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Cureus 2022 May 29;14(5):e25455. Epub 2022 May 29.

Vascular Surgery, Henry Ford Health System, Detroit, USA.

Objective: To analyze whether the rate of lower extremity (LE) ischemia is higher on the ipsilateral side after kidney transplantation.

Methods: Our institutional transplant database was retrospectively queried for all patients who received a kidney transplant and underwent subsequent LE revascularization or major limb amputations between January 2004 and July 2020. The one-sample binomial test was used to test whether the LE ipsilateral to the transplanted kidney was at higher risk of peripheral arterial disease (PAD) complications necessitating intervention (major amputation or revascularization). Read More

J Vasc Surg 2022 Jun 26. Epub 2022 Jun 26.

Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address:

Objective: Black and Hispanic patients have higher rates of chronic limb-threatening ischemia (CLTI) and suffer worse perioperative outcomes after lower extremity bypass compared with White patients. The underlying reasons for these disparities are unclear, and data on 3-year outcomes are limited. Therefore, we examined differences in 3-year outcomes after open infrainguinal bypass for CLTI by race/ethnicity and explored potential factors contributing to these differences. Read More

J Endovasc Ther 2022 Jun 29:15266028221105188. Epub 2022 Jun 29.

Department of Vascular and Endovascular Surgery, General Regional Hospital Ente Ecclesiastico "F. Miulli," Acquaviva Delle Fonti, Italy.

Purpose: Common femoral artery (CFA)-occlusive disease has traditionally been treated with open surgery, yet nowadays the frailty of patients has induced to find new techniques of revascularisation by endovascular means. So far, intravascular lithotripsy (IVL) has shown promising results in several lower limbs arterial districts. The purpose of this article is to report our experience with IVL for severely calcified peripheral arterial disease (PAD) of the CFA. Read More

World J Surg Oncol 2022 Jun 29;20(1):218. Epub 2022 Jun 29.

Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, 317000, Zhejiang, China.

Background: Maffucci syndrome (MS) is a rare, nonhereditary congenital mesodermal dysplasia characterized by multiple enchondromas and hemangiomas, associated with an increased risk of developing malignant tumors. Given their rarity, the pathogenesis of these tumors has not been clarified, and there is no standard treatment.

Case Presentation: We present a case of a 45-year-old man with MS to supplement the clinical manifestations and explore the molecular mechanism of MS. Read More

Diabetes Res Clin Pract 2022 Jun 26;189:109972. Epub 2022 Jun 26.

Antwerp University Hospital, Department of Endocrinology, Diabetology and Metabolism, Drie Eikenstraat 655, B 2650 Edegem, Belgium.

Aims: This study assessed temporal trends in the incidence of lower extremity amputations (LEA) in Belgium from 2009 to 2018, and subsequent secondary amputation rates.

Methods: Nationwide data on LEA were collected. Sex- and age-adjusted annual incidence rates were calculated. Read More

Ochsner J 2022 ;22(2):163-168

Department of Plastic Surgery, Intermountain Medical Center, Murray, UT.

Cutaneous mucormycosis, while less common than sinonasal or pulmonary infections, can cause widespread tissue necrosis after seemingly innocuous encounters. The most common location of cutaneous mucormycosis is the extremities, and extensive infection has been reported after trauma or orthopedic procedures. A 60-year-old female with poorly controlled type 2 diabetes mellitus sustained an open patella fracture after a fall. Read More

Surg Open Sci 2022 Jul 11;9:94-100. Epub 2022 May 11.

Cardiovascular Outcomes Research Laboratories (CORELAB), Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Background: There is a paucity of data examining the impact of advancing chronic kidney disease stages on outcomes following revascularization for acute limb ischemia. The present study examined the association of chronic kidney disease with in-hospital mortality, amputation, and resource utilization following revascularization for acute limb ischemia using a nationally representative cohort.

Methods: The 2016-2018 National Inpatient Sample was queried to identify all adult hospitalizations with lower extremity acute limb ischemia requiring surgical and/or endovascular interventions. Read More

J Diabetes Res 2022 14;2022:7414258. Epub 2022 Jun 14.

Department of Statistical Sciences, University of Bologna, Italy.

Aims: To compare different packages of care across care providers in Scotland on foot-related outcomes.

Methods: A retrospective cohort study with primary and secondary care electronic health records from the Scottish Diabetes Registry, including 6,845 people with type 2 diabetes and a first foot ulcer occurring between 2013 and 2017. We assessed the association between exposure to care processes and major lower extremity amputation and death. Read More

Acta Clin Croat 2021 Dec;60(4):657-664

1University of Novi Sad, Novi Sad Faculty of Medicine, Novi Sad, Serbia; 2Department of Vascular and Endovascular Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia; 3Medical Rehabilitation Department, Clinical Center of Vojvodina, Novi Sad, Serbia.

Lower extremity amputation is a very common amputation and successful prosthetic rehabilitation is a desirable outcome. The aim of this study was to determine which factors affect the success of prosthetic rehabilitation after transtibial vascular amputation. The study included 61 patients who had undergone transtibial amputation (mean age, 64. Read More

JMIR Res Protoc 2022 Jun 22;11(6):e38442. Epub 2022 Jun 22.

Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States.

Background: Lateral ankle sprains (LASs) are common injuries among military service members. Approximately 40% of individuals with an LAS progress to develop chronic ankle instability (CAI), a condition that results in substantial mechanical and neurophysiological impairment and activity limitation. Since proprioceptive and balance training improve functional outcomes and prevent secondary injury following LAS, they are recommended in clinical practice. Read More

JAMA Netw Open 2022 Jun 1;5(6):e2215580. Epub 2022 Jun 1.

Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora.

Importance: Prior studies have observed an association between the burden of atherosclerotic vascular disease and the risk of venous thromboembolism (VTE). The association is not well described in peripheral artery disease (PAD) after lower extremity revascularization (LER).

Objective: To describe the risk of, factors associated with, and outcomes after VTE, as well as the association of low-dose rivaroxaban plus antiplatelet therapy with VTE after LER. Read More

Adv Skin Wound Care 2022 Jul;35(7):1-5

Kyoichi Matsuzaki, MD, PhD, is Professor, Department of Plastic and Reconstructive Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan. Akira Miyamoto, MD, PhD, is Advisor, Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan. The authors have disclosed no financial relationships related to this article. Submitted June 2, 2021; accepted in revised form September 7, 2021.

Abstract: A large diabetic heel ulcer with peripheral arterial disease is an independent predictor of limb loss; below-knee amputation is not uncommon in such cases. One treatment is multimodal therapy, which includes partial calcanectomy. Because there is a limit to the ulcer surface area that can be sutured after partial calcanectomy, the remaining raw surface is treated with another method. Read More

Disabil Rehabil 2022 Jun 18:1-8. Epub 2022 Jun 18.

Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA.

Purpose: Employment status is considered a determinant of health, yet returning to work is frequently a challenge after lower limb amputation. No studies have documented if working after lower limb amputation is associated with functional recovery. The study's purpose was to examine the influence of full-time employment on functioning after lower limb amputation. Read More

J Diabetes Complications 2022 Jul 10;36(7):108222. Epub 2022 Jun 10.

Department of Population and Data Sciences, University of Texas Southwestern Medical Center, United States of America.

Aims: To determine the degree patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations fear complications (death, dialysis, heart attack, stroke, blindness, diabetic foot infection, minor and major lower extremity amputation [LEA]) that can occur and to assess if there is a difference between fears of patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations and diabetic patients without these complications.

Methods: 478 patients completed an eight question Likert scale survey. The study group was defined as non-infected foot ulcers, neuropathic fractures and Charcot neuroarthropathy. Read More

Ir J Med Sci 2022 Jun 17. Epub 2022 Jun 17.

University of Health Sciences, Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, Ankara, 06800, Turkey.

Aims: To determine the relationship between clinic and prosthesis-related characteristics and psychosocial adjustment, activity restriction, satisfaction with the prosthesis and quality of life in myoelectric prosthesis users with upper limb amputation.

Methods: Thirty patients with myoelectric prosthesis users with upper limb amputation took part in this study. The patients' demographic and clinical information were recorded. Read More

Int J Vasc Med 2022 7;2022:3786815. Epub 2022 Jun 7.

Department of Medicine, Rocky Mountain Regional VA Medical Center, Denver, CO, USA.

Background: Acute limb ischemia (ALI) is associated with significant morbidity and mortality. Novel anticoagulants reduce adverse events among patients with peripheral artery disease, though the potential effect of these therapies is unclear in patients with ALI. The present study thus sought to evaluate the potential clinical benefit of universal application of novel anticoagulants to a high-risk population of patients with ALI. Read More

Disabil Rehabil 2022 Jun 16:1-10. Epub 2022 Jun 16.

The London Sarcoma Service, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.

Purpose: Ambulatory activity (walking) is affected after sarcoma surgery yet is not routinely assessed. Small inexpensive accelerometers could bridge the gap. Study objectives investigated, whether in patients with lower extremity musculoskeletal tumours: (A) it was feasible to conduct ambulatory activity assessments in patient's homes using an accelerometer-based wearable (AX3, Axivity). Read More

J Vasc Surg 2022 Jun 13. Epub 2022 Jun 13.

Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY, USA.

Objective: Antiplatelet therapy is recommended in patients with Peripheral Arterial Disease (PAD) to reduce cardiovascular risk and improve outcomes. However, issues including the drug of choice and use of dual antiplatelet (DAPT) vs monotherapy remain unclear. This study aims to compare the impact of aspirin (ASA) monotherapy, P2Y12 monotherapy and DAPT on limb salvage (LS), amputation-free survival (AFS) and overall survival (OS) in patients undergoing lower extremity peripheral endovascular intervention (PVI) for chronic limb threatening ischemia (CLTI). Read More

J Vasc Surg 2022 Jun 13. Epub 2022 Jun 13.

Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address:

Objective: First-line treatment of peripheral artery disease (PAD) involves medical therapy and lifestyle modification. Multiple professional organizations such as the Society for Vascular Surgery (SVS) and the American Heart Association/American College of Cardiology (AHA/ACC) make Class I recommendations for medical management including antiplatelet, statin, antihypertensive, and cilostazol medications, as well as lifestyle therapy including exercise and smoking cessation. Although evidence supports up-front medical and lifestyle management prior to surgical intervention, it is unclear how well this occurs in contemporary clinical practice. Read More

Clin Interv Aging 2022 8;17:925-936. Epub 2022 Jun 8.

University of Turku, Faculty of Medicine, Turku, 20521, Finland.

Purpose: The aim of the present study was to describe and analyze changes in the incidences of lower extremity amputations (LEAs), patient characteristics, vascular history of amputees and survival in Southwest Finland.

Patients And Methods: This is a retrospective patient study in the Hospital District of Southwest Finland. All consecutive patients with atherosclerosis and diabetes-caused LEA, between 1st January 2007 and 31st December 2017, were included. Read More

Prosthet Orthot Int 2022 Jun 14;46(3):290-293. Epub 2021 Dec 14.

Physical Therapy Department, King Fahed Medical City, Saudi Arabia.

Background: The number of amputations secondary to diverse factors in Arabic countries is expected to rise in the coming years. Therefore, there is a need for high-quality service that can be monitored by the use of standardized patient-reported outcome measures of amputee patients' functional status. This study aimed to translate the Lower Extremity Functional status Orthotics and Prosthetics Users' Survey (OPUS-LEFS) to Arabic and test its reliability in a sample of Arabic-speaking people with amputation. Read More

Prosthet Orthot Int 2022 Jun 14;46(3):213-219. Epub 2021 Dec 14.

Department of Occupational therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Background: This study investigated the impact of COVID-19 restrictions on ambulatory activity and health-related quality of life (HR-QoL) in people with a lower limb amputation (LLA) in Norway. We hypothesized that the restrictions would negatively affect HR-QoL and decrease prosthetic wear time and ambulatory activity in participants with already limited mobility.

Methods: Twenty individuals with LLA (age and time since amputation 56. Read More

J Med Econ 2022 Jan-Dec;25(1):880-887

Diaconess Hospital Flensburg, Flensburg, Germany.

Objectives: Antiproliferative therapies based on paclitaxel have been developed to extend the durability of endovascular interventions for lower-extremity atherosclerotic peripheral artery disease, resulting in improved primary vessel patency and fewer target lesion revascularizations. This study evaluated the cost-effectiveness of the sustained-release, paclitaxel-eluting Eluvia stent (Boston Scientific, Marlborough, MA) versus the paclitaxel-coated Zilver PTX stent (Cook Medical, Bloomington, IN) for endovascular intervention in the superficial femoral or proximal popliteal artery.

Design: A microsimulation model was constructed from a United States Medicare perspective with a 24-month time horizon. Read More

Vascular 2022 Jun 14:17085381221107749. Epub 2022 Jun 14.

Division of Vascular Surgery, 5945Lenox Hill Hospital, New York, NY, USA.

Objective: The optimal management for revascularization after critical limb ischemia (CLI) is controversial due to limited studies comparing long-term results of endovascular and open techniques. This study compares long-term outcomes after initial management of CLI via lower extremity bypass (LEB) and percutaneous vascular intervention (PVI).

Methods: This retrospective cohort study investigates outcomes of patients who underwent endovascular or open surgical management for CLI at a single institution from 2013-2018. Read More

J Vasc Surg 2022 Jun 10. Epub 2022 Jun 10.

University of North Carolina at Chapel Hill, Department of Surgery, Division of Vascular Surgery, Chapel Hill, NC. Electronic address:

Objective: Surgical site infection (SSI) after open lower extremity revascularization is a relatively common complication associated with increased hospital stays, graft infection, and in severe cases, graft loss. Though the short-term effects of SSI can be significant, it has not been considered a complication that increases major limb amputation. The purpose of this study was to determine the association of SSI with outcomes in patients undergoing surgical revascularization for peripheral arterial disease (PAD). Read More

Orthop Traumatol Surg Res 2022 Jun 10:103346. Epub 2022 Jun 10.

Department of Orthopaedics, Wuxi 9th People's Hospital Affiliated to Soochow University, 214062 Wuxi, China. Electronic address:

Introduction: Gustilo IIIB open forearm fractures are severe injuries often associated with extensive bone and soft tissue injuries. The treatment of Gustilo IIIB open forearm fractures remains a challenging problem, with a high morbidity rate such as infection, nonunion, even amputation. External fixation is preferred for open lower limb fractures. Read More

Diabetol Int 2022 Jul 26;13(3):493-502. Epub 2021 Nov 26.

Division of Metabolism and Biosystemic Science, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, 078-8510 Japan.

Aims/introduction: It is a reality that there are still many diabetic subjects who suffer from serious complications, but there are few statistics of severe eye complications such as vitrectomy or blindness and diabetic foot including amputations in Japan.

Materials And Methods: To determine the status of medical examination, consultation, and the actual practice for diabetic foot, retinopathy, and nephropathy, we conducted two surveys on diabetic subjects under treatment by the local physicians in Asahikawa area or in the nationwide diabetes-specialized facilities, respectively.

Results: A total of 3649 diabetic subjects responded to the questionnaire from 35 clinics/hospitals in Asahikawa area. Read More

J Diabetes Complications 2022 Jul 3;36(7):108221. Epub 2022 Jun 3.

Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia; St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia; Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Australia.

Aims: To assess trends in hospital admissions for non-traumatic lower extremity amputations (LEAs) and for mortality following LEAs in adult patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) admitted to hospitals in Victoria, Australia during 2004-2016.

Methods: Using hospital discharge data, we calculated age- and sex- adjusted admission rates for incident cases of any LEA, minor LEAs, major LEAs and 12-month mortality following any LEAs for patients according to diabetes type. Joinpoint regression analysis was used to identify changes in linear trends that were described as average annual percentage change (AAPC). Read More

Plast Reconstr Surg 2022 Jun 10. Epub 2022 Jun 10.

Division of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Background: Lower extremity amputations are common and post-operative neuropathic pain (phantom limb pain or symptomatic neuroma) is frequently reported. The use of active treatment of the nerve end has shown to reduce pain but requires additional resources and should therefore be performed primarily in high-risk patients. The aim of this study is to identify the factors associated with the development of neuropathic pain following above the knee amputation (AKA), knee disarticulation (KD) or below the knee amputation (BKA). Read More

Contrast Media Mol Imaging 2022 25;2022:4488797. Epub 2022 May 25.

Department of Vascular Surgery, Taizhou Hospital, Zhejiang Province, Taizhou 317000, China.

Acute lower extremity arterial embolism (AE) is a serious clinical emergency, and, if not treated in time, it can easily lead to limb ischemia and necrosis and eventually facing amputation, which seriously damages patients' physical and mental health. In the past, the conventional drug thrombolytic therapy had slow and limited efficacy, and the best time for treatment is easily delayed, while arterial dissection and thrombectomy treatment, although fast, is traumatic and has many complications, which is not easily accepted by patients. The aim of this study was to investigate the value of evidence-based care model in the application of interventional thrombolysis for acute lower limb arterial embolism. Read More