Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Limb ischemia, acute [keywords]
- Silencing of p53 RNA through transarterial delivery ameliorates renal tubular injury and downregulates GSK-3β expression after ischemia-reperfusion injury. [Journal Article]
- Am J Physiol Renal Physiol 2013 Dec; 305(11):F1617-27.
p53, a pivotal protein in the apoptotic pathway, has been identified as a mediator of transcriptional responses to ischemia-reperfusion (IR) injury. The characteristics and functional significance of the p53 response in vivo are largely unknown in IR-induced kidney injury. Therapeutic opportunities of delivering small interfering RNA (siRNA) via venous injection have gained recognition; however, systemic adverse effects of siRNA therapy should be considered. To prevent IR-induced kidney injury, we tested the efficacy of transarterial administration of siRNA targeting p53 (p53 siRNA). Female C57BL/6 mice underwent unilateral renal artery ischemia for 30 min, followed by reperfusion. siRNA experiments utilized short hairpin (sh) RNA plasmid-based approaches. Transfection of shRNA was performed using cationic polymer transfection reagent. Injection of synthetic p53 shRNA into the left renal artery just after ischemia improved tubular injury, apoptosis, and the swelling of mitochondria in cells of the thick ascending limb of Henle (mTALH) at the outer medullary regions. Staining of upregulated p53 was colocalized with the inducible expression of glycogen synthase kinase-3β (GSK-3β) at mTALH after IR injury. p53 shRNA inhibited GSK-3β expression and restored β-catenin expression at mTALH. For IR-induced kidney injury, transarterial delivery of p53 siRNA is an effective pharmacological intervention. Targeting siRNA to p53 leads to an attenuation of apoptosis and mitochondrial damage through the downregulation of GSK-3β expression and upregulation of β-catenin. Local delivery of vectors such as p53 siRNA through a transaortic catheter is clinically useful in reducing the adverse effect of siRNA-related therapy.
- Endovascular management of acute limb ischemia. [Journal Article]
- Vasc Med 2013 Oct; 18(5):307-13.
Acute limb ischemia (ALI) is defined as a sudden decrease (<14 days) in limb perfusion causing a potential threat to limb viability. Endovascular treatment of ALI is an effective and appropriate primary treatment strategy in patients with a viable acutely ischemic limb due to a recent arterial occlusion. We present a case of acute limb ischemia and discuss percutaneous interventional treatment strategies including catheter-directed thrombolysis, rheolytic thrombectomy, and utilization of distal protection devices.
- [Scores and stages in angiology]. [English Abstract, Journal Article]
- Ther Umsch 2013 Oct; 70(10):567-71.
For the classification of peripheral arterial disease the Fontaine's stages are mostly used in Switzerland whereas the Rutherford's categories are more common in the scientific literature. It is important to distinguish between the Rutherford classification for chronic peripheral artery disease and the one for the acute limb ischemia. The clinical classification of acute limb ischemia is a helpful tool for prognosis of the leg and urgency of revascularization. The Wagner as well as the Armstrong classification is used for diabetic foot ulcers. The advantage of the Armstrong stages is that important informations like wound infection or ischemia are considered. For chronic venous insufficiency the Widmer stages are widely used in Switzerland but have the disadvantage that patient-reported symptom severity is not considered. The CEAP classification includes anatomical information and the etiology and is mostly used for studies. The Wells score helps to define the probability for the presence of a deep vein thrombosis before further tests are performed.
- Usefulness of Neutrophil/Lymphocyte Ratio as a Predictor of Amputation after Embolectomy for Acute Limb Ischemia. [JOURNAL ARTICLE]
- Ann Vasc Surg 2013 Sep 28.
The aim of this study was to examine the predictive ability of admission neutrophil/lymphocyte ratio (NLR) for predicting amputation in patients with acute limb ischemia who underwent embolectomy.We retrospectively analyzed the clinical, hematologic, and amputation data of 254 patients who had undergone embolectomy for acute limb ischemia. There were 152 (52%) men and 93 (48%) women, with a mean age of 66.04 ± 13.30 years. The admission NLR was determined by dividing the absolute neutrophil count by the absolute lymphocyte count. The primary end point was determined as amputation and death.The mean duration of follow-up was 26 months. During the follow-up period, there were 18 (7%) amputations within 30 days of surgery and 36 (15%) amputations over a mean follow-up of 26 months. Based on multivariate logistic regression modeling, no arterial back bleeding and preoperative NLR were observed to be independent risk factors for amputation within 30 days of surgery, and no arterial back bleeding and preoperative NLR were observed to be independent risk factors for midterm amputation for the same time period. A NLR of ≥5.2 was taken as the cutoff based upon the receiver operating characteristic. In receiver operating characteristic curve analysis, a NLR ≥5.2 had 83% sensitivity and 63% specificity in predicting amputation within 30 days of surgery and 63% sensitivity and 63% specificity in predicting midterm amputation.An elevated NLR is associated with a poorer limb survival after embolectomy. This simple, inexpensive test may therefore be added to risk stratification of these high-risk patients.
- Toll-like Receptor 4 inhibitor TAK-242 treatment does not influence perfusion recovery in tissue ischemia. [JOURNAL ARTICLE]
- J Cardiovasc Pharmacol 2013 Sep 30.
Toll-like receptors (TLRs) are important in innate immune responses, which are crucial in collateral artery formation (arteriogenesis). TLR4-/- mice undergoing hind limb ischemia show decreased perfusion recovery accompanied by an impaired infiltration of inflammatory cells. TLR antagonists are currently developed and tested with the objective to inhibit acute exacerbation of organ damaging immune responses. However, systemic inhibition of innate immune responses may negatively influence arteriogenesis. In this study, we evaluated if TLR4 inhibition by a potent TLR4 inhibitor (TAK-242) would negatively influence perfusion recovery in a mouse model for arteriogenesis. Whole blood from human and mouse origin was stimulated with the TLR4 ligand lipopolysaccharide (LPS) following TAK-242 incubation. After stimulation, cellular TLR4 activation was measured using FACS and Tumor Necrosis Factor alpha (TNF-α) release was measured using ELISA. Next, the effect of TAK-242 was tested in a mouse model for arteriogenesis on perfusion recovery. TLR4 responses measured by TNF-α levels were inhibited by TAK-242 in human and mouse blood after long-term stimulation. TAK-242 attenuated TLR4 responses in vivo, but did not inhibit perfusion recovery in mice.In conclusion, TAK-242 does not negatively influence perfusion recovery following hind limb ischemia despite its TLR4 inhibiting properties.
- Acute brain ischemia as a complication of the Ehlers-Danlos syndrome, the case series. [JOURNAL ARTICLE]
- Vascular 2013 Sep 30.
Vascular type of Ehlers-Danlos syndrome involves many severe complications leading not only to organ-specific symptoms but often ends in a sudden death. The aim of this paper was to present a diagnostic possibilities and its efficiency rate in patients with vascular complications of Ehlers-Danlos syndrome who suffered from artery dissection resulting in acute brain or limb ischemia. We analysed three patients with diagnosed Ehlers-Danlos syndrome who were referred to radiology department for diagnostic imaging of affected vascular beds, each experienced brain ischemia. The paper also aims at offering some general recommendations for patients suffering from possible complications of type IV Ehlers-Danlos syndrome basing on our own experience and available literature data.
- Endovascular treatment of acute limb ischemia and proximal deep vein thrombosis using rotational thrombectomy: A review of published literature. [Journal Article]
- Cardiovasc Revasc Med 2013 Nov-Dec; 14(6):343-8.
Acute and subacute ischemia of the lower extremity is still a common reason for amputation. The treatment of this condition includes the well known procedure of local thrombolysis, surgical thrombectomy and, in recent times, percutaneous mechanical thrombectomy procedures such as rotational thrombectomy. However, in randomized studies Fogarty's procedure of surgical thrombectomy was associated with a high rate of perioperative complications and, in part, low technical success rates. On the other hand, local thrombolysis is associated with hemorrhage as well as high costs because of measures requiring substantial resources, such as intensive care monitoring or repeat angiographies. In several studies, the endovascular therapy options of Straub Rotarex® and Aspirex® systems, both products of technical advancements in the field, were shown to be successful in terms of amputation-free survival. Their use was also associated with low complication rates. The majority of studies were focused on arterial blood flow in the femur. However, in the meantime several registers and studies have shown that the systems can also be effectively used to treat proximal deep vein thrombosis. In the present report we review the current study-based value of rotational thrombectomy in the venous and arterial system.
- [Usefulness and limitations of the invasive coronary strategy in nonagerians]. [English Abstract, Journal Article]
- Ann Cardiol Angeiol (Paris) 2013 Nov; 62(5):301-7.
Nonagenarians are systematically excluded from studies of interventional cardiology. Few data exist on the usefulness, safety, and results of coronary angiography (CA) and percutaneous coronary intervention (PCI) in this population.To evaluate the benefits and hazards of CA and PCI in nonagenarians.Retrospective study conducted from the database (Cardioreport(®)) of the CH de Versailles, from January 2001 to December 2011.From the 15,806 procedures performed in the center during the period, 107 (0.9%) were done in 97 patients aged ≥90years. Half of them underwent PCI. Median age was 92±2years (range: 90 to 100), 56% were women. Main indication was an acute coronary syndrome (77%, acute STEMI in 39%). The first group (n=58) had a single CA leading to strengthen medical treatment, and CABG in one case. The second group (n=49) had a CA followed by immediate (41) or delayed (8) PCI. The primary success rate of PCI was 90%. Radial route was used in 94% in the period 2009-2011 (51% overall). Failure of arterial access (4%) and difficulties of catheterization (13%) were rare. Severe complications occurred in 19%. They were local (11 hematomas, 6 severe, 4 transfusions, and 1 fatal acute ischemia of a lower limb), and general (1 stroke, 1 death by left main rupture during PCI). Twenty percent of the complications (11% of severe ones) were directly related to the procedure. Overall hospital mortality was 10%.Angiography is feasible in nonagenarians by radial approach without failures and with a reduced rate of complications. PCI was indicated in about half of the cases. PCI may be proposed in nonagerians with a high success rate, and an acceptable risk of local and general complications.
- Aortic intimal sarcoma masquerading as bilateral renal artery stenosis. [Journal Article]
- J Nephrol 2013 Sep-Oct; 26(5):941-4.
Aortic intimal sarcoma is a rare tumor with poor prognosis. The most common manifestations are thromboembolic phenomena and vascular obstruction. We present a case of aortic intimal sarcoma causing bilateral renal artery stenosis which manifested as resistant hypertension and acute kidney inury. Multiple attempts to stent the renal arteries were unsuccessful. Eventually the patient developed acute limb ischemia and oliguric kidney failure as complications of the primary tumor.
- Independent Factors Predicting Early Lower Limb Intra-arterial Thrombolysis Failure. [JOURNAL ARTICLE]
- Ann Vasc Surg 2013 Sep 5.
Risk factors for early catheter-directed intra-arterial thrombolysis failure in acute lower limb ischemia remain unclear.One hundred forty-nine limbs with acute artery or bypass graft thrombosis underwent catheter-directed thrombolysis (maximum of 48 hours). A retrospective data analysis was carried out to assess possible risk factors for early, 30-day treatment failure.Seventy-nine men (53%) and 70 women (47%) with a median age of 70 (range 32-93) years were treated. Treatment outcomes were determined as success (N = 115, 77%) or failure (N = 34, 23%). The failure criteria comprised rapid progression of ischemia (N = 4, 2.7%) and major bleeding complications (N = 2, 1.3%), both requiring thrombolysis termination and surgery. Inability to reopen native arteries/grafts (N = 10, 6.7%), run-off vessels (N = 10, 6.7%), in-hospital death (N = 4, 2.7%), the need for major amputation (N = 13, 8.7%), and reocclusions (N = 5, 3.4%) within the 30-day follow-up period were also considered as failures. Multivariate analysis of the risk factors' impact on the success of thrombolysis revealed such independent parameters as hypercholesterolemia (OR 0.16, 95% CI 0.06-0.42, P < 0.0001), previous bypass grafting of the ipsilateral limb (OR 0.18, 95% CI 0.06-0.53, P = 0.002), and duration of ischemia prior to the initiation of thrombolysis (OR 0.95, 95% CI 0.91-0.99, P = 0.009, per day).According to our results, factors independently predicting early failure include hypercholesterolemia, previous bypass grafting, and a delay in treatment initiation. Moreover, catheter-directed intra-arterial thrombolysis can be considered safe and effective in the treatment of acute lower limb ischemia.