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Clinical Management of Limb Ischemia
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Clinical Management of Limb Ischemia

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 (20 April 2023) | Viewed by 7242

Special Issue Editor

Prof. Dr. Eugenio Martelli

E-Mail Website
Guest Editor
1. Department of General and Specialist Surgery "Paride Stefanini", Sapienza University of Rome, Rome, Italy
2. Saint Camillus International University of Health Sciences, Rome, Italy
3. Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, Caserta, Italy
Interests: chronic limb-threatening ischemia; diabetic foot; acute lower limb ischemia; thoracic endovascular aneurysm repair; endovascular aneurysm repair; abdominal aortic aneurysm repair; carotid endarterectomy; carotid stenting
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Patients with limb ischemia are the most symptomatic in the vascular scenario, so are limited in their daily activity and suffer from incoercible pain, discomfort, and restless nights. Still, their poor condition seems to be faced by most vascular specialists with a sense of resigned disenchantment, likely because of the complex treatment these patients sometime should undergo, and their poor prognosis. Furthermore, there seems to be a diffuse but wrong opinion that limb loss is not correlated with death. Therefore, limb salvage still looks like a second class procedure, at least compared to other vascular operations, surely more exciting in the short term. The aim is to avoid a major amputation, focusing on some concepts we should deal with when facing a patient with limb ischemia.

Prof. Dr. Eugenio Martelli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral arterial disease
  • chronic limb-threatening ischemia
  • diabetic foot
  • acute limb ischemia
  • popliteal artery aneurysm
  • limb salvage
  • minor amputation
  • major amputation

Published Papers (4 papers)

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Research

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16 pages, 1832 KiB  
Article
Impact of Optimal Medical Therapy on Reintervention and Survival Rates after Endovascular Infrapopliteal Revascularization
by Tim Wittig, Toni Pflug, Andrej Schmidt, Dierk Scheinert and Sabine Steiner
J. Clin. Med. 2023, 12(15), 5146; https://doi.org/10.3390/jcm12155146 - 06 Aug 2023
Cited by 1 | Viewed by 873
Abstract
Within this single-center cohort study, we investigated the impact of optimal medical therapy on all-cause mortality, major amputation-free survival and clinically driven target lesion revascularization (CD TLR) in 552 patients with peripheral arterial disease (PAD) undergoing endovascular infrapopliteal revascularization. From the overall cohort, [...] Read more.
Within this single-center cohort study, we investigated the impact of optimal medical therapy on all-cause mortality, major amputation-free survival and clinically driven target lesion revascularization (CD TLR) in 552 patients with peripheral arterial disease (PAD) undergoing endovascular infrapopliteal revascularization. From the overall cohort, 145 patients were treated for intermittent claudication (IC) and 407 were treated for critical limb ischemia (CLI). Optimal medical therapy (OMT) was defined as the presence of at least one antiplatelet agent, statin and ACE inhibitor or AT-2 antagonist based on guideline recommendations. About half (55.5%) of all patients were prescribed OMT at discharge, with a higher proportion in claudicants (62.1%) versus CLI patients (53.2%). Over three years of follow-up, survival was significantly better in patients with IC (80.6 ± 3.8% vs. 59.9 ± 2.9%; p < 0.001). There was a signal towards better survival in those patients receiving OMT (log-rank p = 0.09). Similarly, amputation-free survival (AFS) was significantly better in patients with IC (p = 0.004) and also in patients receiving OMT (78.8 ± 3.6%) compared to that in those without OMT (71.5 ± 4.2%; p = 0.046). Freedom from CD TLR within three years was significantly better in the IC group (p = 0.002), but there were no statistically significant differences for CD TLR dependent on the presence of OMT (p = 0.79). In conclusion, there is still an important underuse of OMT in patients undergoing infrapopliteal interventions, which is even more pronounced in CLI despite a signal for its benefit regarding all-cause mortality and major amputation-free survival. Full article
(This article belongs to the Special Issue Clinical Management of Limb Ischemia)
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Review

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24 pages, 1151 KiB  
Review
Focus on the Prevention of Acute Limb Ischemia: Centrality of the General Practitioner from the Point of View of the Internist
by Iolanda Enea and Eugenio Martelli
J. Clin. Med. 2023, 12(11), 3652; https://doi.org/10.3390/jcm12113652 - 24 May 2023
Viewed by 1744
Abstract
The thrombotic mechanism, being common to peripheral arterial disease (PAD), acute myocardial infarction (AMI), and stroke, is responsible for the highest number of deaths in the western world. However, while much has been done for the prevention, early diagnosis, therapy of AMI and [...] Read more.
The thrombotic mechanism, being common to peripheral arterial disease (PAD), acute myocardial infarction (AMI), and stroke, is responsible for the highest number of deaths in the western world. However, while much has been done for the prevention, early diagnosis, therapy of AMI and stroke, the same cannot be said for PAD, which is a negative prognostic indicator for cardiovascular death. Acute limb ischemia (ALI) and chronic limb ischemia (CLI) are the most severe manifestations of PAD. They both are defined by the presence of PAD, rest pain, gangrene, or ulceration and we consider ALI if symptoms last less than 2 weeks and CLI if they last more than 2 weeks. The most frequent causes are certainly atherosclerotic and embolic mechanisms and, to a lesser extent, traumatic or surgical mechanisms. From a pathophysiological point of view, atherosclerotic, thromboembolic, inflammatory mechanisms are implicated. ALI is a medical emergency that puts both limb and the patient’s life at risk. In patients over age 80 undergoing surgery, mortality remains high reaching approximately 40% as well as amputation approximately 11%. The purpose of this paper is to summarize the scientific evidence on the possibilities of primary and secondary prevention of ALI and to raise awareness among doctors involved in the management of ALI, in particular by describing the central role of the general practitioner. Full article
(This article belongs to the Special Issue Clinical Management of Limb Ischemia)
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13 pages, 288 KiB  
Review
The Ability to Look Beyond: The Treatment of Peripheral Arterial Disease
by Pasqualino Sirignano, Costanza Margheritini, Federica Ruggiero, Claudia Panzano, Federico Filippi, Luigi Rizzo and Maurizio Taurino
J. Clin. Med. 2023, 12(9), 3073; https://doi.org/10.3390/jcm12093073 - 23 Apr 2023
Viewed by 1277
Abstract
This paper offers a practical overview of the contemporary management of patients with peripheral arterial disease presenting intermittent claudication (IC), including clinical and instrumental diagnosis, risk factors modification, medical management, and evidence-based revascularization indications and techniques. Decision making represents a crucial element in [...] Read more.
This paper offers a practical overview of the contemporary management of patients with peripheral arterial disease presenting intermittent claudication (IC), including clinical and instrumental diagnosis, risk factors modification, medical management, and evidence-based revascularization indications and techniques. Decision making represents a crucial element in the management of the patient with IC; for this, we think a review of this type could be very useful, especially for non-vascular specialists. Full article
(This article belongs to the Special Issue Clinical Management of Limb Ischemia)
16 pages, 2204 KiB  
Review
Chronic Limb-Threatening Ischemia and the Need for Revascularization
by Raffaella Berchiolli, Giulia Bertagna, Daniele Adami, Francesco Canovaro, Lorenzo Torri and Nicola Troisi
J. Clin. Med. 2023, 12(7), 2682; https://doi.org/10.3390/jcm12072682 - 04 Apr 2023
Cited by 4 | Viewed by 2928
Abstract
Background: Patients presenting with critical limb-threatening ischemia (CLTI) have been increasing in number over the years. They represent a high-risk population, especially in terms of major amputation and mortality. Despite multiple guidelines concerning their management, it continues to be challenging. Decision-making between surgical [...] Read more.
Background: Patients presenting with critical limb-threatening ischemia (CLTI) have been increasing in number over the years. They represent a high-risk population, especially in terms of major amputation and mortality. Despite multiple guidelines concerning their management, it continues to be challenging. Decision-making between surgical and endovascular procedures should be well established, but there is still a lack of consensus concerning the best treatment strategy. The aim of this manuscript is to offer an overview of the contemporary management of CLTI patients, with a focus on the concept that evidence-based revascularization (EBR) could help surgeons to provide more appropriate treatment, avoiding improper procedures, as well as too-high-risk ones. Methods: We performed a search on MEDLINE, Embase, and Scopus from 1 January 1995 to 31 December 2022 and reviewed Global and ESVS Guidelines. A total of 150 articles were screened, but only those of high quality were considered and included in a narrative synthesis. Results: Global Vascular Guidelines have improved and standardized the way to classify and manage CLTI patients with evidence-based revascularization (EBR). Nevertheless, considering that not all patients are suitable for revascularization, a key strategy could be to stratify unfit patients by considering both clinical and non-clinical risk factors, in accordance with the concept of individual residual risk for every patient. The recent BEST-CLI trial established the superiority of autologous vein bypass graft over endovascular therapy for the revascularization of CLTI patients. However, no-option CLTI patients still represent a critical issue. Conclusions: The surgeon’s experience and skillfulness are the cornerstones of treatment and of a multidisciplinary approach. The recent BEST-CLI trial established that open surgical peripheral vascular surgery could guarantee better outcomes than the less invasive endovascular approach. Full article
(This article belongs to the Special Issue Clinical Management of Limb Ischemia)
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