Current endovascular management of the ischaemic diabetic foot.

Ischaemic diabetic foot ulcers pose a significant problem which is associated with a high likelihood of amputation. With the advent of endovascular surgery, the management of lower limb arterial lesions in the diabetic population has become more appealing. Coronary 0.014 monorail guide wires, appropriate sized angioplasty balloons and stents, and subintimal recanalisation, are all useful adjuncts and techniques to achieve revascularization. This article reviews the modern endovascular management of the diabetic foot.

Current therapeutic options in the management of superficial femoral artery occlusive disease.

The management of superficial femoral artery occlusive disease remains challenging for vascular surgeons. Despite the advances and dramatic changes we have seen in modern practice with the development and introduction of new endovascular techniques, long-term results with these interventions remain disappointing when compared to the "gold standard" of a vein bypass with a good run-off. Furthermore, there is little Level 1 evidence to guide us with regards to the best treatment strategy. In this article, we review some of the currently available open surgical and endovascular options for the management of superficial femoral artery disease.

Endovascular treatment of popliteal artery aneurysms.

OBJECTIVE: To present the results of the endovascular treatment of popliteal artery aneurysms. METHODS: From April 1999 to January 2002, 11 patients, aged 40-94 years, with 12 popliteal aneurysms were treated. Nine (75%) underwent an endoluminal repair, of whom three were done emergently due to an aneurysm rupture. Aneurysm diameter was 28-105 (mean 69) mm. A Hemobahn stent graft was inserted in six, Wallgraft in two and Passager in one case. RESULTS: During a mean follow-up of 14 (3-31) months, four (44%) thromboses occurred: two in the early postoperative period (30 days) and two during the late postoperative period. Two of the four occluded grafts were successfully reopened, and in the one a stenosis of the distal end of the stent graft was treated with balloon dilatation. Patency rates at 1 and 12 months were 64/47% (primary patency) and 88/75% (secondary patency), respectively. CONCLUSION: Initial experience with endovascular treatment of the popliteal aneurysm in high-risk patients yielded modest results. Larger number of patients and further follow-up time is necessary to evaluate the long-term results.

Metabolic alterations of skeletal muscle tissue after prolonged acute ischemia and reperfusion.

Acute tissue ischemia is usually followed by considerable disturbances of cellular metabolism that often lead to cell death. Reperfusion improves cellular function by withdrawing the toxic products of ischemia and providing energy sources, although sometimes it worsens it. The purpose of this experimental work is to study the metabolic disturbances in skeletal muscle tissue of canines after prolonged acute ischemia in relation to the values of certain substances (ATP, lactate, pyruvate, the ratio of lactate to pyruvate [L/P], and glucose) and whether the alterations in the values of these substances could be used as prognostic indices of the magnitude of tissue damage and the possibility of inverting it. We used 15 mongrel dogs. Complete acute ischemia was induced in the right lower limb lasting 12 h. Reperfusion also lasted for 12 h. The left lower limb was used as reference value. Before the beginning of ischemia, at (1/2), 1, 6, and 12 h after the induction of ischemia, and at (1/2), 1, 6, and 12 h after the restoration of circulation, blood samples, and tissue biopsies were obtained from the healthy and the experimental limb for the measurement of ATP, lactate, pyruvate, the ratio of L/P, and glucose. From the statistical analysis of the values of the controlled parameters the following were concluded: The changes in ATP, lactate, pyruvate, and the L/P ratio in the venous blood of the experimental limb and in the intracellular space of the suffering skeletal muscle could be used as indices to evaluate ischemic injury to the skeletal muscles, the course of its development, and the possibility of reversal after reperfusion.