Graft thrombosis remains one of the more challenging aspects of vascular surgery. In patients with occluded infrageniculate bypass grafts, more than 50% undergo major amputation at 1 year and an additional 15% to 25% die within the first year. The…
Procoagulant states may be divided into acquired and genetic causes. Acquired factors include advanced age, obesity, malignancy, surgery, prolonged immobilization, use of estrogens, antiphospholipid syndrome (APS), heparin-induced thrombocytopenia and thrombosis (HITT), and pregnancy. Genetic conditions include male gender, antithrombin III…
The first U.S. Food and Drug Administration (FDA)–approved randomized clinical trials for saving lower limbs by the patient’s own bone marrow stem cell transplants have been under way since 2007. The initial results are encouraging and provide promise that this…
Critical limb ischemia (CLI) represents the most severe degree of peripheral arterial disease (PAD) manifesting by either ischemic rest pain or tissue loss. In patients with CLI who do not have revascularization options, major amputation is required within 1 year…
Before the era of arterial reconstruction, lower extremity ischemic ulcers regularly progressed to gangrene and limb loss. Lumbar sympathectomy was first used to treat this condition in the 1920s by Diez in Buenos Aires and Adson and Brown at the…
Ulceration is the most important manifestation of a diabetic foot at risk for amputation. If untreated, the diabetic foot ulcer can enlarge, extend to the deep tissues, and become infected. Deep infection and formation of an abscess can follow and…
Many pharmacologic agents have been studied for the medical management of intermittent claudication, there has been little success in identifying drugs that significantly alter the natural history of peripheral artery disease (PAD), and so far none has proved superior to…
Atherosclerotic lower extremity peripheral arterial disease (PAD) represents one of the most common manifestations of systemic atherosclerosis and is known to affect approximately 5% of the adult population and more than 20% of patients older than 70 years. As for…
Atypical claudication symptoms in adolescents and young adults are often associated with athletic overuse injuries and are clinically manifested by isolated muscle group cramping and focal paresthesias on the dorsal or plantar surface of the feet. These complaints commonly have…
Adventitial cystic disease of the popliteal artery is a relatively rare cause of lower limb ischemia in which single or multiloculated cysts develop within the adventitial layer of the wall of the popliteal artery. As the typical gelatinous secretions of…