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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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The Journal of Cardiovascular Surgery 2013 Dicembre;54(6):685-711

CRITICAL LIMB ISCHEMIA AND DIABETIC FOOT: AN UPDATE 

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Tips and tricks for a correct “endo approach”

Ferraresi R. 1, Palena L. M. 2, Mauri G. 3, Manzi M. 4

1 Peripheral Interventional Cathlab, Diabetic Foot Clinic Istituto Clinico Città Studi, Milan, Italy;
2 Interventional Radiology Unit Policlinico Abano Terme, Padua, Italy;
3 Radiology Unit, IRCCS Policlinico San Donato Milan, Italy;
4 Interventional Radiology Unit Policlinico Abano Terme, Padua, Italy

The world is facing an epidemic of diabetes, consequently in the next years critical limb ischemia due to diabetic artery disease will become a major issue for vascular and endovascular operators. Revascularization is a key therapy in these patients because reestablishing an adequate blood supply to the wound is essential for healing avoiding a major amputation. In this paper, we summarize our experience in endovascular treatment of diabetic critical limb ischemia, focusing of the main technical challenges in treating below-the-knee vessels. We describe the following topics: 1) targets of the revascularization therapy: “complete” versus “partial” revascularization and the concept of wound related artery. Every procedure must be tailored on technically realistic strategies and on the general patient status; 2) the antegrade femoral access using both, the X-ray and the ultrasound guided techniques; 3) the chronic total occlusions crossing strategy proposing a step-by-step approach: endoluminal, subintimal, retrograde approaches. Particular attention has been given to the different retrograde approaches: pedal-plantar loop technique, trans-collateral approaches and the different types of retrograde puncture. For each step we provide a complete description of the technical details and of the suitable devices. Eventually we in brief describe: 3) acute result optimization and 4) prevention of restenosis.

lingua: Inglese


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