English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

End stage renal disease (ESRD) and diabetes mellitus are independently associated with advanced atherosclerosis with extended arterial wall calcifications and occlusions in inferior limb arteries (Norgreen et al., 2007). A severe arterial affectation was commonly documented in critical inferior limb ischemic (CLI) wounds, particularly located in the tibial trunks of these patients (Casserly, 2008; Norgreen et al., 2007). The association of CLI in subjects with impaired renal function and particularly ESRD leads to a notable higher rate of subsequent morbidity and mortality (Andreoli et al., 2008; Casserly, 2008; Mlekusch et al., 2004). Although revascularization indisputably represents the primary therapy for limb salvage (Casserly, 2008; Conrad et al., 2009; Norgreen et al., 2007), renal patients seem to require strikingly more challenging interventions, that focus hostile and diffusely diseased leg segments (Andreoli et al., 2008; Casserly, 2008; Conrad et al., 2009; Randon et al., 2010). Literature on arterial reconstruction (surgical and endovascular) reveals poor patency, tissue recovery and limb preservation data, coupled to high short and mid-term mortality rates for ESRD subjects (independently from other cardio-vascular risk factors) (Abou-Zamzam et al., 2007; Bradbury et al., 2010; Casserly, 2008; Leers et al., 1998). Similar observations were independently documented in diabetic ischemic limbs that have the metabolic and neuropathic background, local sepsis and important amount of tissue loss (Apelqvist et al., 1993; Dormandy et al., 1999; Edmonds, 2008; Norgreen et al., 2007). However, despite progresses in both surgical and endovascular approaches, in 14%-20% of these patients exhibiting advanced crural and pedal occlusive disease, neither of the available procedures can provide appropriate distal arterial supply, turning to amputation (Abou-Zamzam et al., 2007; Dormandy et al., 1999; Faglia et al., 2007). In these desperate cases, since all “conventional” arterial revascularization techniques were unsuccessful, the concept of “venous arterialization”, as extreme alternative for delivering the oxygenated blood to distal ischemic tissues was considered. These limb salvage alternatives for extreme CLI presentations (currently intended to amputation) were mostly described as using the available superficial veins of the affected limb (Jacop et al., 1999; Lengua et al., 2001).

intech ebooks

Is Limb Loss Always Inevitable for Critical Neuro-Ischemic Foot Wounds in Diabetic Patients with End Stage Renal Disease and Unfit for Vascular Reconstructions?