Critical Limb Ischemia: Current Challenges and Future Prospects

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (24 January 2024) | Viewed by 3132

Special Issue Editors


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Guest Editor
Department of Vascular and Endovascular Surgery, Research Vascular Centre, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
Interests: PAD; aortic aneurysms; atherectomy; lithotripsy; chimney technique

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Guest Editor
Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany
Interests: PAD; atherectomy; IVUS; lithotripsy
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Special Issue Information

Dear Colleagues,

Atherosclerotic peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI) represent major manifestations of cardiovascular diseases. More than 200 million individuals worldwide suffer from PAD, experiencing high morbidity and mortality rates despite modern pharmacologic treatment options. The associated costs are even higher than in patients experiencing stroke, as shown in recent population-based studies.

Recent innovations in endovascular treatment, such as thrombectomy, atherectomy, and lithotripsy, have created great opportunities to improve treatment algorithms in PAD and, possibly, patient-related outcomes. In addition, the role of biomarkers, which is well-established for the risk stratification of patients with cardiac diseases, is less known in patients with PAD. Thus, there are clear gaps in knowledge and a need for novel evidence-based treatment strategies both for patients with lifestyle limiting claudication and patients with CLTI, encompassing both endovascular and open-repair options.

This Special Issue aims to collect original articles and reviews investigating pathophysiologic, diagnostic, and therapeutic aspects related to the risk stratification and management of PAD patients.

Prof. Dr. Konstantinos P. Donas
Prof. Dr. Grigorios Korosoglou
Guest Editors

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Keywords

  • critical limb ischemia
  • PAD
  • atherectomy
  • lithotripsy
  • stent implantation
  • biomarkers

Published Papers (2 papers)

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Research

15 pages, 2144 KiB  
Article
Three-Year Real-World Outcomes of Interwoven Nitinol Supera Stent Implantation in Long and Complex Femoropopliteal Lesions
by Szymon Salamaga, Hubert Stępak, Mikołaj Żołyński, Jagoda Kaczmarek, Maciej Błaszyk, Michał-Goran Stanišić and Zbigniew Krasiński
J. Clin. Med. 2023, 12(14), 4869; https://doi.org/10.3390/jcm12144869 - 24 Jul 2023
Cited by 2 | Viewed by 1149
Abstract
Background: Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective in limb salvage. The Supera is able to withstand increased compression, [...] Read more.
Background: Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective in limb salvage. The Supera is able to withstand increased compression, biomechanical stress and to have higher radial force. The objective of this study is to evaluate performance, durability and 3-year patency of Supera stent implantation in severe femoropopliteal disease. Methods: A retrospective real-world analysis was performed with consideration of 77 patients that had a Supera stent implanted with femoropopliteal atherosclerotic disease at a single center. Among the 77 individuals, 92 Supera stents were implanted. Analysis of patients’ demographics, lesions characteristics, reintervention rates and patency rates was performed. Results: The median follow-up was 33 months and ranged from 0 to 84 months. Chronic limb-threatening ischemia was observed among 43 patients. Mean lesion length was 152.8 ± 94.6 mm. Chronic total occlusions were observed in a majority of lesions. Overall, primary patency rates at 6, 12, 24 and 36 months were 85.0%, 73.6%, 59.2% and 53.2%, respectively. Conclusions: The Supera stent is effective in the management of long and complex lesions. The results of patency rates were evaluated to be worse among lesions extending to the popliteal artery. Full article
(This article belongs to the Special Issue Critical Limb Ischemia: Current Challenges and Future Prospects)
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12 pages, 1313 KiB  
Article
Cardiac Troponins for the Clinical Management of Patients with Claudication and without Cardiac Symptoms
by Dimitrios Mouselimis, Saskia Hagstotz, Michael Lichtenberg, Konstantinos P. Donas, Ulrike Heinrich, Konstantinos Avranas, Zisis Dimitriadis, Erwin Blessing, Ralf Langhoff, Norbert Frey, Hugo A. Katus and Grigorios Korosoglou
J. Clin. Med. 2022, 11(24), 7287; https://doi.org/10.3390/jcm11247287 - 8 Dec 2022
Cited by 3 | Viewed by 1397
Abstract
Many patients with peripheral arterial disease (PAD) exhibit undiagnosed obstructive coronary artery disease. We aim to identify the patients with lifestyle limiting claudication due to PAD and without cardiac symptoms, requiring coronary revascularization based on high-sensitive troponin T (hsTnT) values. We assessed hsTnT [...] Read more.
Many patients with peripheral arterial disease (PAD) exhibit undiagnosed obstructive coronary artery disease. We aim to identify the patients with lifestyle limiting claudication due to PAD and without cardiac symptoms, requiring coronary revascularization based on high-sensitive troponin T (hsTnT) values. We assessed hsTnT in consecutive patients referred for elective endovascular treatment due to claudication [Rutherford categories (RC) 2 & 3] between January 2018 and December 2021. Diagnostic work-up by non-invasive imaging and, if required, cardiac catheterization was performed according to clinical data, ECG findings and baseline hsTnT. The occurrence of cardiac death, myocardial infarction or urgent revascularization during follow-up was the primary endpoint. Of 346 patients, 14 (4.0%) exhibited elevated hsTnT ≥ 14 ng/L, including 7 (2.0%) with acute myocardial injury by serial hsTnT sampling. Coronary revascularization by percutaneous coronary intervention was necessary in 6 of 332 (1.5%) patients with normal versus nine of 14 (64.3%) patients with elevated hsTnT (p < 0.001). During 2.4 ± 1.4 years of follow-up, 20 of 286 (7.0%) patients with normal versus four of 13 (30.8%) with elevated hsTnT at baseline reached the composite primary endpoint (p = 0.03 by log-rank test). In conclusion, elevated troponins in cardiac asymptomatic patients with claudication modify subsequent cardiac management and may increase the need for closer surveillance and more aggressive conservative management in polyvascular disease. Full article
(This article belongs to the Special Issue Critical Limb Ischemia: Current Challenges and Future Prospects)
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