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      Two effective cases of additional pedal artery angioplasty for severe lower limb ischemia following acute thrombotic artery occlusion with hypercoagulable state diseases

      case-report

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          Abstract

          Background

          Acute limb ischemia (ALI) and critical limb ischemia (CLI) following ALI are life-threatening diseases. The rare potential causes of ALI include hypercoagulable state diseases, such as antiphospholipid syndrome (APS) and essential thrombocythemia (ET). Hypercoagulability often make revascularization for arterial occlusion, especially associated with infrapopliteal lesions, difficult. This is because the vessels have poor run-off, and elevated peripheral vascular resistance associated with microcirculation failure, due to a high thrombus burden. There is no established treatment for this issue.

          Case presentation

          A 45 years-old and a 56 years-old male suffered from thrombotic arterial occlusion as a first manifestation of APS and ET, respectively. Combination therapy with aggressive anti-thrombotic therapy and revascularization, such as endovascular therapy and surgical thrombectomy based on the angiosome concept, was performed. However, the high thrombus burden caused a poor pedal outflow, and significant limb ischemia remained. Additional pedal artery angioplasty was performed to improve residual limb ischemia in each case and provided sufficient blood flow to the foot.

          Conclusion

          The pedal artery angioplasty for thrombotic pedal artery occlusion cases, associated with hypercoagulable state diseases, seems to be a treatment option for relieving residual limb ischemia.

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          Most cited references17

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          Predictors of adverse clinical outcomes after successful infrapopliteal intervention.

          To clarify the clinical and angiographical variables related to delayed wound healing, major amputation and death after successful infrapopliteal intervention in critical limb ischemia patients with tissue loss. There is an underappreciation of adverse clinical outcomes after successful infrapopliteal intervention. Stent-assisted infrapopliteal angioplasty was successful in 106 limbs in 85 patients. Successful intervention was defined as revascularization of at least one straight-line flow to the foot. At 6 months and 1, 2, and 5 years, the repeat intervention-free rates were 55.0, 49.6, 44.4, and 36.1%, respectively; the amputation-free survival rates were 85.7, 68.0, 54.5, and 39.8%, respectively; and the limb salvage rates were 96.0, 92.4, 86.3, and 86.3%, respectively. An infectious wound was an independent predictor of major amputation after successful intervention. The complete wound healing rates were 36.8, 57.5, 67.9, and 73.6% at 3, 6, 9, and 12 months, respectively. In stepwise multivariate Cox analysis, diabetes mellitus, an infectious wound, and the pedal arch classification were identified as independent predictors of wound healing. The long-term survival rates at 6 months and 1, 2, and 5 years were 89.5, 73.8, 62.0, and 43.4%, respectively. Stepwise multivariate Cox analysis indentified end-stage renal disease (ESRD) on hemodialysis to be an independent predictor of death. An infectious wound, comorbidities of diabetes mellitus and ESRD on hemodialysis and classification of pedal arch can be predictors of adverse clinical outcomes after successful infrapopliteal intervention. Copyright © 2012 Wiley Periodicals, Inc.
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            Clinical Outcomes of Pedal Artery Angioplasty for Patients With Ischemic Wounds

            The aim of this study was to investigate the clinical outcomes of pedal artery angioplasty (PAA) for patients with critical limb ischemia.
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              Contemporary outcomes of endovascular interventions for acute limb ischemia

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                Author and article information

                Contributors
                shjksk@koto.kpu-m.ac.jp
                Journal
                CVIR Endovasc
                CVIR Endovasc
                CVIR Endovascular
                Springer International Publishing (Cham )
                2520-8934
                28 September 2020
                28 September 2020
                December 2020
                : 3
                : 71
                Affiliations
                GRID grid.272458.e, ISNI 0000 0001 0667 4960, Department of Cardiovascular Medicine, , Kyoto Prefectural University of Medicine, ; 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
                Author information
                http://orcid.org/0000-0002-3854-7760
                Article
                166
                10.1186/s42155-020-00166-7
                7520864
                32986148
                b2d14946-273a-47ae-a675-c159b56494cf
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 1 July 2020
                : 24 September 2020
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2020

                pedal artery angioplasty,thrombotic artery occlusion,hypercoagulable state disease,critical limb ischemia,acute limb ischemia

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