VOLUME 6, 2023
The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review
VOLUME 7, 2024
Chronic Inferior Vena Cava Filter-Related Occlusion: Presentation, Diagnosis, Management, and Controversy
Tyler Callese
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
Savannah Fletcher
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
Mona Ranade
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
John Moriarty
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Los Angeles, CA, USA.
Abstract
Inferior vena cava filters (IVCF) are caval interruption devices designed to decrease the incidence of pulmonary embolism by capturing thrombus in-transit. Rare, long-term complications of IVCF include fracture, migration, caval perforation, recurrent deep venous thrombosis (DVT) and IVCF-related caval occlusion. Chronic IVCF-related caval occlusion is a challenging complication with a variable presentation, potential for significant morbidity, and limited evidence guiding management. In symptomatic patients, first-line treatment includes endovascular caval reconstruction utilizing various techniques including, venoplasty, thrombolysis, thrombectomy and/or stenting with or without removal of indwelling IVCF.
Keywords :
Inferior vena cava filter, thrombectomy, angioplasty, caval stenting.
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.
Mark Yang
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.
Abstract
Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords :
Diabetic foot ulcer, angiosome, angioplasty