patients were further investigated based of their risk factors. Methods: In this study, MNCs from chronic limb-threatening ischemia (CLTI) patients with coexisting diabetes mellitus (DM), hypertension (HT), current smoker status, or chronic kidney disease (CKD) stage 3 or above were cultured in QQ culture media, and then investigated for angiogenesis-related phenotype and function. CLTI patients with DM, HT, current smoker status, or CKD were prospectively recruited. Forty-eight patients (mean age: 67.5±8.0 years) were included. DM, HT, current smoker status, and CKD was found in 34 (71.0%), 39 (81.0%), 27(56.3%), and 32 (66.7%) patients, respectively. Results: In CLI patients with coexisting diseases, the percentages of CD34+, CD133+,...

Journal of Clinical Medicine

Background: Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be cha... more Background: Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be challenging when the internal iliac artery (IIA) is involved. Embolizing the IIA and extending the limb to the external iliac artery (IIAE + EE) to prevent a type 2 endoleak may lead to pelvic ischemic complications. To avoid these complications, strategies that preserve the IIA, such as the bell-bottom technique (BBT) and the iliac branch device (IBD), have been proposed. This study aims to compare the outcomes of these three endovascular approaches for AAIA. Methods: Between January 2010 and December 2019, 174 patients with asymptomatic AAIA were enrolled in this retrospective analysis. They were divided into two groups: 81 patients underwent non-IIAE procedures, and 93 patients underwent IIAE procedures. The iliac limb study group consisted of 106 limbs treated with the BBT, 113 limbs treated with the IIAE + EE, and 32 limbs treated with the IBD. The primary outcomes included the 30-day ...

Annals of Vascular Surgery, Feb 1, 2022

OBJECTIVE To provide an overview of the literature on the mid-term outcomes of chimney EVAR (ChEV... more OBJECTIVE To provide an overview of the literature on the mid-term outcomes of chimney EVAR (ChEVAR) for the treatment of juxtarenal abdominal aortic aneurysms (JAAA). METHODS Different electronic databases were searched for published articles up to January 2020. The eligibility criteria were studies describing mid- or long-term outcomes of chimney EVAR (mean follow-up at least 1 year) for treatment of JAAA, including more than 10 cases, published in English, and with full text available. The outcomes measure were overall survival rate, target vessel patency, and freedom from reintervention at 3 years. Quality of the included studies was analysed using the MINORS criteria. Pooled effect estimates were analysed using random-effect models and heterogeneity was tested using I2 statistics. RESULTS Thirteen articles met the inclusion criteria. The included studies described 1,019 patients. According to the quality assessment, methodological quality was moderate to poor. The pooled overall survival, freedom from reintervention, and target vessel patency at 3 year was 81.4 % (95%CI 73.8 to 87.9), 85.7% (95%CI 75.6 to 93.5), and 95.1% (95%CI 89.3 to 98.7) respectively. CONCLUSION The results of this review show good to acceptable short and mid-term survival and good mid-term durability, which supports that ChEVAR as a suitable alternative in high-risk JAAA. However, proper patient selection for ChEVAR seems essential to attain good mid-term outcomes, and further large prospective and good quality studies are required to demonstrate its long-term results and enable conclusions on specific determinants for outcome.

Journal of vascular surgery. Venous and lymphatic disorders, Jul 1, 2021

PURPOSE The objective of this study was to evaluate the incidence of, the risk factors for, the n... more PURPOSE The objective of this study was to evaluate the incidence of, the risk factors for, the nature of the disease, and the management of hypersensitivity reaction (HSR) after cyanoacrylate closure (CAC) of incompetent saphenous veins in patients with chronic venous disease. MATERIAL AND METHODS Data consisting of all incompetent saphenous veins, including great saphenous veins (GSV), anterior accessory saphenous veins (AASV), and small saphenous veins (SSV), treated with CAC at Siriraj Hospital (Bangkok, Thailand) during January 2017 to December 2018 were retrospectively evaluated. RESULTS A total of 126 saphenous veins, including 106 (84.1%) GSV, 7 (5.6%) AASV, and 13 (10.3%) SSV of 126 limbs, from 101 patients were included. HSR occurred in 16 of 101 patients (15.8%), in 19 of 126 limbs (15.0%), and in 19 of 126 treated saphenous veins (15.0%). HSR-related erythema, itching, swelling, and pain occurred in 100.0%, 95.0%, 68.4%, and 52.6%, of HSR patients, respectively. HSR occurred 1 week after CAC. All HSR symptoms were mild, could be treated with non-steroidal anti-inflammatory drugs (NSAIDs) and antihistamine, and were resolved within 1 week. The risk factors for HSR were suprafascial saphenous vein with a depth <1 cm from the skin, and saphenous vein diameter ≥8 mm. CONCLUSIONS HSR occurred in 15.8% of patients, and in 15.0% of limbs after CAC. Risk factors for HSR were suprafascial saphenous vein located close to the skin, and large saphenous vein. All HSR symptoms were mild in severity, occurred at 1 week after CAC, and were resolved within 1 week after treatment with NSAIDs and antihistamine. To prevent HSR, CAC should be avoided in suprafascial saphenous veins that are located close to the skin, and CAC in saphenous veins with a size ≥8 mm should be performed with caution.

Annals of Vascular Diseases, 2014

Introduction: Klippel-Trenaunay syndrome is composed of port-wine stain, limb hypertrophy and var... more Introduction: Klippel-Trenaunay syndrome is composed of port-wine stain, limb hypertrophy and varicose veins. Methods: The two patients with Klippel-Trenaunay syndrome treated by endovenous radiofrequency thermal ablation and ultrasound-guided foam sclerotherapy of the abnormal veins was conducted. Results: Radiofrequency thermal ablation resulted in successful occlusion of the incompetent anterior accessory great saphenous vein. Moreover, ultrasound-guided foam sclerotherapy showed complete occlusion of the residual veins. At 6 month follow-up, both patients markedly decreased leg symptoms including pain, cramping, limb swelling, and bulging of veins. Conclusion: Radiofrequency thermal ablation combined with foam sclerotherapy is a minimally invasive procedure alternative to the standard invasive surgery and can be the option for saphenous ablation in Klippel-Trenaunay syndrome patients.

Journal of vascular surgery. Venous and lymphatic disorders, May 1, 2019

Objective: The aim of this study was to investigate the prevalence and clinical predictors of >50... more Objective: The aim of this study was to investigate the prevalence and clinical predictors of >50% iliocaval venous obstruction (ICVO) in Thai patients with lipodermatosclerosis and healed or active venous ulcers and the diagnostic accuracy of duplex ultrasound (DUS) compared with computed tomography venography (CTV). Methods: Limbs with lipodermatosclerosis, healed venous leg ulceration, or active venous leg ulceration were prospectively evaluated by DUS and CTV. Loss of respiratory variation in the common femoral vein (CFV) and reversed flow in the superficial epigastric vein (SEV) were evaluated by DUS. Percentage of venous obstruction was measured by CTV. The prevalence and clinical predictors of >50% ICVO were determined, and the accuracy of DUS for diagnosis of >50% ICVO was compared with the diagnostic accuracy of CTV. Results: A total of 106 patients (135 limbs) were enrolled. The mean age was 58 6 12 years, and 57 (54%) patients were female. Previous history of deep venous thrombosis (DVT) in the symptomatic leg was documented in 21 (15.6%) limbs; >50% ICVO by CTV was found in 38 (28.1%) limbs. Independent predictors of >50% ICVO included left leg (P ¼ .001) and previous history of DVT in the affected leg (P ¼ .001). For diagnosis of >50% ICVO, the sensitivity and specificity of loss of respiratory variation in the CFV were 23.7% and 100%, respectively; the sensitivity and specificity of reversed flow in the SEV were 7.9% and 100%, respectively. Conclusions: Limbs with lipodermatosclerosis or with healed or active venous ulceration, especially in the left limb or in limbs with a history of DVT in the affected limb, had a high prevalence of ICVO; these limbs should be routinely studied with DUS. Limbs with an abnormal finding on DUS, including loss of respiratory variation in the CFV or reversed flow in the SEV, should be routed for venous intervention, and those with normal DUS findings should be referred for CTV. (

Journal of Wound Care, May 1, 2010

Objective: To investigate the threshold of transcutaneous oxygen tension (TcPO 2) values in predi... more Objective: To investigate the threshold of transcutaneous oxygen tension (TcPO 2) values in predicting ulcer healing in patients with critical limb ischaemia in a prospective study. Method: 50 patients suffering from critical limb ischaemia with chronic ischemic ulcers or gangrenous toes were enrolled in this study between January and December 2008. Their demographic data and ankle brachial pressure index (ABPI) were collected. Baseline ulcers were measured with a wound measurement system (Visitrak, Smith & Nephew). TcPO 2 was measured at rest in the supine position and with 30° leg elevation. The patients with infective and ischemic ulcers underwent debridement and gangrenous toes were amputated. Ulcer outcome was classified as either: (1) A healing ulcer, showing good epithelialisation or granulation at both base and edges, or a decrease in ulcer area during the study; or (2) A non-healing ulcer, showing poor granulation tissue formation or a pale base and necrotic edges, or deterioration in an ischaemic ulcer. Results: The mean age of the patients was 67.6 ± 10.8 years. The most common risk factor was hypertension (90%). Mean ABPI was 0.75 ± 0.39. 13 patients (26%) had a TcPO 2 of less than 20mmHg, of which none showed any improvement in ulcer healing (p<0.001). 15 patients (30%) had a TcPO 2 of more than 40mmHg, of which all progressed to complete ulcer healing (p<0.001). In the borderline group (20-40mmHg, 22 patients, 44%), 10 patients (45%) had a TcPO 2 drop of <10mmHg with 30° leg elevation, of which 8 achieved complete ulcer healing (p<0.001). 12 patients (55%) had a TcPO 2 drop of >10mmHg with 30° leg elevation, of which 11 showed no ulcer healing (p<0.001). Conclusion: TcPO 2 measurement is an accurate, non-invasive, and good predictor of ischemic ulcer healing, for cutoff TcPO 2 values of less than 20mmHg and more than 40mmHg. In addition, the leg elevation method for TcPO 2 might provide an important adjunct in the assessment of patients with borderline values.

PubMed, Mar 1, 2012

Introduction: We aimed to study the outcomes of permanent inferior vena cava (IVC) filter implant... more Introduction: We aimed to study the outcomes of permanent inferior vena cava (IVC) filter implantation in Thai patients. Methods: This was a retrospective study of 28 patients with deep vein thrombosis (DVT) who underwent prophylactic implantation of IVC filters for fatal pulmonary embolism (PE) between January 2005 and June 2008. The patients' operative records, protocol and follow-up data were analysed. 11 (39%) patients had PE at the initial diagnosis. The mean age of the patients was 62.1 (range 33-83) years. Indications for IVC filter implantation included contraindications to and complications of anticoagulant therapy and floating thrombi in the iliofemoral veins. Results: No significant technical complication was noted, except for malposition in one patient (3.5%) and failure of the permanent IVC filter to open fully in another. During the follow-up period (mean 17.5 ± 10.9 months), no patients had any episode of PE and nine (32%) died of unrelated causes. Two patients were lost to follow-up. Among the 17 survivors, six (35.2%) had non-recanalised thrombosis vein, four (23.5%) had clinical evidence of chronic venous insufficiency, two (11.7%) had recurrent DVT in the contralateral limb and one (5.8%) developed IVC thrombosis. There was no evidence of migration of the caval filters. No statistical significance was observed in the effects of post-filter anticoagulation drug on current DVT and in the relation between PE at initial diagnosis and death during follow-up. Conclusion: Permanent IVC filter implantation may be effective for preventing symptomatic PE in Thai patients, with no significant sequelae in the lower extremities.

Journal of the Medical Association of Thailand, May 1, 2017

PubMed, Jun 1, 2010

The authors report a successful management of acute superior mesenteric artery embolism in a pati... more The authors report a successful management of acute superior mesenteric artery embolism in a patient during the treatment of popliteal artery embolism. The diagnosis of this disease was confirmed by computerized tomographic angiography. Immediate surgical embolectomy and bowel resection were performed and postoperatively, he made an uneventful recovery except for minimal watery diarrhea for one week. In the present report the authors also review the in-patient records at Siriraj Hospital during 2005-2009 consisting of 14 cases with the claim diagnosis of this condition. Most of the patients developed peritonism on abdominal examinations showing a delay in diagnosis. The mortality rate was 86% (12 cases) which was higher than international reports. It is important to note that patients presenting with abdominal pain with underlying risk factors of arterial embolism is the clue in early diagnosis of this condition. CTA mesenteric artery is the most appropriate investigation to visualize the presence of embolism. Finally, immediate revascularization treatment is essential in the successful management of this fatal vascular problem.

Dermatologic Surgery, Aug 3, 2021

BACKGROUND Cyanoacrylate closure (CAC) is a minimally invasive surgery to treat incompetent saphe... more BACKGROUND Cyanoacrylate closure (CAC) is a minimally invasive surgery to treat incompetent saphenous veins. OBJECTIVE To evaluate the incidence, the risk factors for, and the management of cyanoacrylate granuloma (CAG) after CAC of incompetent saphenous veins in patients with chronic venous disease. MATERIALS AND METHODS Data specific to incompetent saphenous veins, including great saphenous veins, anterior accessory saphenous veins, and small saphenous veins, that were treated with CAC were retrospectively evaluated. RESULTS A total of 126 saphenous veins from 101 patients were included. Recapture of the delivery catheter before withdrawal was not performed in all patients. Cyanoacrylate granuloma occurred in 3 of 101 (2.9%) patients, and in 3 of 126 (2.3%) treated saphenous veins. All patients with CAG presented with granuloma and abscess at the puncture site 3 to 5 months after CAC. All patients were treated with incision, drainage, and removal of the glue foreign body. No recurrent granuloma was observed during the study period. No patient or procedural predictive factor for CAG was identified. CONCLUSION Cyanoacrylate granuloma is not a rare complication after CAC when recapture of the delivery catheter is not performed. Patients should be advised of the possibility of CAG after CAC.

PubMed, Jul 1, 2009

Background: The primary treatments of acute arterial embolism and acute arterial thrombosis are d... more Background: The primary treatments of acute arterial embolism and acute arterial thrombosis are different. The clinical differentiation of the two diseases at initial stage can provide the efficient treatment of acute limb ischemia. Objective: Identification of the clinicalfactors significant for the differentiation between acute arterial embolism and acute arterial thrombosis in acute lower extremity ischemia. Material and method: A prospective study of the consecutive 120 patients with acute lower extremity ischemia was carried out between January 2000 and December 2004. All clinical information was compared between the proven acute arterial embolism and acute arterial thrombosis. Results: Among 120 patients, 91 (75.8%) were with acute arterial embolism and 29 (24.2%) were with acute arterial thrombosis. Normal peripheral pulse on the contralateral limb was more commonly found in patients with acute arterial embolism than in patients with acute arterial thrombosis (71.4% vs. 31.0%, p < 0.001). Atrial fibrillation was detected more in patients with acute arterial embolism than acute arterial thrombosis (31.9% vs. 3.4%, p = 0.004). Mitral valve stenosis (12.1%) and previous arterial embolism (16.5%) were only detected in patients with acute arterial embolism. On the other hand, patients with acute thrombosis had the higher comorbidities such as diabetes mellitus (44.8% vs. 19.8%, p = 0.015), hypertension (55.2% vs. 27.5%, p = 0.012), and hypercholesterolemia (37.9% vs. 6.6%, p < 0.001). Patients with acute arterial embolism had more severe clinical manifestations such as immediately threatened ischemia (56.0% vs. 13.8%, p < 0.001) and higher tendency of suffering from extensive limb gangrene (18.7% vs. 6.9%, p = 0.156). On the contrary, patients with acute arterial thrombosis had the previous symptom of intermittent claudication (51.7% vs. 3.3%, p < 0.001) more than patients with acute arterial embolism. Conclusion: The clinical factors significant for the differentiation between acute arterial embolism and acute arterial thrombosis were the status of peripheral pulse on the contralateral limb, the clinical risk factors of the two diseases, the previous arterial embolism, the clinical manifestation, and progression of ischemic status.

PubMed, Sep 1, 2008

Objective: Determine the impact of 24-hour duration of arterial embolism on the outcomes of manag... more Objective: Determine the impact of 24-hour duration of arterial embolism on the outcomes of management. Material and method: A prospective study of 91 patients with acute arterial embolism of the lower extremities was carried out. Results: Among the 91 patients, 31(34.1%) were with early acute embolism(< 24 hours) and 60 (65.9%) were with late acute embolism (> 24 hours). Extensive limb gangrene was more common in patients with late acute embolism (26.7% versus 3.2%, p = 0.009). Subsequently, primary major amputation was higher in those patients (20% versus 3.2%, p = 0.05). In early acute embolism, surgical embolectomy was only the primary treatment of revascularization (87.1%) whereas in late acute embolism, there were varying modalities of revascularization (68.3%) in addition to surgical embolectomy. The successful revascularization after the initial surgical embolectomy was significantly higher in patients with early acute embolism (92.6% versus 43.9%, p < 0.001). Patients with late acute embolism had a higher tendency of undergoing major amputation after revascularization (24.4% versus 7.4%, p = 0.106). Successful outcome was higher in patients with early acute embolism (83.9% versus 58.3%, p = 0.014). Conclusion: The 24- hour duration of arterial embolism may be a crucial factor influencing the outcome in the management of this disease.

Journal of Wound Care, Jul 2, 2021

Objective: Local intramuscular transplantation of granulocyte colony-stimulating factor (G-CSF)-m... more Objective: Local intramuscular transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilised peripheral blood mononuclear cells (PB-MNC) has been shown to be effective for treating patients with no-option critical limb ischaemia (CLI) who are not considered suitable to undergo surgical bypass or percutaneous transluminal angioplasty. The aim of this study was to investigate the effectiveness and safety of PB-MNCs as a treatment for no-option CLI patients. Method: This prospective cohort study was conducted between April 2013 and December 2017. Patients with no-option CLI were treated with G-CSF 5–10 µg/kg/day for 3 days. PB-MNCs (7.1±2.2×10 10 ) with CD34+ cells (2.1±1.2×10 8 ) were collected by blood cell separator and then injected into the calf or thigh of ischaemic limbs. Ankle–brachial index, toe–brachial index and transcutaneous oxygen tension were recorded at 1 and 3 months after injection. The amputation rate and the wound healing rate were also recorded. Results: Eight patients took part in the study. Two patients experienced rest pain relief 1 month after PB-MNC therapy. Five patients had healed ulcer at 6 months after PB-MNC therapy. Limb ischaemia did not improve after PB-MNC therapy in one patient. Below-knee amputation was performed in that patient due to extension of gangrene. Two patients required reinjection of PB-MNCs because of recurrence of ischaemic ulcer. The limb salvage rate after 1 year was 87.5%. Conclusion: Local intramuscular transplantation of G-CSF-mobilised PB-MNCs might be a safe and effective treatment for no-option CLI patients.

PubMed, Mar 1, 2009

Background: Stem cell therapy has been proposed to enhance the salvage of critically ischemic lim... more Background: Stem cell therapy has been proposed to enhance the salvage of critically ischemic limbs. Objective: Assess the efficacy and safety of the implantation of non-mobilized peripheral blood angiogenic cell precursors (NMPB-ACPs) in patients with critical limb ischemia (CLI) who were poor candidates for standard revascularization treatment options. Material and method: Six patients with CLI due to the infrapopliteal artery occlusive disease were included in the present study. Intramuscular injections of NMPB-ACPs were administered in the ischemic limbs. The efficacy was evaluated by clinical outcomes, ankle brachial index, toe brachial index, and computerized tomographic angiography. Results: There was no evidence of local or systemic complication related to the procedure. Five patients (83.3%) had clinically significant improvement of adequate circulation at the distal limb for the complete healing. Four of them had complete healing of ischemic ulcers and stumps of toe amputation. However one patient with adequate granulation tissue at the stump of the left first toe amputation subsequently suffered from severe foot infection originating from the other toes and eventually underwent below knee amputation. There was no improvement of circulation at the distal limb after the administration of NMPB-ACPs in one patient (16.7%) who eventually underwent major amputation. Conclusion: The preliminary result of NMPB-ACPs therapy may be safe and provide benefits in the improvement of circulation in patients with CLI. A larger controlled trial is required to ascertain these preliminary results.

Vascular and Endovascular Surgery, Dec 29, 2010

Phlebology, Jul 9, 2016

To develop a new pretest probability score for deep vein thrombosis (DVT) in unselected populatio... more To develop a new pretest probability score for deep vein thrombosis (DVT) in unselected population of outpatients and inpatients. The new score was developed using independent factors from 500 patients clinically suspected of leg DVT. The new score was validated in a second group of 315 patients. The score consists of four components: unilateral leg pain, confinement to bed, calf enlargement >3 cm compared with the other side, and previous venous thromboembolism. A score ≥2 indicated a high probability while a score <2 indicated low probability. The sensitivity and specificity of the new score were 71.60% and 79.49%, respectively. The area under the receiver operating characteristic curve for the new score was 0.79. The combination of a new score <2 and D-dimer level <500 µg/L had a negative predictive value of 96.43%. Our new score was valid in an unselected population of outpatients and inpatients.