The Experts below are selected from a list of 11931 Experts worldwide ranked by ideXlab platform

Yoshimitsu Soga - One of the best experts on this subject based on the ideXlab platform.

Nobuyoshi Azuma - One of the best experts on this subject based on the ideXlab platform.

O Iida - One of the best experts on this subject based on the ideXlab platform.

Curt Diehm - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Critical Limb Ischemia: European experiences.
    Journal of Cardiovascular Surgery, 2009
    Co-Authors: Nicolas Diehm, Antonio Silvestro, Iris Baumgartner, Dai-do Do, Jurg Schmidli, Curt Diehm, Florian Dick
    Abstract:

    Chronic Critical Limb Ischemia still poses a substantial threat to both Limb and life of the affected patients since these patients suffer typically also from associated cardiac and cerebrovascular disease and other severe comorbidities. Due to improved secondary prevention strategies and dedicated technical innovation, however, clinical outcomes have improved in the recent years. Purpose of this article is to provide a balanced discussion of contemporary treatment concepts for patients with Critical Limb Ischemia with a focus on arterial revascularization.

  • Long-term outcomes after medical and interventional therapy of Critical Limb Ischemia.
    European journal of internal medicine, 2009
    Co-Authors: Holger Lawall, Peter Bramlage, Hannah Gorriahn, Klaus Amendt, Jürgen Ranft, Curt Diehm
    Abstract:

    Recommendations of clinical guidelines for the treatment of Critical Limb Ischemia (CLI) are based on randomized controlled trials. Recent data from clinical practice are however lacking. Therefore a prospective observational study in patients with Critical Limb Ischemia (CLI) in 3 hospitals with a specialized vascular medicine department was conducted to document the clinical course and outcome of patients with Critical Limb Ischemia (CLI) in clinical practice. 155 patients were stratified: 56 received endovascular intervention, 82 prostanoids and 17 antibiotic treatment. Patients with surgical revascularisation and primary amputation were excluded. All patients received structured wound treatment, analgesia and vascular risk factor treatment during hospital stay. Age 72.0+/-12.7 years, hospitalisation 23.2+/-20.3 days. 56.1% had Diabetes, 9.7% multiresistant staphylococcus aureus infection. 40% patients had rest pain, 60% ischemic tissue loss. At discharge 40.0% had no ulcers, 48.4% ongoing trophic alterations, 10.3% received major amputation and 4.5% had stable necrosis. After 18 month rate of major amputation was 6.3% (prostanoids), 14.5% (endovascular treatment; p=n.s. vs. prostanoids) and 26.7% (antibiotics; p=0.0323 vs. prostanoids). Major amputations were not different in logistic regression analyses adjusting for baseline characteristics. Wound healing and mortality rate was not different between groups (26.8, 25.0 and 23.5%). Structured therapy at specialized vascular centres in combination with interventional or conservative treatment is beneficial in patients with Critical Limb Ischemia. Survival without amputation is higher than expected over 18 months.

  • Non-invasive treatment of Critical Limb Ischemia.
    Current Drug Targets - Cardiovascular & Hematological Disorders, 2004
    Co-Authors: Curt Diehm, Nicolas Diehm
    Abstract:

    : Patients with threatening Ischemia of the lower extremities constitute a steadily increasing patient population owing to the increasing age of the general population and the growing incidence of diabetes. The goals of treatment for patients with Critical Limb Ischemia (CLI) are pain control, wound healing, Limb salvage, improvement of quality of life and reduction of overall cardiovascular risk. A high proportion of patients with CLI have coexisting diseases, mainly cardiovascular and renal disorders. The purpose of this article is to summarize non-invasive treatment options in patients with CLI and to Critically review the results of landmark investigations dealing with conservative therapy for chronic Critical Limb Ischemia.

  • Intraindividual evaluation of the optimal PGE1 application route in Critical Limb Ischemia
    International Journal of Angiology, 1994
    Co-Authors: Thomas Weiss, Curt Diehm, Joachim Griesshaber, Waltraud Rogatti, Claudia Wilhelm, Wolfgang Kübler
    Abstract:

    Since prostaglandin E1 was first used for the treatment of Critical Limb Ischemia, the best route of administration—intraarterial (i.a.) or intravenous (i.v.)—has not yet been determined. The aim of this study was to compare the effects of i.a. and i.v. prostaglandin E1 (PGE1) infusions on transcutaneous partial pressure of oxygen (tcPO2) on a within-patient basis in patients with Critical Limb Ischemia. In a randomized, crossover study, 20 patients with Critical Limb Ischemia were treated with a 30-minute i.a. infusion of 10 µg PGE1 in 25 ml saline and a 60-minute i.v. infusion of 40 µg PGE1 in 125 ml saline. During i.a. infusion of PGE1, the mean tcPO2 (forefoot) decreased significantly from 12.2 mmHg to 3.3 mmHg (−73%,p

  • Prostaglandin E1 in Critical Limb Ischemia transcutaneous PO2: A predictor of efficacy?
    International Journal of Angiology, 1994
    Co-Authors: Thomas Weiss, Curt Diehm, Joachim Griesshaber, Waltraud Rogatti, Claudia Wilhelm, Wolfgang Kübler
    Abstract:

    Prostaglandin E1 (PGE1) has found a widespread use in treating patients with Critical Limb Ischemia. Because therapy with PGE1 is time and cost intensive, a parameter for identifying nonresponders and consecutive therapy failures would be helpful. Therefore, the aim of this study was to evaluate the role of transcutaneous PO2 (tcPO2), before and after IV application of PGE1, in patients with Critical Limb Ischemia as a predictor of efficacy.

Sebastian Schellong - One of the best experts on this subject based on the ideXlab platform.

  • Intermittent intravenous urokinase for Critical Limb Ischemia in diabetic foot ulceration
    Thrombosis and haemostasis, 2008
    Co-Authors: Matthias Weck, Hannes Rietzsch, Holger Lawall, Uwe Pichlmeier, Peter Bramlage, Sebastian Schellong
    Abstract:

    Patients with diabetic foot ulceration and Critical Limb Ischemia have a high risk of major amputation, especially if Limbs can not be revascularized. Urokinase is effective in improving microcirculation in Critical Limb Ischemia and might improve outcomes. There are no data on the efficacy and safety of urokinase treatment (survival free of major amputation, ulcer healing and the rate of minor and major bleeding). Therefore, we aimed to investigate the effect of urokinase treatment in a phase II clinical trial. We performed an open, prospective, non-controlled, multicenter phase II cohort study in 77 type-2 diabetic patients with Critical Limb Ischemia and diabetic foot ulceration. Patients had no surgical or endovascular treatment option based on interdisciplinary consensus. Urokinase (1 Mio IU if plasma fibrinogen >or=2.5 g/l, 0.5 Mio IU if fibrinogen

  • Intermittent intravenous urokinase for Critical Limb Ischemia in diabetic foot ulceration
    Thrombosis and Haemostasis, 2008
    Co-Authors: Matthias Weck, Hannes Rietzsch, Holger Lawall, Uwe Pichlmeier, Peter Bramlage, Sebastian Schellong
    Abstract:

    SummaryPatients with diabetic foot ulceration and Critical Limb Ischemia have a high risk of major amputation, especially if Limbs can not be revascularized. Urokinase is effective in improving microcirculation in Critical Limb Ischemia and might improve outcomes. There are no data on the efficacy and safety of urokinase treatment (survival free of major amputation, ulcer healing and the rate of minor and major bleeding). Therefore, we aimed to investigate the effect of urokinase treatment in a phase II clinical trial. We performed an open, prospective, non-controlled, multi-center phase II cohort study in 77 type-2 diabetic patients with Critical Limb Ischemia and diabetic foot ulceration. Patients had no surgical or endovascular treatment option based on interdisciplinary consensus. Urokinase (1 Mio IU if plasma fibrinogen ≥2.5 g/l, 0.5 Mio IU if fibrinogen < 2.5 g/l) was administered for 21 days as an intravenous infusion over 30 minutes. Each patient was followed up for 12 months. Treatment for a median of 21 days resulted in 33% of patients being alive, having no major amputation and completely healed ulcers after 12 months. Total survival rate was 84.6%,amputation-free survival 69.2% and rate of major amputation 21.1%.Eighty-two percent of patients experienced at least once a complete ulcer healing within the course of study. Three serious adverse events were urokinase-related. Urokinase treatment in diabetic patients with Critical Limb Ischemia appears to be effective, feasible and safe. Although this calls for a larger, randomized and controlled trial, the results are highly relevant for clinical practice to prevent these patients from receiving major amputation due to diabetic foot syndrome.Clinical Trial Registration No.: NCT00537498