cardiovascular-agents and Leg-Ulcer

Chronic wounds are a major cause of morbidity and mortality. Approximately 20% to 23% of nonhealing wounds that are refractory to vascular intervention have other causes, including vasculitis, pyoderma gangrenosum, and other autoimmune diseases. The purpose of this article was to review the literature across medical and surgical specialties with regard to refractory chronic wounds associated with vasculitis and autoimmune diseases and to delineate clinical outcomes of these wounds in response to vascular and other interventions.. An electronic search encompassing MEDLINE, PubMed, Cochrane Library, and Scopus was completed using the following search terms: rheumatoid arthritis; systemic sclerosis; systemic lupus erythematosus; antineutrophil cytoplasmic antibody-associated vasculitis; mixed connective tissue disease; antiphospholipid syndrome; pyoderma gangrenosum; thromboangiitis obliterans; cryoglobulinemia; hydroxyurea; sickle cell; atrophie blanche; livedoid vasculitis; cholesterol emboli; calciphylaxis; antiphospholipid antibodies; prothrombotic; combined with the terms: chronic wound and leg ulcer. Full-text articles published in English up to March 1, 2016, that investigated the clinical outcomes of chronic wounds associated with autoimmune diseases were included. Review articles and evaluations of management of chronic wounds were also reviewed. Primary outcomes included in the review were amputation, ulcer healing, reduction in wound size, overall survival, and freedom from reintervention. Owing to the heterogeneity of data reporting among articles, qualitative analysis is also reported.. Vasculitis and autoimmune diseases play a role in 20% to 23% of patients with chronic lower extremity ulcers. Furthermore, patients with autoimmune disease have a significantly high rate of split thickness skin graft failure (50% compared to 97% in patients without autoimmune disease; P = .0002). The management of leg ulcers associated with autoimmune diseases is discussed.. Autoimmune and vasculitic causes should be considered in patients with chronic wounds who do not respond to appropriate vascular intervention and standard local wound care. A multidisciplinary approach with the involvement of rheumatologists allows investigation for underlying systemic disease and improves clinical outcomes for many of these challenging patients.

Topics: Anemia, Sickle Cell; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antiphospholipid Syndrome; Antirheumatic Agents; Antisickling Agents; Arthritis, Rheumatoid; Autoimmune Diseases; Calciphylaxis; Cardiovascular Agents; Chronic Disease; Cryoglobulinemia; Diagnosis, Differential; Embolism, Cholesterol; Erythema Nodosum; Humans; Hydroxyurea; Leg Ulcer; Panniculitis; Pyoderma Gangrenosum; Steroids; Thromboangiitis Obliterans; Vasculitis; Wound Healing

Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers to treat. This brief review highlights effective methods of management. There is level 1 evidence of the efficacy of compression (bandaging or stockings) in healing ulcers as well as maintaining healing. Patients with superficial saphenous reflux, with or without perforating and deep vein incompetence, benefit from superficial venous surgery. This does not speed ulcer healing but is effective at preventing recurrence after healing with compression. Minimally invasive methods of managing incompetence of superficial saphenous trunks, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are probably also effective in treating patients with venous leg ulcers. Perforating vein ligation is commonly combined with superficial venous surgery for leg ulcer patients, but no systematic data are available to define the role of this treatment. Some centers use deep vein reconstruction to restore competence to deep vein valves. Insufficient data have been published to allow any general recommendation to be made for this treatment. A limited number of drugs have efficacy in promoting leg ulcer healing. They may be used in combination with compression treatment in patients with ulcers refractory to other methods of management. No particular ulcer dressing has been shown to be effective in speeding ulcer healing.

Topics: Bandages; Cardiovascular Agents; Catheter Ablation; Combined Modality Therapy; Evidence-Based Medicine; Humans; Laser Therapy; Leg Ulcer; Ligation; Practice Guidelines as Topic; Sclerotherapy; Stockings, Compression; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing

Topics: Cardiovascular Agents; Chemotherapy, Adjuvant; Combined Modality Therapy; Humans; Leg Ulcer; Randomized Controlled Trials as Topic; Venous Insufficiency

The study was designed as a feasibility trial to evaluate the use of GP IIb/IIIa blockade in connection with drug eluting stents, bare stents and PTA only. Sixty patients with current ulcers were randomly assigned to receive abciximab plus a sirolimus coated stent (N.=14), abciximab plus a bare stent (N.=16), abciximab plus PTA (N.=14) and PTA alone (N.=19). Angiographic control was performed at two and six months. Recanalization was successful in all cases. Two month restenosis rate was 9%, 45.5%, 67% and 46%. At six month follow-up restenosis rate was 9%, 67%, 75% and 58%, respectively; 14% of all patients had major amputations within six months. Adjunctive administration of abciximab during peripheral arterial intervention below the knee was found to be safe. Sirolimus coated stent administration was followed by a higher patency rate.

Topics: Abciximab; Aged; Amputation, Surgical; Angioplasty, Balloon; Antibodies, Monoclonal; Cardiovascular Agents; Drug-Eluting Stents; Feasibility Studies; Female; Humans; Immunoglobulin Fab Fragments; Leg Ulcer; Limb Salvage; Lower Extremity; Male; Metals; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Prospective Studies; Prosthesis Design; Radiography; Recurrence; Sirolimus; Stents; Time Factors; Treatment Outcome; Vascular Patency

In a (negative) multicenter randomized trial on management for inoperable critical lower limb ischemia, comparing spinal cord stimulation and best medical treatment, a number of pre-defined factors were analyzed for prognostic value. We included a radiological arterial disease score, modified from the SVS/ISCVS runoff score. The purpose of this analysis was to evaluate clinical factors and commonly used circulatory measurements for prognostic modeling in patients with critical lower limb ischemia. We determined the incidence of amputation and its relation to various pre-defined risk factors. A total of 120 patients with critical limb ischemia were included in the study. The integrity of circulation in the affected limb was evaluated on five levels: suprainguinal, infrainguinal, popliteal, infrapopliteal and pedal. A total radiological arterial disease score was calculated from 1 (full integrity of circulation) to 20 (maximally compromised state). We used Cox regression analysis to quantify prognostic effects and differential treatment (predictive) effects. Major amputation occurred in 33% of the patients at 6 months and in 51% at 2 years. The presence of ischemic skin lesions and the radiological arterial disease score were independent prognostic factors for amputation. Patients with ulcerations or gangrene had a higher amputation risk (hazard ratio 2.38, p = 0.018 and 2.30, p = 0.036 respectively) as well as patients with a higher radiological arterial disease score (hazard ratio 1.17 per increment, p = 0.003). We did not observe significant interactions between prognostic factors and the effect of spinal cord stimulation. In conclusion, in patients with critical lower limb ischemia, the presence of ischemic skin lesions and the described radiological arterial disease score can be used to estimate amputation risk.

Topics: Aged; Aged, 80 and over; Amputation, Surgical; Arterial Occlusive Diseases; Cardiovascular Agents; Constriction, Pathologic; Critical Illness; Electric Stimulation Therapy; Female; Humans; Ischemia; Kaplan-Meier Estimate; Leg Ulcer; Lower Extremity; Male; Middle Aged; Netherlands; Proportional Hazards Models; Radiography; Risk Assessment; Risk Factors; Severity of Illness Index; Spinal Nerves; Time Factors; Treatment Failure

Topics: Alprostadil; Amputation, Surgical; Cardiovascular Agents; Clinical Trials as Topic; Epoprostenol; Humans; Iloprost; Infusions, Intravenous; Leg Ulcer; Vascular Diseases

To assess the current 'real-world' management of hospitalised patients with lower-extremity peripheral artery disease (LE-PAD) and to assess the 1-year outcome.. The prospective and multicentre registry COhorte des Patients ARTériopathes (COPART) recruited consecutive patients from the departments of vascular medicine of three academic hospitals in Southwestern France.. Among the 940 patients, 27.4% had intermittent claudication (IC), 9.3% ischaemic rest pain, 54.3% ulceration or gangrene and 9.3% acute limb ischaemia (ALI). Patients with IC were younger and more likely to be men, with a history of smoking (89.5%) and chronic obstructive pulmonary disease (17%). Among those with IC, 8.9% had bypass surgery and 41.5% were treated with percutaneous angioplasty. Those with tissue loss had higher rates of cardiovascular disease (CVD) risk factors and co-morbidities. At entry to the study, the level of control of the CVD risk factors was poor. The 1-year mortality rate was of 5.7% in patients with IC, 23.1% in patients with ischaemic rest pain, 28.7% in patients with tissue loss and 23% in those with ALI. Compliance with evidence-based medicine and pharmacological treatment was sub-optimal.. This registry underscores the differences in patient profiles in the daily clinical setting, compared to those enrolled in several trials.

Topics: Aged; Aged, 80 and over; Amputation, Surgical; Angioplasty, Balloon; Cardiovascular Agents; Cardiovascular Diseases; Chi-Square Distribution; Evidence-Based Medicine; Female; France; Gangrene; Guideline Adherence; Hospital Mortality; Hospitalization; Hospitals, University; Humans; Intermittent Claudication; Ischemia; Kaplan-Meier Estimate; Leg Ulcer; Length of Stay; Lower Extremity; Male; Middle Aged; Outcome and Process Assessment, Health Care; Peripheral Vascular Diseases; Practice Guidelines as Topic; Proportional Hazards Models; Prospective Studies; Registries; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures

Topics: Cardiovascular Agents; Catheter Ablation; Chronic Disease; Diagnostic Imaging; Endoscopy; Humans; Leg Ulcer; Ligation; Lower Extremity; Microcirculation; Sclerotherapy; Stockings, Compression; Varicose Veins; Vascular Surgical Procedures; Venous Insufficiency; Venous Thrombosis

Topics: Benzoates; Cardiovascular Agents; Ergot Alkaloids; Leg; Leg Ulcer; Musculoskeletal Diseases

Topics: Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Ergot Alkaloids; Extremities; Humans; Leg; Leg Ulcer; Ulcer

Topics: Cardiovascular Agents; Cyclandelate; Leg; Leg Ulcer; Muscle Relaxants, Central; Ulcer