Gangrene of the Foot After Coronary Artery Bypass Graft Surgery (original) (raw)
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Need for Late Lower Limb Revascularization and Major Amputation after Coronary Artery Bypass Surgery
European Journal of Vascular and Endovascular Surgery, 2008
Objectives. The aim of the present study was to estimate the need for late lower limb revascularization and/or major amputation after coronary artery bypass grafting (CABG). Design. Retrospective study. Patients and methods. 1307 residents of Oulu who underwent CABG from 1990 to 2006 formed the basis of this community-wide study. Results. During a mean follow-up of 7.1 AE 4.5 years, 111 patients (8.5%) underwent 251 vascular procedures for lower limb ischemia and 25 major amputations. In four patients, revascularization was done for complicated wound after vein graft harvesting. Freedom rates from lower limb revascularization and/or major amputation at 5-, 10-and 15-year were 92.9%, 88.4% and 85.1%, whereas freedom rates from lower limb revascularization for critical ischemia and/or major amputation were 98.1%, 95.2% and 94.7%. Age (p ¼ 0.013, HR 1.05), extracardiac arteriopathy (p < 0.0001, HR 5.39), left ventricular ejection fraction classes (p ¼ 0.03), diabetes (p < 0.0001, HR 5.78), and estimated glomerular filtration rate <60 mg/min/m 2 (p ¼ 0.02, HR 2.22) were independent predictors of lower limb revascularization for critical leg ischemia and/or major amputation. Conclusions. Patients with extracardiac arteriopathy, diabetes and decreased glomerular filtration rate at the time of CABG are at risk for late lower limb ischemia. These patients would most benefit of a closer follow-up for prevention of peripheral vascular disease and its related complications.
Management of Necrotic Lesions in Chronic Limb Ischemia
2015
Peripheral vascular disease commonly affects the arteries supplying the leg and is mostly caused by atherosclerosis. Restriction of blood flow due to arterial stenosis or occlusion often leads patients to complain of muscle pain on walking (intermittent claudication). Any further reduction in blood flow causes ischemic pain at rest, affecting by consequence the extremity. Ulceration and gangrene may then supervene and can result in loss of the limb if not treated. We present the case of a 55 year old male, C.I., with tissue necrosis of the right calf, aching pain at rest in the distal foot and disabling claudication (stage IV Fontaine PAOD).The patient’s history reveals that he is a former smoker undergoing anticoagulation and vasodilation treatment. He also suffered severe spinal cord injury leading to paraplegia in 2008, a laryngeal neoplasm surgery in 2013 and a PTA with stent placement in the proximal right CIA.
History of the Diagnosis and Treatment of Critical Limb Ischemia and Diabetic Foot
Seminars in Vascular Surgery, 2019
The history of the recognition and surgical treatment of lower limb ischemia dates to the Middle Ages. The twin Saints Comas and Damian were ascribed to save a gangrenous limb in the 13 th century and became patrons of future surgeons. The physicians that followed developed the theories of blood flow, the anatomy of the arterial circulation, and recognition that occlusive disease was the cause of limb ischemia and gangrene. Innovative physicians developed the techniques of arterial surgery and bypass grafting to restore limb blood flow and allow healing of lesions. In the 1960s, the era of endovascular intervention by the pioneering work of Charles Dotter who developed techniques to image diseased arteries during a recanalization procedure. The development of guidewires, angioplasty balloons, and stents quickly followed. Management of lower limb ischemia and the diabetic foot will continue to evolve building on the history and passion of preceding physicians and surgeons.
Limb Ischemia Due to Use of Internal Thoracic Artery in Coronary Bypass
2010
Immediately after undergoing coronary bypass grafting using the left internal thoracic artery, a 59-year-old man developed left leg ischemia. Right-to-left femoral artery crossover bypass was performed and the ischemia resolved. A 72-year-old man developed left calf pain 12 days after a similar procedure; peripheral angiography revealed stenosis of the abdominal aorta and distal peripheral arteries, which did not require intervention.
Journal of Atherosclerosis and Thrombosis, 2023
Aims: Though the number of patients with peripheral arterial disease (PAD) and critical limb ischemia (CLI) is increasing, few histopathological studies of PAD, particularly that involving below-the-knee arteries, has been reported. We analyzed the pathology of anterior tibial artery (ATA) and posterior tibial artery (PTA) specimens obtained from patients who underwent lower extremity amputation due to CLI Methods: Dissected ATAs and PTAs were subjected to ex-vivo soft X-ray radiography, followed by pathological examination using 860 histological sections. This protocol was approved by the Ethics Review Board of Nihon University Itabashi Hospital (RK-190910-01) and Kyorin University Hospital (R02-179). Results: The calcified area distribution was significantly larger in PTAs than in ATAs on soft X-ray radiographic images (ATAs, 48.3% 19.2 versus PTAs, 61.6% 23.9; p 0.001). Eccentric plaque with necrotic core and macrophage infiltration were more prominent in ATAs than in PTAs (eccentric plaque: ATAs, 63.7% versus PTAs, 49.1%; p 0.0001, macrophage: ATAs, 0.29% [0.095-1.1%] versus PTAs, 0.12% [0.029-0.36%]; p 0.001), histopathologically. Thromboembolic lesions were more frequently identified in PTAs than in ATAs (ATAs, 11.1% versus PTAs 15.8%; p 0.05). Moreover, post-balloon injury pathology differed between ATAs and PTAs. Conclusions: Histological features differed strikingly between ATAs and PTAs obtained from CLI patients. Clarifying the pathological features of CLI would contribute to establishing therapeutic strategies for PAD, particularly disease involving below-the knee-arteries.
Efficacy of dorsal pedal artery bypass in limb salvage for ischemic heel ulcers
Journal of Vascular Surgery, 1999
Purpose: Although pedal artery bypass has been established as an effective and durable limb salvage procedure, the utility of these bypass grafts in limb salvage, specifically for the difficult problem of heel ulceration, remains undefined. Methods: We retrospectively reviewed 432 pedal bypass grafts placed for indications of ischemic gangrene or ulceration isolated to either the forefoot (n = 336) or
Lateral plantar artery bypass grafting: Defining the limits of foot revascularization
Journal of Vascular Surgery, 1989
We placed 20 bypass grafts to the lateral plantar artery in 18 extremities to salvage feet with wet (12) or dry (six) gangrene; 15 grafts were implanted in men (75%), and five were implanted in women (25%). The median age was 65 years. All except two patients had diabetes; eight were treated with insulin. One patient had Buerger's disease, and another had vasculitis with chronic lymphocytic leukemia. History of smoking (65%), hypertension (53%), heart disease (71%), and osteomyelitis in the foot (35%), were noted. Cultures were positive in 15 gangrenous feet, 11 with gram-negative bacilli. Four long femoroplantar bypasses were placed. Ten short grafts were placed from the popliteal artery, and six jump grafts were placed distal to a femoropopliteal or tibiaJ bypass. Hospital stay ranged from 8 to 38 days (median 16 days), and there were two in-hospital deaths. Transmetatarsal or button toe amputations were performed in nine feet. There were two below-knee amputations, one with a patent graft, for a foot salvage rate of 89% at 2 months. In four instances the gangrenous ulcers took longer than 6 months to heal; aU other wounds healed within 6 months. The primary and secondary patency rates were 85% at I month, and 73% at 3 months and thereafter. Four of five graft failures occurred in the two legs with repeat bypass graftings. All patients with successful revascularization are able to walk, and seven returned to work full time.