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Chronic Critical Limb Ischaemia

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Vascular Surgery
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Abstract

A 74 year-old male with a history of diabetes, hypertension, hypercholesterolaemia, coronary artery bypass and active tobacco use presented with a gangrenous right first toe. The patient stated that he had no history of trauma to the area, and complained of rest pain in the foot. The patient had been in otherwise good health since his coronary artery bypass 12 years ago. On physical examination, the patient was in no physical distress. The patient had a well-healed median sternotomy scar. Auscultation of the heart revealed a regular rate without any murmurs. He was obese. Abdominal examination revealed no palpable masses. The patient had bilateral femoral and popliteal pulses but no pedal pulses. The patient had bilateral, well-healed scars from the greater saphenous vein harvest sites. The right gangrenous toe was dry without any evidence of infection.

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References

  1. Ascer E, Veith FJ, Gupta SK. Bypasses to plantar arteries and other tibial branches: an extended approach to limb salvage. J Vasc Surg 1988; 8: 434–41.

    PubMed  CAS  Google Scholar 

  2. Flinn WR, Rohrer MJ, Yao JST, McCarthy WJ, Fahey VA, Bergan JJ. Improved long-term patency of infragenicular polytetrafluoroethylene grafts. J Vasc Surg 1988; 7: 685–90.

    PubMed  CAS  Google Scholar 

  3. Siegman FA. Use of the venous cuff for graft anastomosis. Surg Gynecol Obstet 1979; 148: 930–31.

    PubMed  CAS  Google Scholar 

  4. Miller JH, Foreman RK, Ferguson L, Faris I. Interposition vein cuff for anastomosis of prosthesis to small artery. Aust N Z J Surg 1984; 54: 283–5.

    Article  PubMed  CAS  Google Scholar 

  5. Dardik H, Sussman B, Ibrahim IM, Kahn M, Svoboda J, Mendes K, Dardik I. Distal arteriovenous fistula as an adjunct to maintain arterial and graft patency for limb salvage. Surgery 1983; 94: 478–86.

    PubMed  CAS  Google Scholar 

  6. Ascer E, Veith FJ, White-Flores SA, Morin L, Gupta, SK, Lesser, ML. Intraoperative outflow resistance as a predictor of late patency of femoropopliteal and infrapopliteal arterial bypasses. J Vasc Surg 1987; 5: 820–27.

    PubMed  CAS  Google Scholar 

  7. Albertini JN, Barral X, Branchereau A, Favre JP, Guidicelli H, Magne JL, Magnan PE. Long-term results of arterial allograft below-knee bypass grafts for limb salvage: a retrospective multicenter study. J Vasc Surg 2000; 31: 426–35.

    Article  PubMed  CAS  Google Scholar 

  8. Harris L, O’brien-Irr M, Ricotta JJ. Long-term assessment of cryopreserved vein bypass grafting success. J Vasc Surg 2001; 33: 528–32.

    Article  PubMed  CAS  Google Scholar 

  9. Carpenter JP, Owen RS, Baum RA, Cope C, Barker CF, Berkowitz HD, et al. Magnetic resonance angiography of peripheral runoff vessels. J Vasc Surg 1992; 16: 807–13.

    Article  PubMed  CAS  Google Scholar 

  10. Cambria RP, Kaufman JA, L’Italien GJ, Gertler JP, LaMuraglia GM, Brewster DC, et al. Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: a prospective study. J Vasc Surg 1997; 25: 380–89.

    Article  PubMed  CAS  Google Scholar 

  11. Ascher E, Mazzariol F, Hingorani A, Salles-Cunha S, Gade P. The use of duplex ultrasound arterial mapping as an alternative to conventional arteriography for primary and secondary infrapopliteal bypasses. Am J Surg 1999; 178: 162–5.

    Article  PubMed  CAS  Google Scholar 

  12. Mazzariol F, Ascher E, Salles-Cunha SX, Gade P, Hingorani A. Values and limitations of duplex ultrasonography as the sole imaging method of preoperative evaluation for popliteal and infrapopliteal bypasses. Ann Vasc Surg 1999; 13: 1–10.

    Article  PubMed  CAS  Google Scholar 

  13. Mazzariol F, Ascher E, Hingorani A, Gunduz Y, Yorkovich W, Salles-Cunha S. Lower-extremity revascularisation without preoperative contrast arteriography in 185 cases: lessons learned with duplex ultrasound arterial mapping. Eur J Vasc Endovasc Surg 2000; 19: 509–15.

    Article  PubMed  CAS  Google Scholar 

  14. Neville R, Tempesta B, Sidway A. Tibial bypass for limb salvage using polytetrafluoroethylene and a distal vein patch. J Vasc Surg 2001; 33: 266–72.

    Article  PubMed  CAS  Google Scholar 

  15. Ascher E, Gennaro M, Pollina RM, Ivanov M, Yorkovich WR, Ivanov M, Lorensen E. Complementary distal arteriovenous fistula and deep vein interposition: a five-year experience with a new technique to improve infrapopliteal prosthetic bypass patency. J Vasc Surg 1996; 24: 134–43.

    Article  Google Scholar 

  16. Kreienberg PB, Darling RC 3rd, Chang BB, Paty PS, Lloyd WE, Shah DM. Adjunctive techniques to improve patency of distal prosthetic bypass grafts: polytetrafluoroethylene with remote arteriovenous fistulae versus vein cuffs. J Vasc Surg 2000; 31: 696–701.

    Article  PubMed  CAS  Google Scholar 

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© 2003 Springer-Verlag London

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Ascher, E., Hingorani, A., Yorkovich, W.R. (2003). Chronic Critical Limb Ischaemia. In: Geroulakos, G., van Urk, H., Hobson, R.W., Calligaro, K.D. (eds) Vascular Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-3870-9_22

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  • DOI: https://doi.org/10.1007/978-1-4471-3870-9_22

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-3872-3

  • Online ISBN: 978-1-4471-3870-9

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