Lower Limb Research Articles

Improvement in Health-Related Quality of Life and Symptoms Following Lipedema Liposuction: A Longitudinal Study.

Lipedema is a chronic fat disorder characterized by disproportionate fat deposition in the lower limbs, leading to pain, mobility issues and reduced health related quality of life (HRQoL).There is growing evidence that liposuction of the excess fat not only reduces soft tissue pain but also improves HRQoL. The published data, however, remain limited, and there are no studies of liposuction in the UK lipedema population. This study aimed to evaluate the effectiveness of liposuction on HRQoL and symptoms in UK lipedema patients using 2 HRQoL instruments and a Lipedema Symptom Scale. Lipedema patients undergoing liposuction between January 2016 and December 2021 completed Short-Form Health Survey (SF-36), World Health Organization Quality-of-Life Assessment (WHOQOL-BREF), and 17-question Lipedema Symptom Scale preoperatively and postoperatively. Paired t test was used to compare the preoperative and postoperative mean scores of the different domains of the SF-36 and WHOQOL-BREF and preoperative and postoperative mean scores for the lipedema symptom scale. Paired t test was also used to compare preoperative and postoperative SF-36 scores to age-matched normative data for the English population to assess the extent of HRQoL improvement relative to the general population. Seventy-six women were included in the study with a mean age of 46.4 ± 12 years. Mean follow-up (interval between first liposuction surgery and postoperative completion of the instruments) was 25.3 ± 23.2 months. There was significant improvement in all SF-36 and WHOQOL-BREF domains postoperatively (P < 0.001). Compared with age-matched normative data, postoperative SF-36 scores remained lower in physical functioning, social functioning, and general health. Postoperative results also showed a highly significant improvement (P < 0.001) across all 17 items of the Lipedema Symptom Scale. This longitudinal study indicates liposuction is an effective treatment for improving HRQoL and symptoms in lipedema patients, although it may not completely restore HRQoL to normative levels. Limitations include potential selection bias, sampling bias, and the need for longer follow-up. The findings support liposuction as a first-line treatment for lipedema and could inform decision-making for both patients and policymakers.

Associations Between Inter-Limb Asymmetry in Lower Limb Strength and Jump Performance in 14–15-Year-Old Basketball Players

This study aims to (1) assess the inter-limb asymmetry in hip, knee, and ankle strength and countermovement jump (CMJ) performance among adolescent basketball players and (2) examine the relationship between inter-limb asymmetry and CMJ performance. Moreover, 30 adolescent basketball players (15 boys and 15 girls) aged 14 to 15 years participated in this study. The strength of the lower limb joints was measured using an isokinetic dynamometer at a speed of 60 degrees per second. Three maximal CMJs were performed, and the highest jump was used for the final analysis. The subjects were median-split into high-asymmetry (n = 15) and low-asymmetry (n = 15) groups based on the calculated strength asymmetry scores. The asymmetry scores were calculated using the formula: (dominant–non-dominant)/dominant* 100%. The inter-limb asymmetry data ranged from 12.2% to 21.6%. A Spearman correlation analysis showed that only the inter-limb asymmetry of the ankle plantar flexor was significantly correlated with the CMJ heights (ρ = −0.56, p = 0.001). An independent t-test revealed no significant differences in strength asymmetry between boys and girls (all p &gt; 0.05). The low-asymmetry group demonstrated significantly greater CMJ performance compared to the high-asymmetry group (ES = 1.11, 95% CI = 0.34–1.87, p = 0.007), indicating that inter-limb asymmetry of the ankle plantar flexor has a significant negative impact on CMJ performance. Coaches should focus on enhancing both the strength and symmetry of the ankle joints to improve athletic performance and prevent injuries in sports, where jumping is a common movement.

A rare occurrence of enchondroma with pathological fracture of proximal femur in an adult female: A case report

Enchondroma occurrence in the proximal femur is a very uncommon condition. We report a 40-year-old female with a history of accidental slip and fall, sustained injury to her left lower limb, and was unable to bear weight on the injured leg since the fall. Anteroposterior radiograph of the pelvis with bilateral hips shows a well-defined lytic lesion in the neck of the femur with some calcified matrix and no periosteal reaction with the left femoral subtrochanteric fracture. Magnetic resonance imaging scan revealed hypointense signals on T1 and hyperintense signals on T2 sequence over the proximal femur as well as left subtrochanteric femur fracture. After preanesthetic evaluation, bone curettage with excision biopsy with open reduction and internal fixation with long proximal femoral nail and bolts and iliac crest bone graft was done. A biopsy sample sent for histopathological examination reveals enchondroma. Complete weight bearing was started after four months. No recurrence was noted on follow up.

CORR Insights®: What Are the Factors Associated With Revision Surgery on the Residual Limb and Functional Results in Patients With Posttraumatic Lower Limb Amputations?

CORR Insights®: What Are the Factors Associated With Revision Surgery on the Residual Limb and Functional Results in Patients With Posttraumatic Lower Limb Amputations?

Saddle Aortic Embolus With Paraplegia in a 60-Year-Old Diabetic and Hypertensive Patient: A Rare Case of Acute Lower Limb Ischemia

Saddle Aortic Embolus With Paraplegia in a 60-Year-Old Diabetic and Hypertensive Patient: A Rare Case of Acute Lower Limb Ischemia

A case report on the choice of venous access after ectopic peripherally inserted central catheter in an upper limb of a patient with a second recurrence of right-side breast cancer.

Intravenous catheter placement in the healthy upper extremity is preferred for chemotherapy in patients with breast cancer. Common venous accesses are peripherally inserted central catheters (PICCs) and totally implantable intravenous port catheters (TIVPs). In this case, a patient with breast cancer had a history of infusion port placement through the left internal jugular vein, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. This case can assist PICC catheterization nurses in developing optimal venous access strategies tailored to the specific situations of patients in similar situations. Through adequate evaluations and optimal selection of venous access, the success rate of disposable catheterization can be improved, and the risk of complications reduced. A 53-year-old female with breast cancer had a history of infusion port, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. An axial computed tomography (CT) image before totally implantable venous access port (TIVP) placement and An axial CT 103 days after TIVP placement shows diffuse stenosis of the left innominate vein, associated with infusion port placement through the left internal jugular vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. The patient's lower limb PICC was left in place for 201 days with no complications, completing the full treatment cycle. This case presents a rare and insightful clinical scenario. For patients with a history of infusion port placement, particularly via the left internal jugular vein, careful analysis of the innominate vena cava and examination of chest wall vein exposure are essential to determining the optimal vascular access strategy.

Comparison of Intrathecal Hyperbaric Bupivacaine Alone and Hyperbaric Bupivacaine with Fentanyl in Lower Limb Surgery

Introduction: Subarachnoid block is the preferred anaesthetic technique used for lower limb surgeries because of its rapid and profound sensory and motor blockade. Opioids are widely used in conjunction with local anaesthetics in neuraxial blocks for their property of improving the quality and prolonging the duration of local anaesthetics for surgical anaesthesia, as well as post-operative analgesia. Objectives: Objective of this study was to compare the duration of two segment regression, motor blockade and sensory analgesia, with intrathecal hyperbaric Bupivacaine alone and with Fentanyl added. Method: In this study, 80 patients above 15 years with ASA (American Society of Anaesthesiologist) physical status I and II, undergoing subarachnoid block for various lower limb surgeries were studied in a double-blinded, randomized prospective manner. Patients were divided into two equal groups - Group B (n= 40) received hyperbaric bupivacaine 15 mcg, and Group BF received hyperbaric bupivacaine 12.5 mg with fentanyl 25 mcg, making a total volume of 3 ml in both the groups. Patients were compared intraoperatively and postoperatively for the duration of motor blockade, time for two segment regression and duration of sensory analgesia and complications. Results: The time for two segment regressions, time for sensory analgesia, duration of motor blockade, was significantly higher in group BF i.e., 119 ±19 mins, 310 ±20 mins and 236±17 mins respectively, as compared to group B i.e., 83 ±20, 223 ± 22, 186 ±19 minutes respectively. Both the groups were comparable with demographic profile and hemodynamic parameters. Conclusion: The addition of fentanyl 25 mcg prolongs the time for two segment regression and duration of sensory analgesia for lower limb surgeries.

DETECTING CHANGES IN COMFORT, PAIN, AND MOBILITY OVER CLINICAL MILESTONES FOR INDIVIDUALS WITH LOWER LIMB LOSS

BACKGROUND: Functional mobility, comfort and the absence of pain are key goals of prosthetic treatment. Outcome measures (OMs) evaluate the impact of treatment and normative and minimal detectable change (MDC) values are key to interpreting these scores and measuring treatment outcomes. OBJECTIVES: This study seeks to 1) present practice-based normative values of four commonly used OMs at four prosthetic milestones and 2) explore the MDC of the measures over the treatment period. METHODOLOGY: A chart review was conducted of OMs collected with individuals with lower limb loss between January 1, 2015, and December 31, 2023. This included data for individuals with unilateral transtibial (TT), transfemoral (TF) and rotationplasty (RP) amputations and bilateral transtibial amputation (BTT). OMs included the Socket Comfort Score (SCS), Pain Scale (PS), 2 Minute Walk Test (2MWT), and Prosthetic Limb Users Survey of Mobility (PLUS-M). Data were collected at four milestone time points: (1) Baseline and (2) Discharge from Rehabilitation for those in initial prosthetic rehabilitation, and (3) Initial Evaluation and (4) Definitive Delivery for those receiving a replacement socket. Normative values and MDC values were calculated. FINDINGS: Data from 30 individuals undergoing in-patient rehabilitation and 74 individuals receiving a replacement socket were included. Practice-based normative data were different for each level of amputation and milestone and had the following ranges: SCS: 5.7 – 9.1, PS: 0.8 – 3.7, 2MWT: 68.4 – 146.3 m and PLUS-M: 38.9 – 57.3. MDC values also varied based on time in treatment (Rehabilitation: SCS = 2.5, PS = 1.6, 2MWT = 32.6, PLUS-M = 8.8; Replacement Socket: SCS = 3.1, PS = 2.6, 2MWT = 38.9, PLUS-M = 4.0). All measures had a statistically significant change over the intervention, however, no average scores changed by greater than the MDC. CONCLUSIONS: The normative data and MDC scores demonstrate the PS &amp; PLUS-M are useful measures of pain and mobility at all points within treatment. The 2MWT is indicated for individuals in rehabilitation, while the SCS is indicated for those receiving a replacement socket, as both effectively measure treatment goals that are particularly important for each phase of rehabilitation. This provides clinicians with practice-based evidence that enables them to interpret OM scores, a critical part of the decision-making process along the treatment journey. Layman's Abstract When someone receives a prosthesis, the key goals are to promote mobility and comfort and to reduce pain. Outcome measures are questionnaires or performance-based tests that measure the impact of prosthetic treatment. The scores are interpreted by comparing them to normal values and assessing changes over time against a predetermined threshold for what constitutes a significant amount of change. This study analyzed outcome measure scores collected in clinical practice over a 9-year period, from 2015 - 2023. We included individuals with lower limb loss and presented normal values along with threshold change values taken from a clinical setting for four commonly used measures that assess comfort, pain, and mobility. The data included 30 individuals currently attending initial rehabilitation and 74 individuals who had prior experience using a prosthesis. All the normal values were different for each level of amputation and each milestone within rehabilitation. Suggestions are provided regarding which outcome measures are most useful for assessing changes at different points in time. By providing clinicians with evidence based on clinical practice, we can help them use outcome measures to inform decision-making throughout the rehabilitation journey. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/43890/33243 How To Cite: Pousett B.M, Harasym C.C, Rapaport M.S, Richardson T, Spellen J, Moe D.W, et al. Detecting changes in comfort, pain, and mobility over clinical milestones for individuals with lower limb loss. Canadian Prosthetics &amp; Orthotics Journal. 2024; Volume 7, Issue 1, No.7. https://doi.org/10.33137/cpoj.v7i1.43890 Corresponding Author: Brittany Mae Pousett, CP(C), MSc.540 SE Marine Dr, Vancouver, BC, Canada, V5X 2T4Tel: 604.321.1115E-Mail: brittany@pousett.caORCID ID: https://orcid.org/0000-0002-2272-7847

Comparative study of a femoral amputated limb with and without implant

The contact pressure at the socket–residual limb interface is the most critical parameter for evaluating the comfort of a leg prosthesis. Experimental studies have analyzed this parameter for typical postures and during walking on a flat surface of an amputee; however, experimental tests require a real socket prototype equipped with transducers. To optimize socket design, this work presents a virtual approach based on a digital avatar of a patient wearing a lower limb prosthesis. Our study integrates two different types of simulations: the first concerns the femur with an implant, the second without an implant, and includes the evaluation of pressure at the socket–residual limb interface using finite element analyses (FEA). The objective of this study is to understand the distribution of loads and stresses at the interface between the residual limb and the prosthesis. The lower contact pressure is represented by CPRESS, while CSHEAR1 is the frictional shear stress component in the first local tangent direction, and CSHEAR2 is the frictional shear stress component in the second local tangent direction.

Clinical and Cost-Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta-Analysis.

Indocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost-effectiveness across various plastic and reconstructive surgery procedures. A systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta-analysis concerned perfusion-related complications and cost data. Twenty-five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty-one studies were AHRQ Standard 'Good'; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (n = 3310) and head and neck reconstruction (n = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta-analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, p < 0.0001), fat necrosis (OR 0.31, p < 0.001), infection (OR 0.66, p = 0.02), and re-operation (OR 0.40, p < 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, p = 0.57/OR 0.87, p = 0.56, respectively) or increase in dehiscence (OR 1.55, p = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, p = 0.04), although not partial flap loss (OR 0.37, p = 0.13) and reoperation (OR 0.92, p = 0.73). Lower limb (n = 104) and abdominal wall (n = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta-analysis. ICGFA appears to be a useful, cost-effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.

Lobular panniculitis of the lower legs in a patient with eosinophilic gastrointestinal disease: A case report of scurvy.

Eosinophilic gastrointestinal disease (EGID) is a chronic condition that is commonly treated with restrictive food elimination diets, and may be complicated by food aversion. Here, we present a patient with recalcitrant EGID with lobular panniculitis of the lower legs secondary to scurvy. Cutaneous eruptions are the first manifestations of scurvy, and thus a high suspicion for panniculitis in the context of food restriction is critical to prevent further complications and mortality.

The Synergistic Effects of Incobotulinum Toxin and Physiotherapy in a Rare Case of Paraparesis in a 7-Year-Old Affected by Klippel–Feil Syndrome Related to an MYH3 Gene Mutation: A Case Report

Background: Klippel–Feil disease is a condition characterized by a defect in the spine, consisting of the fusion or non-separation of two or more vertebrae of the cervical tract. It affects 1 in every 50,000 newborns, and the pathogenesis remains unknown to date, although the role of certain genes that are involved in segmentation processes is being studied. A single case of a genetic Myosin Heavy Chain 3 (MYH3) mutation is described here. Affected patients are typically distinguished by a relatively short neck, which leads to limited mobility, a low hairline, and obesity; they may also experience various other health issues. The common occurrence of comorbidities further diminishes the quality of life of these young individuals. Methods: The following case report describes the synergistic effect of Incobotulinum toxin type A and physiotherapy in a 7-year-old patient with MYH3 mutation-related Klippel–Feil syndrome (KFS) complicated by bilateral paraplegia to improve the spasticity condition of the lower limbs. To assess improvements over time, the patient underwent rating scales to determine spasticity (Modified Ashworth Scale: MAS), the neck’s range of motion (ROM), and muscle tone by using MyotonPro®. Specifically, measurements were taken on the day of the first medical examination (T0), the month after the injection and the startup of therapeutic exercise (T1), at three months (T2), and then once a month for a total of 6 months (T3, T4, and T5). Results: This therapeutic approach resulted in highly satisfactory outcomes for the child’s well-being, which was maintained until the sixth month and was accompanied by a complete absence of any side effects.

Multivariable analysis for predicting lower limb muscular strength with a hip-joint exoskeleton

Multivariable analysis for predicting lower limb muscular strength with a hip-joint exoskeleton

A case of complete response to radiotherapy combined with durvalumab and tremelimumab in a patient with unknown primary hepatocellular carcinoma arising in the lumbar spine.

A 58-year-old man visited an orthopedic clinic complaining of pain in his right lower back and numbness in his lower limbs for one month. Imaging tests revealed a tumorous lesion from the left side of the second lumbar vertebra to the paraspinal muscles. CT-guided biopsy of the tumor was performed, and immunostaining results diagnosed hepatocellular carcinoma (HCC). Although the liver showed signs of chronic liver damage, no primary tumor was found within the liver or in other organs. Blood tests showed negative hepatitis virus markers for both HBV and HCV. The tumor markers AFP, AFP-L3, and DCP were high. Because he developed spinal cord compression syndrome due to a lumbar tumor, radiation therapy and denosumab administration were performed. Subsequently, systemic therapy with durvalumab plus tremelimumab was started. In the year following the start of treatment, the tumor has shrunk, and no new lesions have been observed. Tumor markers have also decreased. We have experienced a case of HCC in the lumbar spine without a primary tumor in the liver. This is a very rare case, and the combination therapy with durvalumab and tremelimumab resulted in a complete response, which we consider to be a valuable case.

Effect of foot type on electromyography characteristics and synergy of lower limb muscles during running

The foot structure is associated with different running mechanics. The central nervous system is responsible for using the muscles through synergies during locomotion. The purpose of the present study was to examine the effect of foot structure on the electromyography factors and the synergy of the selected muscles of the lower extremity. Tibialis anterior, extensor digitorum longus, peroneus longus, soleus, biceps femoris, vastus lateralis, gastrocnemius lateralis and medialis muscles activity of 60 barefoot recreational runners with different foot structures was recorded while running at a speed of 3.3 m/s. Muscle activity was measured in the running cycle. Besides, muscle synergies were extracted using non-negative matrix factorization algorithm. The results showed that there were differences between groups with different foot type in muscle activity under different phases of running in some muscles. Furthermore, the findings indicated that the number of synergies was similar in different groups and the relative weight of muscles was not different across groups. In conclusion, despite the difference in muscle activity under different phases of the running cycle, muscle synergies are similar among the groups. This can indicate similar control by the central nervous system in runners with different arch structures while running and the observed changes in muscle activity can be attributed to the type of forces exerted on the body, the length-tension relationship, and changes in the direction of the lower limbs in people with different arch structures.

Hip Manipulation Increases Electromyography Amplitude and Hip Joint Performance: A Double-Blind Randomized Controlled Study

(1) Background: Activation of the gluteus medius (GM) muscle while minimizing the involvement of the tensor fascia latae (TFL) is crucial in treating many lower limb and lumbar spine injuries. Previous studies have demonstrated the effectiveness of joint manipulations in regulating muscle activity. The main objective of this study was to evaluate the effects of hip joint manipulation (HJM) on the muscle strength and activity (GM and TFL) of hip abductors in asymptomatic young participants. (2) Methods: The study followed a double-blind randomized controlled design. Thirty healthy, physically active women and men, free from spinal and lower limb injuries, voluntarily participated. The participants were allocated to two groups: those allocated to the HJM intervention and those in the control group receiving a sham intervention. They were assessed before and after the intervention using surface electromyography to measure muscle activation (EMGRMS) of the GM and TFL during maximal voluntary isometric hip abduction. (3) Results: HJM resulted in a significant increase in EMGRMS amplitude solely within the GM muscle (p &lt; 0.01); (4) Conclusions: This study suggests that HJM may increase EMGRMS amplitude in the GM muscle; however, the effects are neither statistically nor clinically significant when compared to the control group for most of the muscles analyzed.

Effects of Mild Fatigue on Biomechanics of Single Leg Landing in Young Male Volleyball Players

Objective: To investigate the effects of mild fatigue on the biomechanics of the lower limbs of young male volleyball players while performing single leg landing tasks. Methods: A total of ten young male volleyball players were recruited as participants in this study. After the single leg landing was performed, we compared the performance between those with and without fatigue (post- and non-fatigue, respectively). Kinematics and kinetics were collected using instruments, and related captured data were imported into OpenSim to analyze the hip, knee, and ankle joints. Results: We found that the ankle dorsiflexion angle at initial contact was significantly decreased in the post-fatigue group compared to the non-fatigue one. Meanwhile, the peak gluteus maximus force, peak gluteus medius force, peak tibialis posterior force, and peak gastrocnemius force significantly increased. There were no significant differences in the hip and knee joint flexion angles as well as the quadriceps and biceps femoris long head forces between the two groups. Conclusions: Mild fatigue can affect the performance of single leg landing, and players need to control the lower limbs by generating a higher muscle force to cope with the instability induced by fatigue. In a fatigued state, following initial contact with the ground, a decreased ankle dorsiflexion angle necessitates an increase in gastrocnemius and tibialis posterior muscle force to maintain stance during landing.

Biomechanic Differences Between Anticipated and Unanticipated Volleyball Block Jump: Implications for Lower Limb Injury Risk

Volleyball is a high-intensity sport characterized by repetitive jumping, sudden directional changes, and overhead movements, all of which significantly increase the risk of injuries, particularly to the shoulders, knees, and ankles. Despite the frequency of injuries caused by actions like blocking and spiking, there has been limited research focused on the specific biomechanical risk factors unique to volleyball. This study aimed to investigate the lower limb biomechanics during block jumps in both the dominant and non-dominant directions, under both anticipated and unanticipated conditions, in fifteen elite male volleyball players. Kinematic and kinetic data from the ankle, knee, and hip joints were recorded. Our results revealed statistically significant differences between the dominant and non-dominant directions at the ankle, knee, and hip joints. The non-dominant direction exhibited a greater ankle dorsiflexion angle and velocity, as well as higher knee flexion angle, velocity, moment, power, and abduction moment, along with increased hip flexion angle and power. Additionally, unanticipated movements led to increases in vertical ground reaction force (vGRF), hip extension moment, and flexion power, while ankle dorsiflexion plantarflexion velocity and knee flexion power decreased. It appears that movements in the dominant direction were stiffer and less cushioned, potentially increasing the risk of injury. While the non-dominant direction provided better shock absorption, it also elevated the knee valgus moment, which could increase the load on the knee. Furthermore, in unanticipated situations, athletes with short reaction times, unable to quickly adjust their automated movement patterns, faced a higher risk of limb overuse, thereby increasing the likelihood of injury. In practice, coaches should consider differences in limb coordination and movement direction, incorporating unilateral preventive exercises to reduce the risk of injury.

Frequency and clinical implications of findings on true whole-body 18F-FDG PET in the assessment of breast cancer.

In the assessment of breast cancer using 18-F FDG PET/CT, the incremental clinical benefit in performing a true whole-body PET/CT (with a field of view (FOV) from the vertex to the toes) over a limited whole-body PET/CT (with a FOV from the base of skull to the mid-thighs) is uncertain. Two hundred and one studies of 120 patients who underwent staging or restaging true whole body 18F-FDG PET/CT for breast cancer were retrospectively identified. Any abnormal hypermetabolic or structural focus outside the limited FOV was recorded and characterised, and referenced with the patient's known disease status and any symptomatology. A total of 18 (9.0%) studies had FDG avid and/or structural abnormalities detected outside the limited whole-body FOV which were identified as malignant. Seventeen out of 18 (94.4%) were skeletal and of these, 15/17 (88.2%) were located within the lower limbs. In three cases, there were de novo findings but identified in the presence of interval progression of other metastases within the limited whole-body FOV. None of these additional findings is known to have resulted in a change to staging or clinical management. In the assessment of breast cancer, a true whole-body PET/CT can reveal metastases outside the limited whole-body FOV, but these are unlikely to be encountered in isolation and therefore may have little bearing on clinical stage or management. Ultimately, while the choice of FOV should still be based on the individual patient situation, routine utilisation of the true whole-body FOV in the asymptomatic patient may not be necessary.

Outcomes of Catheter Directed Thrombolysis for Early and Late Re-occlusions in Acute Lower Limb Ischemia.

Acute lower limb ischemia (ALI) is a sudden decrease in arterial limb perfusion due to an arterial blockage, threatening limb and life. Catheter-directed thrombolysis (CDT) is a minimally invasive procedure to remove such obstructions. However, approximately one-third of patients endure a re-occlusion after successful CDT. This study aimed to investigate the short- and long-term outcomes of CDT for early (<1 year) and late (>1 year) re-occlusions. This retrospective multicenter study reviewed patients from 2 medical centers with an acute arterial re-occlusion of the lower limb after successful CDT between December 1996 and April 2021. The primary endpoints were angiographic success, defined as thrombus dissolution over 95% with outflow to at least 1 crural artery, and clinical success, defined as a score of ≥1 on the Rutherford scale for assessing changes in clinical status. Secondary endpoints included bleeding complications, patency, amputation, and mortality. Kaplan-Meier analyses were used to estimate patency, survival, and freedom from amputation. Seventy-seven cases were included, with 52 early re-occlusions (<1 year) and 25 late re-occlusions (>1 year). The median time to re-occlusion since the last CDT treatment was 4 months in the early re-occlusion group and 24 months in the late re-occlusion group. Angiographic success was achieved in 73% of early and 64% of late re-occlusions. Clinical success rates were 80.8% for the early and 80.0% of the late re-occlusion cases. Major bleeding occurred in 2% of the early and 8% of the late re-occlusion group. Patients were followed up until symptoms or signs of limb ischemia were resolved, with a median follow-up time of 15 months for the early and 22 months for the late re-occlusion group. During follow-up, secondary re-occlusions were observed in 59.6% of the early and 44% in the late group. Cumulative amputation rates at 1, 5, and 8 years were 36%, 36%, and 52% for early and 18%, 30%, and 30% for the late re-occlusions, respectively. In our experience, CDT is an effective short-term revascularization strategy for the majority of patients with both early and late re-occlusions. Long-term results are limited by secondary re-occlusions and limb loss. Catheter-directed thrombolysis (CDT) is a well-established treatment for acute lower limb ischemia (ALI). Re-occlusions after successful treatment are, however, observed in almost a third of the patients. Yet, the outcomes of CDT for re-occlusions for patients who were previously treated with CDT are not well known. This study showed that CDT is effective in achieving revascularization in cases of early and late re-occlusion after treatment for ALI, but the risk for further re-occlusions is high. Future studies should focus on maintaining patency after successful CDT for ALI.