Search Our Scientific Publications & Authors

JAMA Surg 2019 Mar 20. Epub 2019 Mar 20.

Division of Acute Care Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.

Importance: The need for improved methods of hemorrhage control and resuscitation has resulted in a reappraisal of resuscitative endovascular balloon occlusion of the aorta (REBOA). However, there is a paucity of data regarding the use of REBOA on a multi-institutional level in the United States.

Objective: To evaluate the outcomes in trauma patients after REBOA placement. Read More

World J Diabetes 2019 Mar;10(3):200-211

Department of Medicine, Federal Medical Center Umuahia, Abia 440001, Nigeria.

Background: Nigeria bears the greatest burden of diabetes prevalence in Sub-Saharan Africa. Diabetic foot ulcer (DFU) is a serious and potentially life-threatening complication of diabetes. Significant improvements in diabetic foot incidence and outcomes have been recorded in many Western countries in the past decade. Read More

J Diabetes Res 2019 11;2019:7132861. Epub 2019 Feb 11.

Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Background: The occurrence and complications of diabetes are increasing worldwide. This study examined the prevalence and determinants of diabetic foot ulcers and lower extremity amputations in three selected tertiary hospitals in Ghana.

Methods: A cross-sectional multicenter study involving 100 subjects was carried out. Read More

Eklem Hastalik Cerrahisi 2019 Apr;30(1):24-31

Department of Orthopedics and Traumatology, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, 06200, Demetevler, Ankara, Turkey.

Objectives: This study aims to evaluate the clinical characteristics and treatment outcomes of patients with primary malignant tumors located in the proximal fibula.

Patients And Methods: This retrospective study included 23 patients (15 males, 8 females; mean age 22.1 years; range, 9 to 63 years) with primary malignant tumors located in the proximal fibula between May 2007 and May 2017. Read More

Plast Reconstr Surg Glob Open 2019 Feb 13;7(2):e2058. Epub 2019 Feb 13.

Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex.

Exposed orthopedic hardware in the lower extremity complicated by peripheral arterial disease typically demands multiple operative procedures by several disciplines to maintain skeletal integrity and achieve complete wound healing. For ambulatory patients that are either not candidates for lower extremity revascularization or prefer not to pursue surgical attempts at limb preservation, wound palliation is a potential management strategy. We discuss a patient with a history of severe peripheral arterial disease and a left pilon fracture previously treated with open reduction and internal fixation. Read More

Int J Angiol 2019 Mar 2;28(1):39-43. Epub 2019 Jan 2.

Department of Cardiothoracic and Vascular Surgery, Kinan Hospital, Sinjyocho, Tanabe, Japan.

Graft infections are a challenging complication in lower extremity bypass surgery with poor outcome, even when treated with graft removal (Gr-R) as a gold standard therapy. The efficacy of negative pressure wound therapy (NPWT) for graft infections has been reported recently, but it is still controversial. The purpose of this study was to assess the efficacy of NPWT and Gr-R for treating graft infections. Read More

Diabetologia 2019 Mar 12. Epub 2019 Mar 12.

The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia.

Aims/hypothesis: The primary analysis of the Canagliflozin cardioVascular Assessment Study (CANVAS) Program showed canagliflozin to have a beneficial effect on cardiovascular and renal outcomes in people with type 2 diabetes at high cardiovascular risk, but also an unexpected increased risk of major or minor lower extremity amputation. These secondary analyses explore this finding in more detail.

Methods: The effect of canagliflozin on amputation risk in the CANVAS Program was calculated for amputations of different types and proximate aetiologies and different canagliflozin doses. Read More

Br J Surg 2019 Mar 13. Epub 2019 Mar 13.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.

Background: Patients who undergo lower extremity amputation secondary to the complications of diabetes or peripheral artery disease have poor long-term survival. Providing patients and surgeons with individual-patient, rather than population, survival estimates provides them with important information to make individualized treatment decisions.

Methods: Patients with peripheral artery disease and/or diabetes undergoing their first unilateral transmetatarsal, transtibial or transfemoral amputation were identified in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. Read More

Ugeskr Laeger 2019 Mar;181(11)

In this case report, a 67-year-old woman presented with increasing pain in the left side of the thigh and pelvis. A PET scan revealed a large malignant tumour in the left side of the pelvis and proximal left femur, and an ultrasound-guided biopsy diagnosed an undifferentiated pleomorphic sarcoma. Combined orthopaedic and plastic surgery resulted in a left-sided hemipelvectomy and amputation of the left leg. Read More

Ann Burns Fire Disasters 2018 Sep;31(3):181-184

Iran University of Medical Sciences.

The incidence of diabetes and diabetic foot burns is increasing worldwide. In the present study, we surveyed frequency, morbidity and mortality of diabetic foot burn patients in our centre. The study was a cross-sectional survey with one-year follow up of our adult diabetic patients with lower extremity burns. Read More

Semin Plast Surg 2019 Feb 8;33(1):17-23. Epub 2019 Mar 8.

Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.

With the advent of the Industrial Revolution, traumatic injuries of the upper extremity increased exponentially. As a result, surgeons began to reevaluate amputation as the standard of care. Following the Second World War, local and regional pedicled flaps became common forms of traumatic upper extremity reconstruction. Read More

J Vasc Surg 2019 Mar 6. Epub 2019 Mar 6.

Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, Calif. Electronic address:

Background: The impact of preoperative glycemic control on the risk of adverse perioperative outcomes in diabetic patients undergoing lower extremity bypass (LEB) surgery is not well-understood. We determined whether higher preoperative hemoglobin A1c (HbA1c) levels are associated with an increased risk of major adverse limb events, major adverse cardiovascular events, and mortality in diabetic patients undergoing infrainguinal LEB.

Methods: A retrospective review of all infrainguinal LEB surgeries in the Vascular Quality Initiative registry from January 2012 to February 2017 was performed. Read More

Clin Biomech (Bristol, Avon) 2019 Feb 27;63:95-103. Epub 2019 Feb 27.

F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40506, USA. Electronic address:

Background: Alterations and asymmetries in trunk motions during activities of daily living, involving lower extremities, are suggested to cause higher spinal loads in persons with unilateral lower limb amputation. Given the repetitive nature of most activities of daily living, knowledge of the amount of increase in spinal loads is important for designing interventions aimed at prevention of secondary low back pain due to potential fatigue failure of spinal tissues. The objective of this study was to determine differences in trunk muscle forces and spinal loads between persons with and without lower limb amputation when performing sit-to-stand and stand-to-sit tasks. Read More

J Foot Ankle Surg 2019 Mar;58(2):295-300

Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC. Electronic address:

Patients with diabetic Charcot neuroarthropathy (CN) are at high risk for ulcerations and major lower extremity amputations (LEAs). Osseous reconstruction is an important component in ulcer healing and prevention; however, despite such efforts, major LEAs remain a serious postreconstruction concern. The aim of this study was to identify risk factors for major LEA in patients who underwent osseous Charcot reconstruction. Read More

Curr Diabetes Rev 2019 03 7. Epub 2019 Mar 7.

Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background And Aims: Diabetic foot ulcer is recognized as the consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter-related nursing interventions concerned with diabetic foot ulcers are limited. Read More

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2019 Feb;44(2):180-185

Department of Burn Reconstruction Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.

Objective: To summarize the clinical features of Marjolin's ulcers in lower limbs and the diagnosis and treatment methods for it.
 Methods: The clinical data of 89 patients with lower limbs Marjolin's ulcers, who were treated in Xiangya Hospital, Central South University from Jan 1998 to Dec 2017, were retrospectively analyzed, including demographics, injury factors, length of cancer incubation period, lesion location, ulcer area, pathological type, bone invasion, lymph node metastasis, surgical methods, repair methods and prognosis.
 Results: There were 70 males and 19 females among 89 patients with lower limbs Marjolin's ulcers. Read More

J Vasc Surg 2019 Mar 2. Epub 2019 Mar 2.

Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn. Electronic address:

Objective: Aortobifemoral (ABF) bypass is the preferred method of bilateral inflow revascularization, with axillobifemoral (AXBF) bypass reserved for high-risk patients. Hybrid (HYB) surgery in the form of femorofemoral bypass and retrograde endovascular aortoiliac intervention is increasingly being used to achieve the same goal. This study compared the perioperative outcomes of HYB surgery with traditional surgery for bilateral inflow revascularization. Read More

Clin Orthop Relat Res 2019 Apr;477(4):802-810

Uniformed Services University - Walter Reed Department of Surgery, Bethesda, MD, USA.

Background: Amputations sustained owing to combat-related blast injuries are at high risk for deep infection and development of heterotopic ossification, which can necessitate reoperation and place immense strain on the patient. Surgeons at our institution began use of intrawound antibiotic powder at the time of closure in an effort to decrease the rate of these surgical complications after initial and revision amputations, supported by compelling clinical evidence and animal models of blast injuries. Antibiotic powder may be useful in reducing the risk of these infections, but human studies on this topic thus far have been inconclusive. Read More

Clin Orthop Relat Res 2019 Apr;477(4):829-835

K. Spahn, Department of Orthopedics, Naval Medical Center San Diego, San Diego, CA, USA M. P. Wyatt, J. M. Stewart, C5 Gait Analysis Laboratory, Naval Medical Center San Diego, San Diego, CA, USA B. N. Mazzone, A. J. Yoder, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA, USA; and Naval Medical Center San Diego, San Diego CA, USA K. M. Kuhn, Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA.

Background: Surgical attempts at lower limb preservation after trauma may be complicated by pain and gait disturbances, which can impact the activity level of a military service member. It is unclear how later transtibial amputation (TTA) might affect patients who elect this option after attempts at limb preservation.

Questions/purposes: The purposes of the study were to compare preamputation and postamputation (1) the numeric rating scale for pain and pain medication use; (2) self-reported activity level, Four Square Step Test (FSST) results, and assistive device use; and (3) spatiotemporal variables measured with instrumented gait analysis in individuals who elected TTA after multiple attempts at limb preservation. Read More

Clin Orthop Relat Res 2019 Apr;477(4):838-847

M. Quacinella, E. Bernstein, K. M. Kuhn, Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA B. Mazzone, Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, San Diego, CA, USA M. Wyatt, Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA.

Background: Pilon fractures are high-energy fractures about the ankle observed commonly in both civilian and military trauma populations. Despite surgical management, outcomes are predictably poorly characterized by functional deficits secondary to pain and stiffness. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) and Return-to-Run clinical pathway were initially designed to treat military service members after complex battlefield lower extremity injuries. Read More

Mil Med 2019 Feb 23. Epub 2019 Feb 23.

Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX.

Introduction: Severe lower limb injuries have a negative impact on many aspects of an individual's life. One rehabilitative option for patients who have undergone limb salvage is the Intrepid Dynamic Exoskeletal Orthosis (IDEO). The IDEO is a custom-made dynamic response device which is used to restore function for patients with a wide variety of injuries. Read More

Trauma Surg Acute Care Open 2019 24;4(1):e000267. Epub 2019 Jan 24.

Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA.

Background: Timely tourniquet placement may limit ongoing hemorrhage and reduce the need for blood products. This study evaluates if prehospital tourniquet application altered the initial transfusion needs in arterial injuries when compared with a non-tourniquet control group.

Methods: Extremity arterial injuries were queried from our level I trauma center registry from 2013 to 2017. Read More

Hisp Health Care Int 2019 Feb 21:1540415319828267. Epub 2019 Feb 21.

2 San Antonio Vascular and Endovascular Clinic, San Antonio, TX, USA.

Background:: In the United States, ethnic minorities are disproportionately affected by diabetes-related lower extremity amputations (LEA) and have higher associated mortality rates than non-Hispanic Whites. Bexar County, a county in south Texas, had higher diabetes rates than both Texas and the national average. Bexar County also had one of the highest LEA hospital admission rates in the State. Read More

World J Diabetes 2019 Feb;10(2):133-136

Infectious Diseases and Internal Medicine, San Francisco VA Medical Center, Santa Rosa, CA 95492, United States.

Background: Sodium glucose cotransporter 2 (SGLT2) inhibitors use has been associated with toe amputations and non-healing ulcers and gangrene mostly of lower extremities. There are no case reports about association of Empagliflozin with finger ulcers or gangrene. This is the first case report of Empagliflozin (Jardiance) an SGLT2 inhibitor causing gangrene of fingers and second case in literature about any SGLT2 inhibitor causing gangrene of upper extremity. Read More

J Vasc Surg 2019 Feb 18. Epub 2019 Feb 18.

Department of Surgery at the Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md. Electronic address:

Objective: Vascular injury is a leading cause of death and disability in military and civilian settings. Most wartime and an increasing amount of civilian vascular trauma arises from penetrating mechanisms of injury due to gunshot or explosion. The objective of this study was to provide a comprehensive examination of penetrating lower extremity arterial injury and to characterize long-term limb salvage and differences related to mechanisms of injury. Read More

Vasc Med 2019 Feb 21:1358863X18817610. Epub 2019 Feb 21.

8 Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

The efficacy of biologic therapies in critical limb ischemia (CLI) remains elusive, in part, due to limitations in trial design and patient selection. Using a novel design, we examined the impact of complementing revascularization therapy with intramuscular JVS-100 - a non-viral gene therapy that activates endogenous regenerative repair pathways. In this double-blind, placebo-controlled, Phase 2B trial, we randomized 109 patients with CLI (Rutherford class V or VI) to 8 mg or 16 mg intramuscular injections of placebo versus JVS-100. Read More

J Cell Biochem 2019 Feb 19. Epub 2019 Feb 19.

Department of Peripheral Vascular, Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China.

Objective: To clarify and quantify risk factors among local characteristics of the foot for major amputation in diabetic foot patients.

Methods: Articles published before January 2018 on PubMed and Embase were conducted observational studies about risk factors for major amputation in patients with diabetic foot were retrieved and systematically reviewed by using Stata 12.0 statistical software. Read More

BMJ Open 2019 Jan 15;9(1):e024963. Epub 2019 Jan 15.

Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.

Objectives: To evaluate the healthcare cost of amputation and prosthesis for management of upper and lower extremities in a single institute.

Design: Retrospective cohort study conducted between 2000 and 2014.

Participants: All patients who underwent upper (UEA) and lower extremities amputation (LEA) were identified retrospectively from the operating theatre database. Read More

J Am Soc Nephrol 2019 Feb 19. Epub 2019 Feb 19.

Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington.

Background: Lower extremity amputation is common among patients with ESRD, and often portends a poor prognosis. However, little is known about end-of-life care among patients with ESRD who undergo amputation.

Methods: We conducted a mortality follow-back study of Medicare beneficiaries with ESRD who died in 2002 through 2014 to analyze patterns of lower extremity amputation in the last year of life compared with a parallel cohort of beneficiaries without ESRD. Read More

J Vasc Surg 2019 Feb 15. Epub 2019 Feb 15.

Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Mich. Electronic address:

Objective: The objective of this study was to evaluate the safety and efficacy of a retrograde tibial approach in revascularization of lower extremities for treatment of ischemia in anatomically challenging patients.

Methods: This is a retrospective study of 57 procedures performed between 2012 and 2016 using the retrograde approach to treat patients with flush occlusion, inability to cross the lesion, failed bypass, or hostile groin. Demographic data, Rutherford classes, vessels treated, and approach were noted. Read More

Sensors (Basel) 2019 Feb 14;19(4). Epub 2019 Feb 14.

Department of Nursing, University of Extremadura, E06006 Badajoz, Spain.

One of the diseases that could affect diabetic patients is the diabetic foot problem. Unnoticed minor injuries and subsequent infection can lead to ischemic ulceration, and may end in a foot amputation. Preliminary studies have shown that there is a positive relationship between increased skin temperature and the pre⁻ulceration phase. Read More

Ann Vasc Surg 2019 Feb 13. Epub 2019 Feb 13.

Department of Surgery, Johns Hopkins Bayview Vascular and Endovascular Research Center, Baltimore, MD; Department of Surgery, University of California San Diego, La Jolla, CA. Electronic address:

Background: Drug abuse may affect lower extremity vessels due to ischemia following intra-arterial injections, vasospasm, arterial and venous pseudoaneurysms, arteriovenous fistulae, vasculitis, and complicated abscesses. Little is known about the outcomes of lower extremity bypass (LEB) for peripheral arterial disease (PAD) in patients with a history of drug abuse disorder. The aim of this study is to evaluate the outcomes of LEB in this patient population. Read More

J Wound Care 2019 Feb;28(Sup2):S24-S29

Michigan State University College of Human Medicine, Grand Rapids, Michigan, US.

Objective:: The purpose of this study was to use a fluorescence imaging system (FIS) (SPYElite, NOVADAQ, US) during lower extremity amputations and develop parameters to predict amputation healing, for which there are no proven, objective tests. We hypothesised that the FIS may identify areas of poor perfusion at the time of amputation and predict potential healing complications. There are no studies involving the FIS used in this study in lower extremity amputation. Read More

Int Wound J 2019 Feb 15. Epub 2019 Feb 15.

Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.

To compare the outcomes of diabetic foot ulcers (DFU) in terms of healing and lower extremity amputation (LEA) rate before and after training of multidisciplinary foot care team (MDFCT). Subjects were categorised into two groups; Group-A cases seen between 1997 and 2006 (before upgrading of training and services of MDFCT) and Group-B cases seen between 2007 and 2016 (after upgrading of training and services of MDFCT). Baseline demographic characteristics, biochemical results, and outcomes of DFU in terms of healing or amputation were analysed by using statistical package social science (SPSS) version 20. Read More

Prosthet Orthot Int 2019 Feb 14:309364619826386. Epub 2019 Feb 14.

1 Center for the Intrepid, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA.

Background:: Individuals with severe lower extremity injuries often require ankle-foot orthoses to return to normal activities. Ankle-foot orthoses alignment is a key consideration during the clinical fitting process and may be particularly important during dynamic activities such as running.

Objective:: To investigate how 3° changes in sagittal plane ankle-foot orthoses alignment affect running mechanics. Read More

J Hand Surg Asian Pac Vol 2019 Mar;24(1):89-92

† Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico.

Parkes Weber Syndrome (PWS) is a congenital disorder characterized by the presence of arteriovenous malformations (AVMs) in upper or lower extremities. We herein present a 35 year-old male with PWS with complex AVMs in the right upper extremity; he had been previously treated with multiple sessions of vessel embolization, sclerotherapy and AVM resections. The patient presented to our clinic with two month history of progressive hand ischemia, digit necrosis and infection. Read More

J Orthop Sports Phys Ther 2019 Feb 13:1-26. Epub 2019 Feb 13.

Naval Medical Center San Diego, San Diego, CA.

Background: Severe ankle and foot injuries in the U.S. military can result in high-level functional limitation, lost duty days and medical discharge. Read More

J Am Podiatr Med Assoc 2018 Nov;108(6):503-507

Background:: The scope of podiatric practice has changed significantly in the past couple of decades. Despite the increased quality of training, many people outside of podiatry may not realize what our scope of practice entails.

Methods:: We conducted a survey consisting of 10 items and asked internal medicine residents at Rush University Medical Center and patients whether they would feel comfortable consulting podiatrists, or being treated for each issue. Read More

Ann Vasc Surg 2019 Feb 4. Epub 2019 Feb 4.

Department of Vascular Surgery, Heart and Vascular Institute, Cleveland, OH.

Background: Critical limb ischemia (CLI) patients who do not undergo revascularization are at great risk for major lower extremity (LE) amputation. It has been reported that less than half (49%) of a reference Medicare amputation population had any diagnostic vascular evaluation prior to a major LE amputation. We were surprised by these data so we reviewed the preoperative evaluation in all patients who had a major LE amputation. Read More

SAGE Open Med Case Rep 2019 22;7:2050313X18823438. Epub 2019 Jan 22.

Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, QC, Canada.

The management of a mangled limb is a challenging endeavor. With the advancement in microsurgery, spare parts surgery (fillet flaps) has gained recent interest. In the context of lower extremity amputation secondary to trauma, viable spare parts can provide stump soft tissue coverage, potentially preserving critical length and obviating above-knee amputations. Read More

Semin Intervent Radiol 2018 Dec 5;35(5):461-468. Epub 2019 Feb 5.

Division of Vascular and Interventional Radiology, Rush University Medical Center, Rush Oak Park Hospital, Chicago, Illinois.

Endovascular recanalization for patient with peripheral arterial disease and the end of its spectrum critical limb ischemia (CLI) has become a preferred method of revascularization due to advancement of techniques and equipment, allowing reduction of limb amputations while maintaining a minimally invasive approach compared to surgical approaches. Interventionalists have undertaken a progressively increasing complexity of diseased vessels in the hopes of providing inline unobstructed flow through occlusions for patients with claudication as well as direct flow to a nonhealing wound in patients with CLI. One of the major roadblocks encountered in lower extremity recanalization procedures is managing severely calcified chronic thrombotic occlusions which decrease luminal revascularization, ultimately increasing use of adjunctive interventions such as subintimal tracking, reentry device utilization, and stent placement. Read More

Semin Intervent Radiol 2018 Dec 5;35(5):399-405. Epub 2019 Feb 5.

Vascular and Interventional Radiology, Olympia, Washington.

Peripheral arterial disease (PAD) is a currently underdiagnosed and underrecognized vascular disease afflicting up to 200 million people worldwide, with at least 1 million of those suffering from critical limb ischemia (CLI). The 5-year mortality after major amputation for CLI (70%) is twice the average 5-year cancer mortality in the United States, and as many as 50% of CLI patients proceed directly to amputation without preceding vascular assessment or revascularization. Each year, twice as many breast augmentations are performed as leg revascularizations. Read More

Semin Intervent Radiol 2018 Dec 5;35(5):365-377. Epub 2019 Feb 5.

University of Miami, Miller School of Medicine, Miami, Florida.

Lower extremity peripheral arterial disease (PAD) is the manifestation of atherosclerotic disease within the lower extremities. The presentation of PAD is diverse ranging from asymptomatic disease to claudication or to debilitating rest pain, nonhealing ulcers, and gangrene. PAD is associated with significant morbidity, mortality, and healthcare costs. Read More

Curr Vasc Pharmacol 2019 Feb 6. Epub 2019 Feb 6.

Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa. Italy.

Lower extremity artery disease (LEAD) represents a major public health burden, affecting hundreds of millions people worldwide. Although risk-factor modification, exercise training and medical treatment are the mainstay of the management of LEAD, endovascular or surgical revascularisation is recommended when there is the risk of limb amputation and when drug-resistant claudication severely affects patient lifestyle. Over recent years, the number of peripheral vascular interventions (PVI) has soared worldwide, driven by the improvements in endovascular techniques and devices. Read More

Curr Vasc Pharmacol 2019 Feb 6. Epub 2019 Feb 6.

Department of Cardiology, Dupuytren University Hospital Centre, Limoges. France.

Lower extremity artery disease (LEAD) is a marker of a more advanced atherosclerotic process often affecting multiple vascular beds beyond the lower limbs, with a consequent increased risk for all-cause and cardiovascular mortality. Antithrombotic therapy is the cornerstone of management of these patients to prevent ischaemic cardiovascular and limb events and death. In patients with symptomatic LEAD, the efficacy of aspirin has been established long ago for the prevention of cardiovascular events. Read More

Bone Joint J 2019 02;101-B(2):221-226

Duke University Hospital, Durham, North Carolina, USA.

Aims: The aim of this study was to characterize the factors leading to transfemoral amputation after total knee arthroplasty (TKA), as well as the rates of mortality and functional independence after this procedure in these patients.

Patients And Methods: This was a multicentre retrospective review with a prospective telephone survey for the assessment of function. All patients with a TKA who subsequently required transfemoral amputation between January 2001 and December 2015 were included. Read More

Diabetes Obes Metab 2019 Jan 29. Epub 2019 Jan 29.

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.

Aim: To examine whether sodium-glucose co-transporter-2 (SGLT2) inhibitors are associated with a higher risk of lower-extremity amputation than dipeptidyl-peptidase-4 (DPP-4) inhibitors and sulphonylureas.

Methods: We conducted a retrospective cohort study, using the MarketScan Commercial Claims and Encounters Database (2013-2015), to compare the incidence of lower-extremity amputation (LEA) between initiators of SGLT2 inhibitors and initiators of two second-line drugs, DPP-4 inhibitors and sulphonylureas (SUs). We estimated crude incidence rates (IRs) and adjusted hazard ratios (aHR), with 95% confidence intervals (CIs), before and after propensity-score weighting. Read More

Disabil Rehabil 2019 Jan 27:1-10. Epub 2019 Jan 27.

b Schulich School of Medicine and Dentistry Department of Physical Medicine and Rehabilitation , University of Western Ontario , London , ON , Canada.

Purpose: Falls are prevalent among people with lower extremity amputations. A knowledge of risk factors is important in preventing falls, though no research has evaluated patient understanding of falls in this population. The study objective was to evaluate knowledge of falls risk factors and falls prevention strategies at discharge and 4-months after inpatient prosthetic rehabilitation. Read More

Ann Vasc Surg 2019 Jan 23. Epub 2019 Jan 23.

David Geffen School of Medicine at UCLA, Los Angeles, CA; Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA. Electronic address:

Background: Early identification of peripheral vascular injuries is crucial to prevent acute limb ischemia and amputation. We sought to identify predictors of vascular injury in patients with blunt lower extremity fractures.

Methods: A single institutional retrospective analysis of patients with blunt lower extremity fractures at a university-affiliated, County hospital over a 2-year period was performed. Read More

Medicine (Baltimore) 2019 Jan;98(4):e14224

Department of Orthopedic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.

Rationale: Diabetic foot ulcer is a severe complication of diabetes, and most patients with diabetic foot ulcer require amputation. The incidence of Budd-Chiari syndrome is low; it is relatively rare. Diabetic foot ulcer combined with Budd-Chiari syndrome has not been reported so far. Read More