Peripheral Arterial Insufficiency Research Articles

Peripheral Arterial Insufficiency: A Comprehensive Review of Revascularization Surgery Benefits

Peripheral Arterial Insufficiency: A Comprehensive Review of Revascularization Surgery Benefits

A comparison in women with newly diagnosed diabetes between those with and without a history of gestational diabetes: a new perspective

AimsPrevious gestational diabetes mellitus (GDM) entails increased risk of future diabetes. We describe the characteristics of women with previous GDM and compare with no previous GDM from the cohort Diabetes in Kalmar and Kronoberg (DKK) of 1248 adults, 40% women, with new diabetes, and factors affecting age and C-peptide levels at diagnosis of diabetes.MethodsAge-at-diagnosis of diabetes, BMI, hypertension, hyperlipidemia, smoking, physical activity, and pre-existing myocardial infarction, stroke, or peripheral arterial insufficiency were registered at ordinary care visits close to diagnosis of diabetes, for the 43 women (9.4% of 456 from DKK with complete data for this analysis) with self-reported previous GDM (yes/no) and 86 controls without it, matched for date of diagnosis of diabetes. Blood samples were centrally analyzed for GADA and C-peptide for classification of diabetes.ResultsWomen with previous GDM had lower mean age-at-diagnosis of diabetes, 53.4 vs 65.0 years, lower systolic blood pressure (SBP), 131.2 vs 137.5 mmHg, and fewer had pre-existing hypertension than without previous GDM (p < 0.001–0.05). Among antibody negative women with previous GDM, BMI (p = 0.024), hypertension (p = 0.023) and hyperlipidemia (p < 0.001) were associated with higher levels of C-peptide, while physical activity was inversely associated (p = 0.035), and SBP (p = 0.02) and hypertension (p = 0.016) were associated with age-at-diagnosis of diabetes.ConclusionsWomen with previous GDM were a decade younger and had lower prevalence of hypertension at diagnosis of diabetes; C-peptide levels were associated with BMI, hypertension, and hyperlipidemia and showed a tendency to be lower, possibly indicating a phenotype with higher risk of overt cardiovascular disease later in life.

249. Evaluation of 99 Radiologically-proven Osteomyelitis Cases

BackgroundHerein we aimed to evaluate osteomyelitis cases in our setting.MethodsWe evaluated the hospital records of patients with osteomyelitis between January 2013 and December 2020 retrospectively. Osteomyelitis was confirmed by direct radiography or magnetic resonance imaging or pathology. Demographic features, risk factors, clinical/laboratory findings, treatment response and mortality rates were evaluated. Clinical response was defined as (resolution of clinical signs including fever and purulent discharge and other symptoms) and/or negative culture at the end of antimicrobial therapy.ResultsPatients were 33 female, aged 29–85 years (mean 59±12.6). Fourty nine of the patients were diabetic foot infection, 30 were spondylodiscitis, eight were primary, seven were post-traumatic, and five were post-surgical osteomyelitis. Overall 62 patients had diabetes mellitus and 16 patients had chronic renal failure. Peripheral arterial disease, neuropathy, diabetic retinopathy and venous insufficiency rate in the DM subgroup is shown in table. Fever was present in 24.2% of the cohort. İncreasing of CRP was in 95,9%, erythrocyte sedimentation rate in 83,9%, and leukocytosis in 37.3%. The radiological findings of osteomyelitis were detected via magnetic resonance imaging in 73 patients. Etiology in biopsy cultures were elucidated in 59.5% and the most common pathogen was S. aureus (30%) Table1. The most common empirical treatment regimens were tigecycline in 27 patients, ampicillin/sulbactam in 19 patients and ceftriaxone+teicoplanin in 12 cases. Duration of treatment was 36,2±17.3 days (range 6-104 days). Overall, clinical response was obtained in 91.9%. Fifty patients were performed surgical procedure + antibacterial treatment, clinical response was 96% (p:0.091). Surgical debridement could be performed in 22 patients, clinical response was obtained in all (p:0.193). Thirteen patients developed recurrence within one year. Sixty-seven patients received oral consecutive treatment after discharge. In hospital mortality rate was 2/99 (2,02%). ConclusionDespite surgical debridement and/or developed antimicrobial treatment, approximately 1/5 of osteomyelitis cases required further treatment Further interventions seem to be needed to reach better outcomes.Disclosures All Authors: No reported disclosures

Platelet Lysate and Non-Healing Ulcers

Platelet lysate contained a wide range of bioactive molecules involved in cell proliferation, migration. The paper analyzes the possibility of using platelet lysate for the treatment of non-healing ulcers. The levels of bioactive molecules were determined by ELISA in platelet lysate. Efficacy of treatment with platelet lysate patients with diabetic foot ulcers, ulcers in patients with peripheral arterial disease and venous insufficiency were analyzed on wound surface area, total epithelialization. Twice injection of platelet lysate with an interval of 5-7 days possess to wound surface area closure on Day 180 at 96% in patients with diabetic foot ulcers, while in patients with peripheral arterial disease and venous insufficiency ulcers wound closure was less. Platelet lysate from patients with non-healing ulcers contained growth factor, cytokine, components of the extracellular matrix, and nitric oxide. Between levels of bioactive molecules in platelet lysate and outcome were found significant correlation. The obtained results indicate that platelet lysate possesses wound healing activity.

A Doppler-based evaluation of peripheral lower limb arterial insufficiency in diabetes mellitus.

To determine the frequency, level and flow patterns of lower limb arterial insufficiency in diabetic patients on Doppler ultrasound study. Cross-sectional study. Radiology Department, Civil Hospital, Karachi, from February 2007 to September 2008. One hundred adult diabetic patients with suspected peripheral vascular insufficiency irrespective of gender were included. Demographic data, presenting complaints, treatment history, and level of HbA1c were recorded. Doppler evaluated arterial status and ankle brachial index (ABI) were recorded on proforma. Statical analysis were done on SPSS version 12. The mean HbA1c was 8.4+/-1.4 gm/dl, a majority of 77% having a controlled level of <10mg/dl. Arterial insufficiency on Doppler ultrasound was documented in 62% (p=0.016) and the dorsalis paedis artery was the predominant site of stenosis (24%). Spectral broadening and biphasic flow were salient features. The mean value of resistive index in stenotic cases was 0.563+/-0.16 with a mean velocity difference of 0.37+/-0.29 m/s (p<0.001) at the site of stenosis. Peripheral vascular insufficiency was a significant finding in patients having diabetes for an average of 9.8 years, even in the presence of controlled HbA1c. The dorsalis paedis was the commonest site of involvement. The insufficiency was moderate with a biphasic flow pattern in a majority of cases. Difference in resistive index and flow velocities at and above the site of stenosis provided an important clue to the diagnosis of level of stenosis that helps in planning limb salvage management.

Isokinetic strength and endurance in peripheral arterial insufficiency with intermittent claudication

Isokinetic plantar flexor peak torques (PT) and contractional work (CW) of the triceps surae muscle have been measured in 24 patients with peripheral arterial insufficiency and intermittent claudication and in 15 controls. Tests were performed both during non-fatiguing (30-180 degrees/s) and fatiguing (200 repeated plantar flexions at 60 degrees/s) conditions. The electromyographic signals (iEMG) from all three heads of the triceps surae were measured. The patients were significantly weaker (PT) and produced significantly less contractional work (CW) than the controls. In contrast, similar iEMGs of the triceps surae heads indicated similar levels of activation. At 40 contractions the majority of the patients had already given up and the remainder showed significantly greater declines in PT (50%) and CW (55%) than did the controls (13% and 18%, respectively). The decline in muscular excitations was similar in both groups. The ratio CW/iEMG showed a dramatic decline in the patients but was virtually constant in the controls. These results indicate a fatigue of low-frequency type in the patient group. There were close correlations between maximum walking tolerance and total work production.

One-Time Acute Heat Treatment Is Effective for Attenuation of the Exaggerated Exercise Pressor Reflex in Rats With Femoral Artery Occlusion.

The purpose of this study was to determine the effects of one-time acute heat treatment (HT) on the exaggerated exercise pressor reflex in a model of peripheral arterial insufficiency induced by ligation of the femoral artery and was to further examine the underlying mechanism of ATP-P2X3 signal activity during this process. The blood pressure (BP) response to static muscle contraction and muscle tendon stretch was recorded to determine the exercise pressor reflex. Also, αβ-methylene ATP (αβ-me ATP) was injected into the arterial blood supply of the hindlimb muscles to stimulate P2X3 receptors in the muscle afferent nerves. To process one-time acute HT, a heating pad was placed locally on the hindlimb and the muscle temperature (Tm) was increased by ~1.5°C and maintained for 5 min. Compared with control rats, a greater mean arterial pressure (MAP) response to muscle contraction was observed in rats with femoral occlusion in a pre-heat control session (28 ± 2 mmHg in occluded rats/n = 12 vs. 18 ± 2 mmHg in control rats/n = 9; p < 0.05). The one-time acute HT attenuated the amplification of the BP response in rats with femoral artery occlusion (MAP response: 19 ± 8 mmHg in occluded rats + HT/n = 11; p < 0.05 vs. occluded rats). In contrast, HT did not significantly attenuate amplification of MAP response to muscle stretch and αβ-me ATP injection in rats with femoral artery occlusion and controls (all p > 0.05). Our data suggest that one-time acute HT selectively attenuates the amplified pressor response induced by activation of the metabolic and mechanical components of the reflex in rats after femoral artery occlusion. The suppressing effects of acute HT on the exaggerated exercise pressor reflex are likely mediated through a reduction in metabolites (e.g., ATP) stimulating the muscle afferent nerves in contracting muscle, but unlikely through direct alteration of P2X receptors per se.

Muscle cramps — a mini review of possible causes and treatment options available with a special emphasis on diabetics — a narrative review

Muscle cramps are characterized by sudden, painful involuntary contraction of the muscles. The cramps sometimes become disabling and the prevalence is more in the elderly. The etiology of the cramps are diverse and some time the cramps are idiopathic. There are many underlying pathophysiological disorders like hypocalcemia, hypomagnesemia, hypothyroidism, and hepatorenal dysfunction which causes muscle cramp. Similarly, diabetes mellitus results in muscle cramps due to electrolytic imbalance, hypoglycemia, peripheral arterial insufficiency, and neuropathies. Persistent muscle pain in diabetic patients degrades the quality of life of those patients. Although the pathophysiology and etiology of the muscle cramp are understood to some extent, the same is less explored from diabetes mellitus perspective. Hence the objective of this review is to explore the underlying factors responsible for muscle cramps in diabetes so that proper strategy for pharmacotherapy can be made to manage this condition.

Contribution of Non Traditional Cardiovascular Risk Factors to the Cardiovascular Disease in Patient with Type 2 Diabetes

Background: T2DM is a major risk factor for heart failure, peripheral arterial insufficiency and microvascular complications, affecting life quality and expectancy. Diabetes also increases coronary death rates conferring the patient a worst prognosis after having the first CHD event. The mortality rate in non-diabetic patients was less compared to diabetic patients who experienced CHD. Objectives: to study was the association of nontraditional risk factors with incidence of coronary heart disease in Patient with Type 2 Diabetes. Patients & Methods: Our study had been carried out in cardiology department, Zagazig University from April 2017 to December 2017. The study included 105 patients divided into 3 groups; they were young and middle aged subjects selected conveniently according to specified groups (normal control group, diabetic control group without history of coronary artery disease and ischemic heart disease group with history of coronary artery disease. History and physical examinations were recorded and laboratory tests were performed for all patients. Results: showed that there ws a statistical significant difference regarding Diastolic dysfunction, Ventricular hypertrophy, Uric acid, Serum hsCRP, Serum fibrinogen and Homocystein in T2DM patients group. Conclusions: Cardiovascular risk factors were higher in subjects with diabetes compared to subjects without diabetes, Non-traditional cardiovascular risk factors may be related independently to incident coronary heart disease in T2DM patients.

High tolerance of progressive elastic compression in peripheral arterial disease.

Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6x6 plan) evaluating the short-term tolerance of progressive compression stockings (18±2mmHgat calf and 8±2mmHgat ankle level) in patients with PAD (ankle brachial index ABI>0.60<0.75) and chronic venous insufficiency (C1s-C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease>15% of ABI on each side, no decrease>15% of toe brachial index (TBI) on each side and no decrease>25% of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8%, mean age was 77.3±7.5years and no patient were diabetic. At inclusion, the mean low ABI was 0.60±0.04 and the mean high ABI was 0.77±0.18. The mean low TBI was 0.32±0.09 and the mean high TBI 0.46±0.15. The mean number of active standing plantar flexions was 33.0±5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7%, class C2s: 27.8%, class C3: 44.4%, class C4: 5.6% and class C4s: 5.6%). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18±2mmHgat calf and 8±2mmHgat ankle level) in symptomatic PAD.

Impact of heat therapy on body composition and skeletal muscle function in a model of peripheral artery disease

IntroductionPatients with symptomatic peripheral artery disease (PAD) have a profound limitation in exercise performance that is partly caused by ischemia‐related skeletal muscle abnormalities, including reduced muscle mass and strength. Current medical therapy for the exercise limitation in PAD is limited. We recently reported that exposure to leg heat therapy (HT) causes a marked increase in leg blood flow in patients with PAD. In this study, we used a model of diet‐induced obesity and peripheral arterial insufficiency to examine the effects of repeated treatment with HT on body composition and skeletal contractile function.MethodsMale 32‐week‐old C57Bl/6 mice were fed 60% high‐fat diet for 10 weeks. At 42 weeks of age, the animals underwent bilateral ligation of the femoral artery to induce hindlimb ischemia. After two weeks of recovery, the animals were randomly assigned to receive HT or a control intervention. Heat therapy was applied by placing the animal in a flat bottom restrainer and immersing the lower half of the body in a glass container filled with water at 39°C (n=7) for 30 min daily over 3 consecutive weeks. Animals assigned to the control group (n=8) were also restrained, but were placed in an empty container. Rectal temperature was measured before and during exposure to a single session of HT or the control intervention (n=3/group). Body composition was assessed prior to the onset of the treatment and then once a week throughout the intervention. Forty‐eight hours following the last treatment session, the animals were anesthetized and the soleus and extensor digitorum longus (EDL) muscles were harvested for the assessment of contractile function.ResultsRectal temperature increased during acute exposure to HT from a baseline of 35.1±0.4°C to 38.3±0.2°C. In the control group, rectal temperature remained at baseline levels throughout the treatment session (35.4±0.3°C). At baseline, fat mass (Control: 17.2±0.7 g vs. 16.0±0.8 g, p=0.51) and lean mass (Control: 28.4 g vs. HT: 28.4 g, p=0.7) were not different between groups. However, fat mass was significantly lower in the group exposed to HT at week 2 (Control: 19.6 g vs. HT: 14.72 g, p=0.03) and week 3 (Control: 20.32 g vs. HT: 14.54 g, p=0.01), while there was no difference between groups in lean mass throughout the intervention period (p&gt;0.05). Muscle mass relative to body mass was significantly higher in animals exposed to HT as compared to the control group in the EDL muscle (Control: 0.33±0.01 mg/g vs. HT: 0.38±0.01 mg/g, p=0.003). Maximal absolute force of the EDL muscle was also higher in animals treated with HT when compared to the control group (Control: 488.5±12.4 mN, HT: 529.5±14.5 mN, p=0.05). There were no differences between groups in relative muscle mass and maximal force development of the soleus muscle (p&gt;0.05).ConclusionThese findings indicate that repeated exposure to HT has positive effects on body composition and improves skeletal muscle function in a mouse model of diet‐induced obesity and PAD. This new therapeutic tool might be a practical alternative for PAD patients with restricted locomotion and multiple comorbidities, including diabetes and obesity.Support or Funding InformationFunding: Ralph W. and Grace M. Showalter Research Trust AwardThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A near-infrared spectroscopy-assisted test discriminates patients with peripheral arterial disease and venous insufficiency with changes of foot oxygenation following light elastic compression therapy.

Background: Elastic compression therapy (CT) in patients with peripheral artery disease (PAD) and chronic venous insufficiency (CVI) may compromise arterial perfusion. We evaluated the feasibility of a toe-flexion test, which quantifies dynamic foot perfusion by near-infrared spectroscopy (NIRS), for the assessment of hemodynamic sustainability of CT in PAD patients with CVI. Patients and methods: In this prospective observational study, PAD patients aged 50-85 with combined CVI at CEAP stages II-IV were studied. The ankle-brachial index (ABI) was measured, and foot perfusion was determined after 10 consecutive toe-flexion movements with NIRS sensors placed on the dorsum of each foot. Knee-high open-toe compression stockings were applied, and the degree of compression was measured. Toflex-area was determined by calculating the area under the curve of the oxygenated hemoglobin track recorded by NIRS. A toflex-area reduction >20% following CT was arbitrarily defined to identify limbs of patients with improved foot perfusion. These subjects received CT to be worn and a diary to report adherence and symptoms. Results: Forty-seven PAD patients (74±9 years; ABI 0.67±0.24) with CVI were enrolled. For all legs, superimposable toflex-areas were observed for the first two attempts (ICC 0.92). Following application of CT (17±2 mmHg), the toflex-area improved (from -162±110 a.u. to -112±104 a.u.; p<.001). Sixty-two limbs (n=32 patients) exhibited improved foot perfusion after CT, with a mean variation of 80±47 a.u., while 32 limbs (n=23 patients) showed stable or worsened values. In a regression model, favorable variations in toflex-area after CT were linked to a worse baseline toflex-area (R2=0.18; p<0.001; rpartial=-0.42) while the percentage improvement directly correlated with CEAP class (p=0.033). Conclusions: The NIRS-assisted test, which is feasible in a laboratory context, objectively discriminates the hemodynamic tolerability of the treatment and identifies subjects with combined PAD and CVI with improved perfusion after CT, in spite of the presence of PAD.

An Overview on Diabetic Foot Infections, including Issues Related to Associated Pain, Hyperglycemia and Limb Ischemia.

Factors strongly related to the risk of developing diabetic foot infections include vascular, neuropathic and hyperglycemic complications of long-standing diabetes mellitus. These infections are common and serious, posing a worldwide burden on administrative providers of healthcare, patients and physicians. The most appropriate approach to these infections is with a multidisciplinary team. This subchapter summarizes the current state-of the-art concerning therapy, and scientific knowledge, for peripheral arterial insufficiency, hyperglycemia, and peripheral neuropathy of the diabetic foot, with an emphasis on the infectious complications.

Combined Approach of Vasodilators and Surgical Reconstruction in Diabetic Foot Ulcer: Experience in a Tertiary Care Hospital

Background: Diabetic patients frequently suffer from chronic non-healing ulcer on the sole of foot as a result of combined peripheral neuropathy and arterial insufficiency. Many of them end up in amputation. The aim of this study was to see the outcome of diabetic patients presenting with ulcers that showed no signs of healing in sole of the foot for 3 months or more treated with combination of peripheral vasodilators and surgical reconstruction.Methods: A cross sectional study of 249 patients who presented to Plastic surgery department in BIRDEM fromJanuary 2013 toDecember2015 was done. The patients who had existing associated chronic medical illness like Chronic Kidney Disease (CKD) requiring dialysis, malignancy, Status Asthmaticus and foot ulcer withWagner grade 4 and 5 and patients receiving drugs that cause immunosuppression like chemotherapeutic agents, steroids, and methotrexates were excluded from the study.Results: All patients presented with non-healing ulcerations average size of which was 1.48 cm (range, 0.68 to 4 cm) of more than 3 months in various parts of sole of the foot complicated by peripheral neuropathy and/or arterial insufficiency. After the use of peripheral vasodilators, these patients underwent a variety of surgical reconstructions such as simple skin graft, local flaps, regional flaps and distant flaps. In follow up of 3 to 36 months, 194 patients (77.91%) achieved good results, 55(22.08%) patients’ required secondary procedure such as flap revision, debridement or Split thickness skin graft (STSG) due to post operative complications.Conclusion: We conclude that chronic non-healing ulcers in diabetic patients can be successfully treated by combined approach of surgical reconstruction and peripheral vasodilators.Birdem Med J 2018; 8(2): 108-113

Incidence and predictors of clinical peripheral artery disease in asymptomatic persons with a low ankle–brachial index

To determine the occurrence of clinical peripheral artery disease in a cohort of middle-aged and older persons who, though they initially had no symptoms of peripheral artery disease, had blood pressure levels in the arteries of their ankles and feet that were at least 10% lower than those in the arteries of their arms. We analyzed data obtained in the Multi-Ethnic Study of Atherosclerosis, in which lower and upper extremity blood pressures were assessed in over 6000 Americans aged 45-84 and the ratio of these (the ankle-brachial index) was calculated. During a median follow-up of 13 years, the incidence of symptomatic peripheral artery disease (identified through annual questionnaires, review of hospital records, and notations of peripheral artery disease found in data obtained from the Center for Medicare Services) was compared between persons whose ankle-brachial index was ⩽9 and persons with higher ankle-brachial index values. The incidence of clinical peripheral artery disease was 23.0 per 1000 person-years among the 172 participants whose baseline ankle-brachial index was <0.9, compared with 2.0 per 1000 person-years in those with a higher ratio. The incidence of clinical peripheral artery disease rose steadily with decreasing ankle-brachial index below 0.9. The excess risk associated with a low ankle-brachial index was present in persons with and without the other measured risk factors for peripheral artery disease (cigarette smoking, hyperten sion, diabetes, and obesity). Even in persons asymptomatic for peripheral artery disease, those with a low ankle-brachial index are at an appreciable risk of the development of manifestations of peripheral arterial insufficiency.

Exaggerated cardiovascular responses to treadmill running in rats with peripheral arterial insufficiency.

Patients with atherosclerotic peripheral artery disease have an augmented pressor response to treadmill walking, but the underlying mechanisms remain poorly understood and difficult to isolate because of the confounding presence of numerous cardiovascular risk factors. In the present study, we tested the hypothesis that a chronic deficit in muscle blood flow capacity would be sufficient to trigger an exaggerated pressor response to dynamic exercise. Sprague-Dawley rats (5 male and 5 female) were instrumented with radiotelemetry devices to measure the cardiovascular responses to treadmill running before and after bilateral femoral artery ligation, which has been previously shown to reduce the blood flow capacity of distal hindlimb muscles by >60%. Treadmill running evoked reproducible increases in mean arterial pressure (MAP) and heart rate (HR), which were significantly augmented 3 days after femoral artery ligation in both male rats [ΔMAP: +10 ± 1 (SE) vs. +18 ± 3 mmHg and ΔHR: +94 ± 12 vs. +148 ± 15 beats/min, P < 0.05] and female rats (ΔMAP: +16 ± 3 vs. +30 ± 5 mmHg and ΔHR: +128 ± 20 vs. +178 ± 19 beats/min, P < 0.05). Similar exaggerated MAP and HR responses were observed at repeated intervals between 3 and 65 days postligation. These findings indicate that a chronic deficit in muscle blood flow capacity is an important, persistent cause of the abnormal pressor and cardioaccelerator responses to dynamic exercise in both male and female rats with peripheral arterial insufficiency. NEW & NOTEWORTHY Using radiotelemetry to assess cardiovascular effects of exercise, we showed that femoral artery obstruction in male and female rats is an important, persistent cause of exaggerated pressor and cardioaccelerator responses to treadmill running. This translational model reproduces the abnormal cardiovascular response to exercise seen in patients with peripheral artery disease. Listen to this article's corresponding podcast at http://ajpheart.podbean.com/e/treadmill-bp-in-simulated-peripheral-artery-disease/ .

Risk Factors for Premature Death in Diabetes Patients who Undergo Amputations below Ankle Level

To identify risk factors for early death in diabetes patients who undergo amputations below the ankle. A retrospective study, where all hospital records of all diabetes patients who had undergone minimum one amputation below the ankle at the CWHC Bispebjerg Hospital, Denmark, in the period 1996-2013, were examined. The amputations were mainly trans-metatarsal amputations and partial amputations of toes. The participants were found via ICD10-codes. The included patients were followed from their first contact to the last registered contact. The statistical analysis in this article is performed on patients with a of minimum 5-year follow-up. The 5 year mortality was 42% for patients with type 2 diabetes, and 29% for patients with type 1 diabetes. For patients with type 2 diabetes, multivariable analysis showed that high age, peripheral arterial insufficiency and short time from first admission to amputation were independently statistically significantly associated with increased 5-years mortality. Use of statins was associated with decreased mortality. 35% died as a result of their diabetes, mostly due to cardiovascular causes. Short time from first admission to amputation is a risk factor for early death. Arterial insufficiency and high age is also associated with increased mortality, whereas use of statin is associated with decreased mortality, in patients with type 2 diabetes.

Peripheral Arterial Insufficiency: A Study of Prevalence and Factors Associated with Complications in Baja California Sur

Peripheral Arterial Insufficiency: A Study of Prevalence and Factors Associated with Complications in Baja California Sur

Hyperbaric Oxygen Therapy of Ischemic Cranial Skin Flap: Case Report and Review of the Literature

Hyperbaric Oxygen Therapy (HBOT) is a medical procedure and therapeutic modality that utilizes 100% oxygen. HBOT has been used various medical conditions such as progressive necrotizing fasciitis, peripheral arterial insufficiency, and diabetic wounds of the lower extremities. The case report reported here describes the usage of HBOT as an adjunctive “rescue” measure to salvage a patient’s cranioplasty scalp flap after flap ischemia was noted 2 days post-operatively. Patient is a 54 year-old caucasian female who presented to our facility with symptoms of a left MCA infarct. CT and MRI of her brain revealed a left MCA infarct with hemorrhagic stroke with significant cerebral edema, and midline shift. She was taken to the operating room for a left decompressive hemi-craniectomy. She had cranioplasty utilizing native bone flap delayed fashion. She had wound infection after cranioplasty which required removal of native bone. After appropriate treatment for infection, she had cranioplasty utilizing prosthetic Biomet implant. Post-cranioplasty, patient developed ischemic cranial flap. This was recognized within 48 hrs and HBOT was implemented. She has a successful rescue of the ischemic cranial flap after she received 14 consecutive treatments over two weeks. In our knowledge, this is the first successful treatment of HBOT reported after prosthetic cranioplasty for scalp flap ischemia.

Compression treatment following polytrauma and in endocrinopathies

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