PUT YOUR BEST FOOT FORWARD

Size: px
Start display at page:

Download "PUT YOUR BEST FOOT FORWARD"

Transcription

1 PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow. Estimated costs $ billion (2010 data): range depends on data being used and cost counted. Exposed bones and/or tendons make limb salvage more difficult. HPI 57 year old woman Chronic non-healing wound on the left foot. Over the course of 1 year she underwent a series of vascular and wound treatments at an OSH for the left foot including an atherectomy of the left popliteal and anterior tibial arteries and a popliteal stent. HBO therapy but no improvement. TMA of the left foot which then necrosed and was slowly worsening. Advised BKA. SH: 40 pack year smoker stopped 6 years ago. Physical Examination Lower extremity pulse exam: Right lower extremity- all pulses were palpable. Left lower extremity- femoral pulse palpable, popliteal pulse non-palpable, Pedal pulses non-palpable. Peroneal signal was heard at the distal ankle. Foot exam: Left open TMA with superficial necrosis of the distal end of the wound, plantar skin viable, normal sensation in the foot and good ankle range of movement, no venous stasis changes in leg. Non-invasive vascular studies: ABI: Right-0.92, Left TcPO2 on the plantar surface of the Left foot- 12 mmhg. Ultrasound- Greater saphenous vein in the left leg measured >3mm throughout its length, no reflux, no deep vein thrombosis. 1

2 A. YES? B. NO? Is this limb salvageable? Y E S? 46% 54% N O? Given the normal right lower extremity what most likely represents her diagnosis? 40% A. Atherosclerosis B. Embolism C. Trash foot following atherectomy D. Thrombosed popliteal artery aneurysm A t h e r o s c l e r o s i s 23% E m b o l i s m 7% T r a s h f o o t f o l l o w i n g a t h... T h r o m b o s e d p o p l i t e a l a r... 30% 2

3 Imaging- Angiogram What are the options for management? A. Below knee amputation B. Patient should be referred to a no revascularization option: cell-based or gene therapy trial C. Pedal access and recanalization of the anterior tibial and peroneal arteries D. SFA to peroneal bypass with soft tissue coverage E. Anterograde access and recanalization of the anterior tibial artery B e l o w k n e e a m p u t a t i o n 19% P a t i e n t s h o u l d b e r e f e r r e... 0% P e d a l a c c e s s a n d r e c a n a l i... 19% A n t e r o g r a d e a c c e s s a n d... S F A t o p e r o n e a l b y p a s s w... 46% 15% 3

4 Case Management Left SFA-Peroneal Bypass with non-reversed greater saphenous vein (Vascular surgery). Left foot debridement of subcutaneous tissue, muscles, tendons and metatarsals were debrided back to the base (Podiatry). Right rectus abdominis free flap to left TMA Stump (Plastic Surgery)- inferior epigastric artery and vein were anastomosed to a jump graft off the SFA-peroneal bypass and anterior tibial vena commitante. Split thickness skin graft placed over the muscle flap. Postoperative course Uneventful recovery in the hospital. Flap was closely monitored. Discharged to rehabilitation facility on POD 18 on aspirin. 1 week later the patient noted a change in the color of the flap and was readmitted. 4

5 She had no history of trauma to the flap or symptoms. On examination: The flap appeared dark with loss of about 30-40% of the skin graft. It had dopplerable arterial and venous signals. Ultrasound showed a patent bypass graft and no DVT in the leg. What should be done? A. Systemic anticoagulation. B. Conservative management with wound vac. C. Amputation. D. Apply leaches. E. OR for exploration of the flap and excision of necrotic tissue. F. OR for exploration and revision of anastomosis. G. New free flap. S y s t e m i c a n t i c o a g u l a t i o n. 0% 3% 16% 16% C o n s e r v a t i v e m a n a g e m e.. A m p u t a t i o n. A p p l y l e a c h e s. O R f o r e x p l o r a t i o n o f t h e... 56% 3% 6% O R f o r e x p l o r a t i o n a n d r e... N e w f r e e f l a p. Case Management Underwent debridement of the flap and was found to have a viable flap with an intramuscular hematoma. No further events postoperatively. Activity was gradually increased. Got another split thickness skin graft and was discharged home. On follow up in clinic, she had viable muscle flap, warm foot, 100% take of her skin graft 5

6 Biomechanical issues with a TMA Increased pressure in the forefoot- leads to ulcer development. Equinovarus is the most common complication. Parabola of the metatarsals may not be maintained leading to increased pressure over the elongated metatarsal. MANAGEMENT: Custom shoes and regular follow up. Tendoachilles lengthening or gastrocnemius recession for equinovarus deformity. FLAP FACTS Free muscle flap increases the outflow for lower extremity bypass. Neovascularization from surrounding ischemic tissues by collaterals occurs as soon as 3 weeks and the flap can survive even if the bypass occludes. Free flap can serve as the sole outflow for a bypass graft in patients with unacceptable or no runoff. Contraindications: ESRD, uncontrolled diabetes, current smoker. Relative- history of graft thrombosis. Workup of a failing free flap Arterial duplex of the bypass graft to evaluate the inflow- angiogram if issue with the bypass. Venous ultrasound for deep venous thrombosis. Examination of the flap for temperature, color and arterial and venous signals. 6

7 FLAP FAILURES Flap thrombosis- occurs in a bimodal pattern. Usually within 1 st 48 hours or after 1 week. Reasons- arterial or venous thrombosis (more common), pressure on the flap. Management All free flap patients are started on aspirin, subcutaneous heparin immediately postop. If trouble with anastomosis during surgery-some surgeons use low dose heparin drip. If flap thrombosis suspected- exploration in the OR within 6 hours of onset. Conclusions Combined lower extremity bypass with complex foot reconstruction with free tissue transfer is an option for patients with good foot function and large soft-tissue defects. These procedures are associated with high rate of early perioperative revisions of both the bypass and the free flap. 7

CHAPTER 16 LOWER EXTREMITY. Amanda K Silva, MD and Warren Ellsworth, MD, FACS

CHAPTER 16 LOWER EXTREMITY. Amanda K Silva, MD and Warren Ellsworth, MD, FACS CHAPTER 16 LOWER EXTREMITY Amanda K Silva, MD and Warren Ellsworth, MD, FACS The plastic and reconstructive surgeon is often called upon to treat many wound problems of the lower extremity. These include

More information

Role of free tissue transfer in management of chronic venous ulcer

Role of free tissue transfer in management of chronic venous ulcer Original Article Role of free tissue transfer in management of chronic venous ulcer K. Murali Mohan Reddy, D. Mukunda Reddy Department of Plastic Surgery, Nizams Institute of Medical Sciences, India. Address

More information

Pedal Bypass With Deep Venous Arterialization:

Pedal Bypass With Deep Venous Arterialization: Pedal Bypass With Deep Venous Arterialization: Long Term Result For Critical Limb Ischemia With Unreconstructable Distal Arteries Pramook Mutirangura Professor of Vascular Surgery Faculty of Medicine Siriraj

More information

Critical Limb Ischemia A Collaborative Approach to Patient Care. Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017

Critical Limb Ischemia A Collaborative Approach to Patient Care. Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017 Critical Limb Ischemia A Collaborative Approach to Patient Care Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017 Surgeons idea Surgeons idea represents the final stage of peripheral

More information

Will it heal? How to assess the probability of wound healing

Will it heal? How to assess the probability of wound healing Will it heal? How to assess the probability of wound healing Richard F. Neville, M.D. Professor of Surgery Chief, Division of Vascular Surgery George Washington University Limb center case 69 yr old male

More information

VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS

VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS KANSAS ASSOCIATION OF OSTEOPATHIC MEDICINE ANNUAL CME CONVENTION APRIL 13, 2018 THREE

More information

Combat Extremity Vascular Trauma

Combat Extremity Vascular Trauma Combat Extremity Vascular Trauma Training teams to be a TEAM Chatt A. Johnson LTC, MC, USA 08 March 2010 US Army Trauma Training Center Core Discussion Series Outline: Combat Vascular Injury Physiologic

More information

Transmetatarsal amputation in an at-risk diabetic population: a retrospective study

Transmetatarsal amputation in an at-risk diabetic population: a retrospective study The Journal of Diabetic Foot Complications Transmetatarsal amputation in an at-risk diabetic population: a retrospective study Authors: Merribeth Bruntz, DPM, MS* 1,2, Heather Young, MD 3,4, Robert W.

More information

Social History. Retired internist 2 scotches a day 50 pack-year history, stopped in 2005

Social History. Retired internist 2 scotches a day 50 pack-year history, stopped in 2005 April 17, 2008 HPI 78 year old internist complains of 10 days of tingling and discomfort in left toes Unable to walk or sleep due to severe pain Pain worse with movement Redness in left toes Bilateral

More information

Arthroplasty after previous surgery: previous vascular problems

Arthroplasty after previous surgery: previous vascular problems Arthroplasty after previous surgery: previous vascular problems Jacques Menetrey & Victoria B. Duthon Centre de médecine de l appareil locomoteur et du sport Swiss Olympic medical Center Unité d Orthopédie

More information

EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists

EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists Nothing To Disclosure DISCLOSURES I have no outside conflicts of interest, financial incentives, or

More information

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute. Introduction Compartment Syndromes of the Leg Related to Athletic Activity Mark M. Casillas, M.D. Consequences of a misdiagnosis persistence of a performance limitation loss of function/compartment loss

More information

Practical Point in Holistic Diabetic Foot Care 3 March 2016

Practical Point in Holistic Diabetic Foot Care 3 March 2016 Diabetic Foot Ulcer : Vascular Management Practical Point in Holistic Diabetic Foot Care 3 March 2016 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai

More information

Vascular Surgery Cases: Detours. Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists

Vascular Surgery Cases: Detours. Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists Vascular Surgery Cases: Detours Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists Brian.Stull@Unchealth.unc.edu Objectives Anatomy of a bypass graft Where does it connect, where does it

More information

Non-invasive examination

Non-invasive examination Non-invasive examination Segmental pressure and Ankle-Brachial Index (ABI) The segmental blood pressure (SBP) examination is a simple, noninvasive method for diagnosing and localizing arterial disease.

More information

Resident Teaching Conference 3/12/2010

Resident Teaching Conference 3/12/2010 Resident Teaching Conference 3/12/2010 Goals Definition and Classification of Acute Limb Ischemia Clinical Assessment of the Vascular Patient History and Physical Diagnostic Modalities Management of Acute

More information

Peripheral Vascular Disease

Peripheral Vascular Disease Peripheral artery disease (PAD) results from the buildup of plaque (atherosclerosis) in the arteries of the legs. For people with PAD, symptoms may be mild, requiring no treatment except modification of

More information

Fluorescence Angiography in Limb Salvage

Fluorescence Angiography in Limb Salvage Fluorescence Angiography in Limb Salvage Ryan H. Fitzgerald, DPM, FACFAS Associate Professor of Surgery-University Of South Carolina School of Medicine, Greenville Etiology of Lower extremity wounds Neuropathy

More information

VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT

VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT Lucy Stopher, A/CNS Vascular Surgery ...it is best to think of a wound not as a disease, but rather as a manifestation of disease. Joe McCulloch In order

More information

Current Status of Endovascular Therapies for Critical Limb Ischemia

Current Status of Endovascular Therapies for Critical Limb Ischemia Current Status of Endovascular Therapies for Critical Limb Ischemia Bulent Arslan, MD Associate Professor of Radiology Director, Vascular & Interventional Radiology Rush University Medical Center bulent_arslan@rush.edu

More information

John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division

John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,

More information

Access strategy for chronic total occlusions (CTOs) is crucial

Access strategy for chronic total occlusions (CTOs) is crucial Learn How Access Strategy Impacts Complex CTO Crossing Arthur C. Lee, MD The Cardiac & Vascular Institute, Gainesville, Florida VASCULAR DISEASE MANAGEMENT 2018;15(3):E19-E23. Key words: chronic total

More information

National Vascular Registry

National Vascular Registry National Vascular Registry Bypass Patient Details Patient Consent* 2 Not Required If patient not consented: Date consent recorded / / (DD/MM/YYYY) Do not record NHS number, NHS number* name(s) or postcode.

More information

Acute arterial thrombosis associated with total knee arthroplasty

Acute arterial thrombosis associated with total knee arthroplasty Acute arterial thrombosis associated with total knee arthroplasty Keith D. Calligaro, MD, Dominic A. DeLaurentis, MD, Robert E. Booth, MD, Richard H. Rothman, MD, Ronald P. Savarese, MD, and Matthew J.

More information

Surgical Options for revascularisation P E T E R S U B R A M A N I A M

Surgical Options for revascularisation P E T E R S U B R A M A N I A M Surgical Options for revascularisation P E T E R S U B R A M A N I A M The goal Treat pain Heal ulcer Preserve limb Preserve life The options Conservative Endovascular Surgical bypass Primary amputation

More information

FLORIDA MEDICARE PART B LOCAL MEDICAL REVIEW POLICY

FLORIDA MEDICARE PART B LOCAL MEDICAL REVIEW POLICY FLORIDA MEDICARE PART B LOCAL MEDICAL REVIEW POLICY CPT/HCPCS Codes 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study 93926 unilateral or limited study Policy

More information

Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC

Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC Interventional Cardiologist/Endovascular Specialist Bradenton Cardiology Center Bradenton,

More information

LIMB SALVAGE IN THE DIABETIC PATIENT

LIMB SALVAGE IN THE DIABETIC PATIENT LIMB SALVAGE IN THE DIABETIC PATIENT WHO? HOW? BEST? DISCLOSURES Educational grant from Cook Inc OBJECTIVES Review risk stratification and staging schemes for the threatened limb Discuss current concepts

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Abscesses, 27 30 Acellular products, for bone healing, 55 56 Acetaminophen, 79 80 Achilles tendon lengthening, for pediatric flatfoot,

More information

Vasile Goldiş Western University of Arad Faculty of Medicine, Pharmacy and Dental Medicine, Arad, Romania

Vasile Goldiş Western University of Arad Faculty of Medicine, Pharmacy and Dental Medicine, Arad, Romania ENDOVASCULAR TREATMENT FOR VASCULAR GRAFT RESTENOSIS Bogdan Totolici 1, Francisca Blanca Călinescu 1*, Ionel Droc 2, Carmen Neamţu 1 1 Vasile Goldiş Western University of Arad Faculty of Medicine, Pharmacy

More information

Versatility of Reverse Sural Artery Flap for Heel Reconstruction

Versatility of Reverse Sural Artery Flap for Heel Reconstruction ORIGINAL ARTICLE Introduction: The heel has two parts, weight bearing and non-weight bearing part. Soft tissue heel reconstruction has been a challenge due to its complex nature of anatomy, weight bearing

More information

The Burden of CLI and Crosser Catheter Recanalization Strategies

The Burden of CLI and Crosser Catheter Recanalization Strategies , LLC an HMP Communications Holdings Company November 2013 Volume 25/ Supplement D www.invasivecardiology.com The Official Journal of the International Andreas Gruentzig Society The Burden of CLI and Crosser

More information

Peripheral arterial disease for primary care Ed Aboian, MD

Peripheral arterial disease for primary care Ed Aboian, MD Peripheral arterial disease for primary care Ed Aboian, MD Division of Vascular and Endovascular Surgery Palo Alto Medical Foundation, Burlingame Ca Disclosures Nothing to disclose Clinical presentation

More information

Root Cause Analysis for nontraumatic

Root Cause Analysis for nontraumatic Root Cause Analysis for nontraumatic amputations 2016 (Full Data) Date Richard Leigh and Stella Vig, Co-Chairs London SCN Footcare Network October 2015 Outline of London RCA 2016 London Hospitals invited

More information

Endovascular Should Be Considered First Line Therapy

Endovascular Should Be Considered First Line Therapy Revascularization of Patients with Critical Limb Ischemia Endovascular Should Be Considered First Line Therapy Michael Conte David Dawson David L. Dawson, MD Revised Presentation Title A Selective Approach

More information

Popliteal-to-distal bypass for limb-threatening ischemia

Popliteal-to-distal bypass for limb-threatening ischemia Popliteal-to-distal bypass for limb-threatening ischemia Jeffrey Marks, MD, Terry A, King, MD, Henry Baele, MD, Jeffrey Rubin, MD, and Cynthia Marmen, RN, Cleveland, Ohio In a subset of patients requiring

More information

Intended Learning Outcomes

Intended Learning Outcomes 2011 Acute Limb Ischemia Definition, Etiology & Pathophysiology Clinical Evaluation Management Ali SABBOUR Prof. of Vascular Surgery, Ain Shams University Acute Limb Ischemia Intended Learning Outcomes

More information

Definitions and criteria

Definitions and criteria Several disciplines are involved in the management of diabetic foot disease and having a common vocabulary is essential for clear communication. Thus, based on a review of the literature, the IWGDF has

More information

Global Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care

Global Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care Global Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care Michael S. Conte MD Professor and Chief, Division of Vascular and Endovascular

More information

Limb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017

Limb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Limb Salvage in Diabetic Ischemic Foot Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Case Male 67 years old Underlying DM, HTN, TVD Present with gangrene

More information

CASE REPORT Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion

CASE REPORT Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion CASE REPORT Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion Julien Pauchot, MD, PhD, a Emilie Ducroux, MD, b Grégoire Leclerc, MD, a Laurent Obert,

More information

Recommendations for Follow-up After Vascular Surgery Arterial Procedures SVS Practice Guidelines

Recommendations for Follow-up After Vascular Surgery Arterial Procedures SVS Practice Guidelines Recommendations for Follow-up After Vascular Surgery Arterial Procedures 2018 SVS Practice Guidelines vsweb.org/svsguidelines About the guidelines Published in the July 2018 issue of Journal of Vascular

More information

Practical Point in Diabetic Foot Care 3-4 July 2017

Practical Point in Diabetic Foot Care 3-4 July 2017 Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University

More information

Due to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice.

Due to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice. A summary Disclaimer The information contained in this document is intended to provide general information only. It is not intended to be, nor does it constitute, medical advice. Under no circumstances

More information

PAD and CRITICAL LIMB ISCHEMIA: EVALUATION AND TREATMENT 2014

PAD and CRITICAL LIMB ISCHEMIA: EVALUATION AND TREATMENT 2014 PAD and CRITICAL LIMB ISCHEMIA: EVALUATION AND TREATMENT 2014 Van Crisco, MD, FACC, FSCAI First Coast Heart and Vascular Center, PLLC Jacksonville, FL 678-313-6695 Conflict of Interest Bayer Healthcare

More information

Amputations of the digit, ray and midfoot

Amputations of the digit, ray and midfoot Amputations of the digit, ray and midfoot Dane K. Wukich M.D. Chief, Division of Foot and Ankle Surgery Medical Director, UPMC Foot and Ankle Center University of Pittsburgh School of Medicine Disclosure

More information

National Vascular Registry

National Vascular Registry National Vascular Registry Angioplasty Patient Details Patient Consent* 2 Not Required If patient not consented: Date consent recorded / / (DD/MM/YYYY) Do not record NHS number, NHS number* name(s) or

More information

Indications: following: embolization. artery that has diseases 5. The evaluation. of suspected. such entities. a cold hand. biopsy

Indications: following: embolization. artery that has diseases 5. The evaluation. of suspected. such entities. a cold hand. biopsy Peripheral Arterial Ultrasound Protocol Using Color and Spectral Doppler Reviewed by: Mark Yuhasz, MD Last Review Date: January 2015 Contact: (866) 761 4200, Option 1 Indications: The indications for peripheral

More information

Case study: A targeted approach to healing complex wounds using the geko device.

Case study: A targeted approach to healing complex wounds using the geko device. Case study: A targeted approach to healing complex wounds using the geko device. Authors: Mr Sameh Dimitri Consultant Vascular and Endovascular Surgeon MSc FRCS (Eng Edin) Nikki Pavey Physiotherapist at

More information

Fluorescent Angiography: Practical uses in the Clinical Setting

Fluorescent Angiography: Practical uses in the Clinical Setting Fluorescent Angiography: Practical uses in the Clinical Setting Charles Andersen MD, FACS, MAPWCA Chief Vascular/Endovascular/ Limb Preservation Surgery Service (Emeritus) Chief of Wound Care Service Madigan

More information

Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI?

Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI? Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI? Peter F. Lawrence, M.D. Gonda Vascular Center Division of Vascular Surgery

More information

Limb Salvage Achieved by Paramalleolar Bypass with Topical Treatment

Limb Salvage Achieved by Paramalleolar Bypass with Topical Treatment 14 83 89 2005 Limb Salvage Achieved by Paramalleolar Bypass with Topical Treatment Nobuyoshi Azuma, Masashi Inaba, Nobuyuki Akasaka, Masae Haga, Kazutomo Goh, Yumi Sasajima, Can C Erdem and Tadahiro Sasajima

More information

Imaging Strategy For Claudication

Imaging Strategy For Claudication Who are the Debators? Imaging Strategy For Claudication Duplex Ultrasound Alone is Adequate to Select Patients for Endovascular Intervention - Pro: Dennis Bandyk MD No Disclosures PRO - Vascular Surgeon

More information

Role Of Reverse Sural Artery Flap In Ankle, Foot And Leg Defects

Role Of Reverse Sural Artery Flap In Ankle, Foot And Leg Defects IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 5 Ver. VIII (May. 2016), PP 64-68 www.iosrjournals.org Role Of Reverse Sural Artery Flap In

More information

Clinical teaching/experi ence. Lectures/semina rs/conferences Self-directed. learning. Clinical teaching/experi ence

Clinical teaching/experi ence. Lectures/semina rs/conferences Self-directed. learning. Clinical teaching/experi ence Regional Medical Center (The MED) Plastic Surgery PGY-3 By the end of the Plastic Surgery at the MED, the PGY-3 residents are expected to expand and cultivate knowledge and skills developed during previous

More information

Peripheral Artery Disease Interventions Utilizing the Angiosomal Approach to the Complex Wound

Peripheral Artery Disease Interventions Utilizing the Angiosomal Approach to the Complex Wound Peripheral Artery Disease Interventions Utilizing the Angiosomal Approach to the Complex Wound Craig M. Walker, MD, FACC, FACP Chairman, New Cardiovascular Horizons Clinical Professor of Medicine Tulane

More information

Vascular Surgery Rotation Objectives for Junior Residents (PGY-1 and 2)

Vascular Surgery Rotation Objectives for Junior Residents (PGY-1 and 2) Vascular Surgery Rotation Objectives for Junior Residents (PGY-1 and 2) Definition Vascular surgery is the specialty concerned with the diagnosis and management of congenital and acquired diseases of the

More information

Acute arterial complications associated with total hip and knee arthroplasty

Acute arterial complications associated with total hip and knee arthroplasty From the Eastern Vascular Society Acute arterial complications associated with total hip and knee arthroplasty Keith D. Calligaro, MD, a Matthew J. Dougherty, MD, a Sean Ryan, MD, a and Robert E. Booth,

More information

Lower Extremity Artery: Physiologic Testing

Lower Extremity Artery: Physiologic Testing Master Title Ultrasound for Initial Evaluation of Lower Extremity Arterial Occlusive Disease: WHY? Gregory L. Moneta MD Professor and Chief Knight Cardiovascular Institute Division of Vascular Surgery

More information

BC Vascular Surgery Day

BC Vascular Surgery Day BC Vascular Surgery Day November 4, 2017 1 Table of Contents Abdominal Aortic Aneurysm 3 4 Acute DVT 5 6 Peripheral Arterial Disease 7 9 Varicose Veins 10 11 Diabetic Foot Ulcers 12 13 Carotid Stenosis

More information

Case Discussion. Disclosures. Critical Limb Ischemia: A Selective Approach to Revascularization Works Best 4/28/2012. None. 58 yo M, DM, CAD, HTN

Case Discussion. Disclosures. Critical Limb Ischemia: A Selective Approach to Revascularization Works Best 4/28/2012. None. 58 yo M, DM, CAD, HTN Critical Limb Ischemia: A Selective Approach to Revascularization Works Best None Disclosures Michael S. Conte MD, FACS Division of Vascular and Endovascular Surgery Co-Director, Heart and Vascular Center

More information

Popliteal Aneurysm: When is surgical therapy indicated? PROF. GRZEGORZ OSZKINIS

Popliteal Aneurysm: When is surgical therapy indicated? PROF. GRZEGORZ OSZKINIS Popliteal Aneurysm: When is surgical therapy indicated? PROF. GRZEGORZ OSZKINIS Asymptomatic mass - 38-40%will develop symptoms at a rate of 14%/yr Intermittent claudic ation (chronic ischemia) - 25%-40%

More information

Traumatic Posterior Tibial Pseudoaneursym: A rare late complication repaired conventionally

Traumatic Posterior Tibial Pseudoaneursym: A rare late complication repaired conventionally Volume 2 Issue 3 Article 3 2016 Traumatic Posterior Tibial Pseudoaneursym: A rare late complication repaired conventionally Farzad Amiri, MD; Zachary Sanford; and Constantinous Constantinou, MD Follow

More information

Disclosures. Talking Points. An initial strategy of open bypass is better for some CLI patients, and we can define who they are

Disclosures. Talking Points. An initial strategy of open bypass is better for some CLI patients, and we can define who they are An initial strategy of open bypass is better for some CLI patients, and we can define who they are Fadi Saab, MD, FASE, FACC, FSCAI Metro Heart & Vascular Metro Health Hospital, Wyoming, MI Assistant Clinical

More information

Vascular Injuries. Chapter 27

Vascular Injuries. Chapter 27 Vascular Injuries Chapter 27 Vascular Injuries Introduction History. ο World War II: Popliteal artery injuries were routinely ligated with a 73% amputation rate. ο Korean War: Formal repair of peripheral

More information

Disclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium

Disclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium Disclosures Vascular Testing in the CLI Patient None 2015 UCSF Vascular Symposium Warren Gasper, MD Assistant Professor of Surgery UCSF Division of Vascular Surgery Critical Limb Ischemia Chronic Limb

More information

Francisco Acín, César Varela, Ignacio López de Maturana, Joaquín de Haro, Silvia Bleda, and Javier Rodriguez-Padilla

Francisco Acín, César Varela, Ignacio López de Maturana, Joaquín de Haro, Silvia Bleda, and Javier Rodriguez-Padilla International Journal of Vascular Medicine, Article ID 27539, 13 pages http://dx.doi.org/1.1155/214/27539 Clinical Study Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients

More information

Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps

Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps e50 Case Report THIEME Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps Shuhei Yoshida, MD 1 Isao Koshima, MD 1 Shogo Nagamatsu, MD 2 Kazunori Yokota, MD 2 Shuji Yamashita,

More information

Popliteal Artery Occlusion After Total Knee Replacement: A Vascular Team Approach for Limb Salvage

Popliteal Artery Occlusion After Total Knee Replacement: A Vascular Team Approach for Limb Salvage ASE REPORT Popliteal Artery Occlusion After Total Knee Replacement: A Vascular Team Approach for Limb Salvage Sohail Khan, MD; Hamid Salam, MD; John Kessels, MD From St. Tammany Parish Hospital, ovington,

More information

Nanogen Aktiv. Naz Wahab MD, FAAFP, FAPWCA Nexderma

Nanogen Aktiv. Naz Wahab MD, FAAFP, FAPWCA Nexderma Nanogen Aktiv Naz Wahab MD, FAAFP, FAPWCA Nexderma Patient BM 75 y.o female with a history of Type 2 Diabetes, HTN, Hypercholesterolemia, Renal insufficiency, Chronic back Pain, who had undergone a L3-L4

More information

Critical Limb Ischemia: Diagnosis and Current Management

Critical Limb Ischemia: Diagnosis and Current Management Research Article Joseph Karam, MD Elliot J. Stephenson, MD From: Minneapolis Heart Institutet at Abbott Northwestern Hospital, Minneapolis, MN Address for correspondence: Joseph Karam, MD Minneapolis Heart

More information

Introduction. Risk factors of PVD 5/8/2017

Introduction. Risk factors of PVD 5/8/2017 PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental

More information

NCVH. What's New on the Vascular Horizons? Craig M. Walker, MD, FACC, FACP. New Cardiovascular Horizons

NCVH. What's New on the Vascular Horizons? Craig M. Walker, MD, FACC, FACP. New Cardiovascular Horizons What's New on the Vascular Horizons? NCVH New Cardiovascular Horizons KNOW YOUR OPTIONS Craig M. Walker, MD, FACC, FACP Clinical Professor of Medicine Tulane University School of Medicine New Orleans,

More information

Acute Limb Ischemia. R. J. Guzman M. J. Osgood 10/7/11

Acute Limb Ischemia. R. J. Guzman M. J. Osgood 10/7/11 Acute Limb Ischemia R. J. Guzman M. J. Osgood 10/7/11 Outline Etiologies Classification Presentation Workup/diagnosis Management Outcomes Etiologies Embolic Thrombotic Bypass Graft Occlusion Trauma Iatrogenic

More information

Case Report Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

Case Report Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair Case Reports in Orthopedics, Article ID 502657, 4 pages http://dx.doi.org/10.1155/2014/502657 Case Report Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated

More information

Patient Brochure. Clearstream Technologies, Ltd. Moyne Upper Enniscorthy Co. Wexford, Ireland. PK Rev. 0 05/17

Patient Brochure. Clearstream Technologies, Ltd. Moyne Upper Enniscorthy Co. Wexford, Ireland. PK Rev. 0 05/17 Patient Brochure Clearstream Technologies, Ltd. Moyne Upper Enniscorthy Co. Wexford, Ireland PK1411100 Rev. 0 05/17 LIFESTREAM Patient Brochure If you or a member of your family has been diagnosed with

More information

Keisuke Miyake 1,2, Shinsuke Kikuchi 1, Hiroko Okuda 1, Atsuhiro Koya 1, Satomi Abe 3, Yoshiki Sawa 2, Tetsuo Ota 4 and Nobuyoshi Azuma 1*

Keisuke Miyake 1,2, Shinsuke Kikuchi 1, Hiroko Okuda 1, Atsuhiro Koya 1, Satomi Abe 3, Yoshiki Sawa 2, Tetsuo Ota 4 and Nobuyoshi Azuma 1* Miyake et al. Surgical Case Reports (2018) 4:40 https://doi.org/10.1186/s40792-018-0449-9 CASE REPORT Open Access Successful limb salvage through staged bypass combined with free gracilis muscle transfer

More information

THE popliteal artery is the second most common site of aneurysm. The

THE popliteal artery is the second most common site of aneurysm. The POPLITEAL ANEURYSM Treatment by Vein Graft: Case Report A. W. HUMPHRIES, M.D. Department of Orthopedic Surgery F. A. LeFEVRE, M.D. and V. G. dewolfe, M.D. Department of Cardiovascular Disease THE popliteal

More information

I have no financial interests to disclose in regards to this lecture.

I have no financial interests to disclose in regards to this lecture. Evaluation and Treatment of Diabetic Foot Ulcerations John M. Giurini, D.P.M. Associate Professor in Surgery Harvard Medical School Disclosure Statement I have no financial interests to disclose in regards

More information

GLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE

GLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE GLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE Michael S. Conte MD Professor and Chief, Vascular and Endovascular Surgery Co-Director, Center for Limb Preservation Co-Director, Heart and Vascular

More information

PERONEAL ARTERY FOLLOWING ANKLE FRACTURE.

PERONEAL ARTERY FOLLOWING ANKLE FRACTURE. TRAUMATIC ANEURYSM OF THE PERFORATING PERONEAL ARTERY FOLLOWING ANKLE FRACTURE. V.S.Pai MS(Orth), MCh(Orth). J FOOT & ANKLE SURG 36: 417-420,1999 ABSTRACT This report describes a case of traumatic aneurysm

More information

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 6/30/2012 Radiology Quiz of the Week # 79 Page 1 CLINICAL PRESENTATION AND RADIOLOGY

More information

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved. Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of June 4, 2018 Thrombolysis, Thrombectomy & Angioplasty

More information

BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8

BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8 BC Vascular Day Contents Abdominal Aortic Aneurysm 2 3 November 3, 2018 Peripheral Arterial Disease 4 6 Deep Venous Thrombosis 7 8 Abdominal Aortic Aneurysm Conservative Management Risk factor modification

More information

Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage

Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage Shareef Jandali, MD, and David W. Low, MD Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia Correspondence:

More information

Perfusion Assessment in Chronic Wounds

Perfusion Assessment in Chronic Wounds Perfusion Assessment in Chronic Wounds American Society of Podiatric Surgeons Surgical Conference September 22, 2018 Michael Maier, DPM, FACCWS Cardiovascular Medicine Cleveland Clinic Disclosures Speaker,

More information

A A U

A A U PVD Venous AUC Rating Sheet 2nd Round 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Median I NI MADM Rating Agree Disagree Upper Extremity Venous Evaluation Table 1. Venous Duplex of the Upper Extremities for Patency

More information

Distal By-Pass procedures can reduce limb loss

Distal By-Pass procedures can reduce limb loss Conventional treatment of the diabetic foot Distal By-Pass procedures can reduce limb loss Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department of Surgery,

More information

Surgery is and Remains the Gold Standard for Limb-Threatening Ischemia

Surgery is and Remains the Gold Standard for Limb-Threatening Ischemia Surgery is and Remains the Gold Standard for Limb-Threatening Ischemia Albeir Mousa, MD., FACS.,MPH., MBA Professor of Vascular and Endovascular Surgery West Virginia University Disclosure None What you

More information

Salvaging the Unsalvageable: Intermittent Pneumatic Compression and Foot Ulcer Healing. Revascularize (when possible)

Salvaging the Unsalvageable: Intermittent Pneumatic Compression and Foot Ulcer Healing. Revascularize (when possible) Salvaging the Unsalvageable: Intermittent Pneumatic Compression and Foot Ulcer Healing Thom Rooke, MD Thom Krehbiel Professor of Vascular Medicine Mayo Clinic Approach to the Severely Ischemic Limb Identify

More information

Approach to the Patient with (suspected) Arterial Insufficiency Related Ulceration

Approach to the Patient with (suspected) Arterial Insufficiency Related Ulceration Approach to the Patient with (suspected) Arterial Insufficiency Related Ulceration Elisa C. Taffe, MD, CWSP Vascular Medicine Medical Director Allegheny General Advanced Wound Healing and Lymphedema Center

More information

Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship

Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship CLINICAL PROBLEMS IN VASCULAR SURGERY 1. ABDOMINAL AORTIC ANEURYSM A 70 year old man presents in the emergency department with

More information

REPLANTATION OF POST-TRAUMATIC LOWER LIMB AMPUTATION

REPLANTATION OF POST-TRAUMATIC LOWER LIMB AMPUTATION Int. J. Pharm. Med. & Bio. Sc. 2014 Sanjitsingh R Sulhyan et al., 2014 Research Paper ISSN 2278 5221 www.ijpmbs.com Vol. 3, No. 1, January 2014 2014 IJPMBS. All Rights Reserved REPLANTATION OF POST-TRAUMATIC

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Abscess, with diabetic foot ulcers, 472 Achilles tendon, in calcanectomy, for osteomyelitis, 473, 483 in calcaneus anatomy, 477 478 in Syme

More information

Infected Lower Extremity Aneurysms C. Stefan Kénel-Pierre, MD

Infected Lower Extremity Aneurysms C. Stefan Kénel-Pierre, MD Infected Lower Extremity Aneurysms C. Stefan Kénel-Pierre, MD University Hospital of Brooklyn Department of Surgery History 52F c PMHx of HTN, asthma p/w fever, malaise s/p one week of ABx for presumed

More information

Disclosures. Tips and Tricks for Tibial Intervention. Tibial intervention overview

Disclosures. Tips and Tricks for Tibial Intervention. Tibial intervention overview Tips and Tricks for Tibial Intervention Donald L. Jacobs, MD C Rollins Hanlon Endowed Professor and Chair Chair of Surgery Saint Louis University SSM-STL Saint Louis University Hospital Disclosures Abbott

More information