Endovascular techniques for limb salvage in diabetics with crural and pedal disease.

Diabetics with critical limb ischemia (CLI) usually have significant multilevel arterial disease, very often with compromised outflow on the foot arteries. The combination of severe peripheral arterial occlusion with the increased blood flow requirement, necessary to achieve the healing of the skin lesions or surgical incisions, makes this population particularly challenging. Additionally, diabetics and CLI patients have a high rate of comorbities, that increase the surgical risks or contraindicate surgical by-pass. Since its initial applications, endovascular recanalization for tibial vessels and foot arteries has proven to be feasible and safe, especially in diabetics with CLI. Actually, it is an established treatment option for limb salvage, avoiding amputation in lot of cases and improving lesions healing. The development of new technologies, such as dedicated guidewire's or low profile catheter balloons helps the interventionists, but the knowledge of most important techniques could be indispensable to obtain the procedural success and clinical outcomes.

Paclitaxel-coated balloon angioplasty for lower extremity revascularization: a new way to fight in-stent restenosis.

In the last years the development of new techniques and technologies for the endovascular treatment of peripheral arterial occlusive disease has allowed to treat a vast array of lesions with high technical success and low complications. Despite these advances, restenosis, and in particular in-stent restenosis, is a problem that significantly affects middle and long-term results and remains to be solved. Drug-eluting balloons (DEB) have shown good results in the treatment of coronary in-stent restenosis in experimental and clinical trials, but only few experimental and clinical trials focus on the peripheral district. This review summarizes the available experimental and clinical data in support of DEB in the treatment of ISR in the peripheral district. Larger clinical trials focused on paclitaxel-coated balloon in the treatment of ISR in the peripheral arteries will be necessary to provide definitive evidence of clinical benefit.

Differential diagnosis between splenic nodules and peritoneal metastases with contrast-enhanced ultrasound based on signal-intensity characteristics during the late phase.

PURPOSE: This study was done to assess the enhancement characteristics of splenic implants and to evaluate whether contrast-enhanced ultrasound (CEUS) after SonoVue injection allows the differential diagnosis with peritoneal metastases. MATERIAL AND METHODS: Thirteen consecutive patients with splenosis and 13 consecutive patients with peritoneal metastases were investigated with CEUS after injection of 2.4 ml of SonoVue. Lesion enhancement was evaluated in real time for 240 s. All examinations were recorded digitally and analysed retrospectively. Frames were selected at different time intervals ranging from 0 to 4 min after injection. Average signal intensity was evaluated by measuring the average grey level in a region of interest encompassing the entire nodule. Results were evaluated using the Mann-Whitney test and interobserver variability using the Bland and Altmann method. RESULTS: Splenic grafts presented with intense enhancement and without significant washout. Metastases presented with variable enhancement and progressive washout. Signal intensity values were significantly higher for splenic grafts, starting from 40 s after microbubble administration. Starting from 90 s after injection, there was no overlapping between enhancement of splenic grafts and peritoneal metastases, and only splenic grafts showed a percent of enhancement higher than 60% of the maximum enhancement. CONCLUSIONS: CEUS after SonoVue injection may be considered a valuable alternative to scintigraphy for characterising peritoneal splenic grafts without radiation.