Abstract:
:Patients with end-stage renal disease (ESRD) who present with critical limb ischemia (CLI) have become an increasingly common and complex treatment problem for vascular surgeons. Dialysis patients have high short-term mortality rates regardless of whether revascularization is pursued. ESRD patients with CLI can be managed with: local wound care, endovascular or surgical revascularization, or amputation. Some patients may heal small foot wounds with local wound care alone, even if distal perfusion is marginal, as long as any infectious process has been controlled. Surgical revascularization has a mortality rate of 5-10% but has a high chance of limb salvage. However, overall 5-year survival may be as low as 28%. Endovascular therapy also carries a high perioperative mortality risk in this population with similar limb salvage rates. Amputation is indicated in patients with advanced stage CLI, as described by the Society for Vascular Surgery's Wound, Ischemia and foot Infection (WIfI) system. Statistical models predict that endovascular or surgical revascularization strategies are less costly and more functionally beneficial to patients than primary amputation alone. Decisions on how to manage ESRD patients with CLI are complex but revascularization can often result in limb salvage, despite limited overall survival. Dialysis patients with good life expectancy and good quality conduit may benefit most from surgical bypass.
journal_name
Vasc Endovascular Surgjournal_title
Vascular and endovascular surgeryauthors
Jones DW,Dansey K,Hamdan ADdoi
10.1177/1538574416674843subject
Has Abstractpub_date
2016-11-01 00:00:00pages
582-585issue
8eissn
1538-5744issn
1938-9116pii
1538574416674843journal_volume
50pub_type
杂志文章abstract::Finger ischemia due to embolic occlusion of digital arteries resulting from trauma to the palmar ulnar artery has been termed hypothenar hammer syndrome (HHS). In HHS, arterial thrombosis and/or aneurysm formation with embolization to the digital arteries causes symptoms of ischemia. We describe a patient in whom the ...
journal_title:Vascular and endovascular surgery
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journal_title:Vascular and endovascular surgery
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journal_title:Vascular and endovascular surgery
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doi:10.1177/1538574410395040
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pub_type: 社论,评审
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