36 results found in Peripheral Arterial & CLTI
Seasonality of Acute Vascular Surgery Cases in Austria: A Retrospective Observational Study between 2009 and 2023
By: Maria Leinweber
Background: Chronobiological patterns in general and seasonality in specific have been investigated for a multitude of pathologies. While cardiovascular events such as myocardial infarction and stroke are well researched, evidence on other vascular segments and events remains comparably small. Methods: A retrospective observational study analyzed hospital admission data from 2009 to 2023 for pulmonary embolism (PE), aortic dissection (AD), deep vein thrombosis (DVT), acute limb ischemia (ALI), and ruptured abdominal aortic aneurysm (RAA). Admissions were stratified by calendar month, weekday, and DST transitions to identify temporal trends. Results: Seasonal variations were observed for PE and AD, with peak hospital admissions in winter and troughs in summer, reflecting reductions of approximately 18%. DVT followed a similar pattern, while ALI and RAA showed less consistent or minimal seasonal trends. A strong weekend effect was observed for PE, DVT, ALI, and AD, with significantly lower admissions on weekends compared to weekdays. No significant differences in hospital admissions were found in relation to daylight saving time transitions. Conclusion: This 15-year analysis confirms significant seasonal and weekend effects in vascular emergency admissions, particularly for PE, AD, and DVT. Regional differences in season manifestation and healthcare access limit generalizability, necessitating context-specific research into underlying mechanisms, including air pollution, healthcare system characteristics, and behavioral factors, to inform targeted interventions.
Peripheral Arterial & CLTIEvaluation of Low Dose Protocol in Radiation Exposure and Image Quality during Peripheral Interventions
By: Tec C
Achieving optimal image quality with minimal radiation exposure allows operators to accurately assess and treat target lesions during Percutaneous Transluminal Angioplasty (PTA) without being subjected to increased radiation risk. Depending on clinical needs, imaging protocols are optimized and evaluated. This study aims to compare two imaging protocols – Conventional Dose Protocol (CDP) and Low Dose Protocol (LDP) – to evaluate impact of fine-tuned x-ray acquisition parameters (detector entrance dose, copper filtration, tube voltage) as well as post-processing parameters (edge enhancement, window contrast). 30 patients who underwent lower limb PTA from February to April 2021 were retrospectively reviewed. 2D-Digital Subtraction Angiography (DSA) images obtained during the procedure were analyzed for Contrast-to-Noise Ratio (CNR) to evaluate image quality quantitatively. The same images were assessed qualitatively by two experienced operators for parameters such as overall image quality and image contrast. Dose reports were analyzed for patient’s radiation dose. Compared to CDP, LDP showed an 80% reduction in Dose Area Product (DAP) (2.49±1.65 µGym2/frame vs 0.48±0.42 µGym2/frame, p<0.001) and Air Kerma (AK) (0.10±0.3 mGy/frame vs 0.02±0.02 mGy/frame, p<0.001). Quantitative image assessment revealed significantly higher CNR in LDP (p<0.001), yet no significant differences were determined from the qualitative image assessment. This suggests that despite a lower radiation dose, LDP generates better quality images than CDP that do not affect operator’s clinical assessment during the procedure. Radiation dose saving can be achieved through adjustment and optimization of angiography parameters.
Peripheral Arterial & CLTIBurger Disease and Fibromuscular Dysplasia: A Case Report
By: Othman Alabdullah
Non-atherosclerotic vascular diseases, such as Buerger’s disease and fibromuscular dysplasia (FMD), are rare but can lead to severe limb ischemia -whether chronic or critical limb threatening ischemia-, particularly in younger patients. Isolated lower-limb FMD is extremely rare, and the coexistence of FMD and Buerger’s disease in the same lower limb has not been previously reported. A 37-year-old male with poorly controlled diabetes and a history of heavy smoking presented with bilateral lower limb pain and a non-healing foot ulcer. Imaging revealed preserved aortoiliac and proximal runoff vessels, but angiography showed a “string of beads” sign in the superficial femoral artery (SFA) and a corkscrew appearance distally below the knee, consistent with fibromuscular dysplasia (FMD) and Buerger’s disease. Treatment plan consisted of risk factor modification, smoking cessation and education about the condition. Follow-ups at short intervals continued to show ulcer healing and symptom resolution, although he was still occasionally smoking. Potential for long-term limb salvage will depend on smoking cessation, as well as the understanding that distal microvascular progression is still possible. This unique case reinforces the need for a broad differential diagnostic evaluation for young patients with limb ischemia and supports some overlap and coexistence of non-atherosclerotic vasculopathies, and most importantly, we reaffirm the effectiveness of individualized, multimodal management in those with such complex presentations.
Peripheral Arterial & CLTIENDOVASCULAR TREATMENT OF ADVANCED AORTOILIAC OCCLUSIVE LESIONS (TASC II C AND D): REAL-WORLD OUTCOMES FROM A TERTIARY CENTRE IN SOUTH INDIA
By: Poornima Palanisamy
Background: Management of complex aortoiliac occlusive disease (AIOD) classified as Trans-Atlantic Inter-Society Consensus II (TASC II) C and D has undergone a major paradigm shift from traditional open surgical reconstruction to endovascular therapy. This transition has been driven by advances in endovascular techniques, improved device technology, and growing operator expertise. Endovascular approaches, once reserved for less complex lesions, are now being successfully applied to chronic total occlusions (CTOs) of the aortoiliac segment with outcomes comparable to open surgery but with lower morbidity and faster recovery. This study presents our institutional experience and outcomes with endovascular interventions for TASC II C and D aortoiliac occlusive lesions. Methods: We conducted a combined prospective and retrospective study of 59 consecutive patients with TASC II C and D aortoiliac chronic total occlusions who underwent endovascular revascularization at our tertiary vascular centre between January 2022 and June 2023. Patients were evaluated clinically and radiologically, and data were recorded in a standardized proforma. Parameters analyzed included demographic details, Rutherford category, lesion type, technical success, complications, and post-procedural outcomes including ankle–brachial pressure index (ABPI) and limb salvage. Follow-up data were obtained from outpatient records and telephonic follow-up. Results: Of the 59 patients, 58 (98%) were male and 1 (2%) female, reflecting the well-established male predominance in atherosclerotic peripheral arterial disease. Rutherford classification at presentation included 6 (10%) category 4, 34 (58%) category 5, and 17 (29%) category 6 patients; 2 (3%) had acute-on-chronic ischemia. Based on TASC II classification, 18 (31%) were type C and 41 (69%) were type D lesions. Endovascular revascularization achieved technical success in 54 of 59 patients (92%). Stent placement was performed in 53 (90%), while balloon angioplasty alone was performed in 1 (2%). Lesion crossing was predominantly achieved via antegrade brachial access, with adjunctive femoral access as required. Procedural complications such as dissection and plaque shift occurred in 3 (5%) patients, and access-site complications were noted in 4 (7%). There were no intra-procedural mortalities. The mean ABPI improved significantly from 0.39 ± 0.12 pre-procedure to 0.88 ± 0.10 post-procedure (p < 0.001), indicating effective hemodynamic restoration. Clinically, all category 4 patients experienced complete relief of claudication. Wound healing was achieved in 23 (39%) patients, minor amputations were required in 9 (15%), and major amputations in 3 (5%). The mean duration of follow-up was 13.5 months. The average time to complete wound healing after revascularization was 3.5 months. During follow-up, 9 (15%) patients were lost, and 4 (7%) had died from unrelated causes. Conclusion: Endovascular management of TASC II C and D aortoiliac occlusive disease demonstrates high technical success (92%), low complication rates, and excellent short-term functional outcomes. The significant improvement in ABPI and limb salvage underscores the clinical efficacy of this minimally invasive approach. The predominance of male patients in this cohort reflects the higher prevalence of atherosclerotic disease among men. Endovascular reconstruction represents a durable and effective solution for complex aortoiliac occlusive lesions. With advancing device technology and growing operator expertise, it is increasingly establishing itself as the preferred first-line therapy even for challenging TASC II C and D lesions.
Peripheral Arterial & CLTIThe Bycross-Atherectomy-Device
By: Matthias Walter Mende
A cohort of 350 Patients in my clinic have been treated in the SFA and popliteal region with nthe Bycross-Atherectomy-Device. Low embolisation rate and a very good performany in Thrombus, Calcium and neointimal lesions, makes it a relevant device for debulking and vessel-prep
Peripheral Arterial & CLTITunneled Sheath In The Common Femoral Artery As Ipsilateral Antegrade Access For Ostial And Proximal Superficial Femoral Artery Lesions
By: Mohamed Mosadak Zaied
ostial and flush SFA lesions are representing unique technical challenges due to: lack of adequate landing zone, working area and frequently calcified.(1) Ipsilateral antegrade approaches that provide a short, stable, coaxial route improve pushability and device control: tunneled antegrade CFA sheath techniques have been described to reduce sheath kinking and allow sufficient work space while the sheath is secured.(2) Choice of therapy should be individualized according to lesion morphology (length, calcification, in-stent restenosis), patient comorbidity and limb threat, and personal experience(3)• Aim the main objective of this study is to Evaluate the tunnelled sheath in the common femoral artery as An access for ipsilateral antegrade revasculraization of ostial and proximal Superfical femoral artery lesions according to ability to cross the lesion, success rate and complications • Methods 30 cases with chronic lower limb ischemia due to ostial or proximal SFA lesions, were admitted in the vascular surgery departement kafr elsheikh university, Egypt for revascularization of thre SFA. all cases were done in the angiosuit of the departement, all cases were done through tunnelled sheath insetion in the CFA ipsilateral to the lesion The idea is to just insert small distal part of the sheath in the CFA and tunneling the sheath under skin and subcutaneous tissue to gain more support and achieve more pushability to cross lesions• Results 28 cases from the 30 patientsa had succesful recanalization for the ostial and proximal SFA lesions through the tunneled sheath. access site hematoma recorded in 7 cases, one patient went for surgical bypass and one patient was succesfully done trhrogh transbrachial sheath • Conclusion tunnelled sheath is a good technique for accessing and recanalizng ostial and proximal SFA lesions with lower cost than transbrachial and antegrade contralateral accesses and accepted complications rate
Peripheral Arterial & CLTIIn A Challenging Case Of Critical Lower Limb Ischemia Revascularisation Is Not The End Point In The Journey Of Limb Salvage
By: Mohamed Mosadak Zaied
Patient Profile: Age: 48 years Medical History: Type 2 Diabetes Mellitus, Hypertension Presenting Symptoms: Infected ischemic ulcer on the lateral aspect of the left foot Imaging Findings: CT Angiography: Chronic total occlusion of the left popliteal artery (P2, P3), as well as occlusion of the trifurcation of the anterior, posterior tibial and peroneal arteries. Intervention Chosen: Approach: Antegrade left common femoral artery (CFA) access Multiple attempts for antegrade recanalization of the lesions failed. Alternative Strategy: Distal bypass (femoral to posterior tibial artery, retro-malleolar) Outcome: Post-Surgery: Restoration of posterior tibial pulse with triphasic Doppler waveforms. Clinical Progress: The patient developed a deep left foot infection with signs and symptoms of sepsis Management: Serial debridements and minor amputations were performed until the foot was clean and granulation tissue developed. Follow-up: One week later, the patient developed fever, tachycardia, hypotension Lab Results: White blood cell count (WBC) elevated to 25,000/µL, CRP 289 mg/L, creatinine 4.1 mg/dL Surgical Intervention: Extensive debridement, anterolateral left leg compartment fasciotomy, and multiple tunnels for pus drainage Post-operative Recovery: The patient underwent further debridement and was placed on aggressive antibiotic therapy. Six Months Later: Complete healing of all wounds, with successful limb salvage The patient regained functional use of the limb after a long and challenging recovery. This case underscores the importance of a multidisciplinary approach to the management of complex critical limb ischemia with infection. Successful Revascularization alone is insufficient; timely surgical debridement, appropriate antibiotic therapy, and management of complications such as sepsis are critical to successful limb salvage.
Peripheral Arterial & CLTIWhen Antiplatelet is Not Enough
By: Meiling MacDonald-Nethercott
Objective Antiplatelet therapy is the cornerstone of medical management for peripheral artery disease (PAD). However, a substantial proportion of people with PAD demonstrate poor platelet inhibition despite antiplatelet therapy with clopidogrel monotherapy. Although clinically concerning, the impact of inadequate platelet inhibition on clinical outcomes following revascularisation remains unclear, and platelet function testing is not routinely performed. Furthermore, no established strategy exists to identify patients with suboptimal platelet inhibition who are at highest risk of early adverse outcomes. Methods A single-centre, prospective cohort study was conducted. Patients with PAD undergoing lower-limb revascularisation and prescribed clopidogrel monotherapy between 2024 and 2025 were enrolled. Perioperative platelet function testing was performed using the Multiplate® analyser. The primary outcome of interest was a composite of target lesion reintervention, major amputation, or all-cause mortality within four months of revascularisation. Multivariable logistic regression was used to develop a prediction model to identify patients at highest risk of early adverse events. Results A total of 80 patients underwent perioperative platelet function testing before lower-limb revascularisation while receiving clopidogrel monotherapy. All patients were followed for at least four months. Among these patients, significant variability in platelet reactivity was observed, with greater variance among patients who experienced early adverse outcomes despite antiplatelet therapy (Levene’s test, p = 0.00022). On multivariable analysis, variables commonly associated with poor outcomes in patients with PAD such as gender, ethnicity, body mass index (BMI), chronic obstructive pulmonary disease (COPD), hypertension, cardiac comorbidity, cerebrovascular disease (previous stroke/transient ischaemic accident TIA), rest/night pain, tissue loss did not show statistical significance. However, higher adenosine diphosphate (ADP) value and higher glycated haemoglobin (HbA1c) levels were the only two variables independently associated with adverse outcomes. A prediction model incorporating ADP-induced platelet aggregation and HbA1c stratified patients into high-risk (n=28, 35%) and low-risk (n=52, 65%) groups. Among high-risk patients, 46% (13/28) experienced adverse events, including eleven target lesion reinterventions and two major amputations compared with 4% adverse event in the low-risk group. Kaplan–Meier analysis demonstrated significantly earlier and higher number of adverse events in the high-risk group (log-rank p = 0.00059***). This prediction model combining patients’ individual response to anti-platelet therapy and HbA1c demonstrated good discrimination (area under the curve AUC, 0.89). Conclusions Substantial variability in response to clopidogrel was observed among patients with PAD undergoing lower-limb revascularisation. A dual-marker strategy integrating platelet function testing and glycaemic control identifies patients at high risk of early adverse outcomes and may enable targeted optimisation of medical therapy after revascularisation.
Peripheral Arterial & CLTIIn-vivo UTE MRI Can Evaluate Plaque Morphology Changes After Endovascular Intervention in CLTI
By: Trisha Roy
Introduction Restenosis after endovascular therapy for CLTI is common, with some studies suggesting it to be as high as 70% at 3 months. Typically, surveillance imaging is performed with duplex ultrasound (DUS). However, DUS often struggles to clearly define disease below the knee due to calcification. Ultrashort echo time (UTE) MRI is a non-contrast MRI technique that can evaluate plaque morphology and composition for enhanced arterial evaluation. The aim of this study was to evaluate vessel wall remodeling after endovascular intervention. Methods Patients with CLTI were included in the study and underwent UTE MRI prior to their endovascular procedure. The surgeon was blinded to the findings of the MRI and proceeded to treatment based on pre-clinical and intraprocedural imaging. Patients then underwent follow up UTE MRI. The primary outcome of interest was restenosis/occlusion of the treated artery following treatment compared to DUS. Results 16 patients (mean age 74.0 years, 23.1% female) with 30 arterial lesions underwent pre- and post-operative UTE MRI (72.7% tibial, 27.3% femoropopliteal). Median time from procedure to UTE MRI was 4 months (1-11m). DUS had a higher rate of non-diagnostic imaging compared to MRI (25.0% vs 9.4%). DUS also identified less areas of restenosis compared to UTE MRI (16.7% vs 61.5%). 66.7% of the treated lesions had hard plaque components (calcific/collagenous) and 33.3% had soft plaque components (thrombus/lipidic/smooth muscle) but restenosis/occlusion rates were similar between the two groups (61.5% vs 55.6%). Figures one and two show cases of hard plaque lesions that a had maintained increase in patent area after POBA and intravascular lithotripsy/DCB respectively. In both cases a sustained increase in overall vessel area also occurred, suggesting positive arterial remodeling. Conclusion Non-contrast UTE MRI can provide high detail insights into morphological changes following endovascular treatment, delivering superior spatial resolution. The integration of this technique both before and after surgery could revolutionize patient outcomes.
Peripheral Arterial & CLTINon-Contrast MRI-Based Sizing of Below the Knee CLTI: A Multi-Modality Validation Study
By: Trisha Roy
Introduction In peripheral vascular interventions (PVIs), IVUS is recommended for appropriate sizing but is expensive, invasive and time consuming. Ultrashort echo time (UTE) MRI is a non-contrast non-invasive MRI technique with high 3D spatial resolution that could support sizing decision making. The aim of this study was to evaluate the sizing decision making by surgeons in comparison to UTE MRI sizing. Methods CLTI patients underwent UTE MRI prior to PVI in a prospective study. Surgeons were blinded to the MRI. UTE MRI vessel diameter was measured by two metrics 1) intima to intima diameter, 2) external elastic laminal (EEL) to EEL diameter above and below the lesions. Under/over sizing was defined as the final device used being >0.5mm from the MRI measurement. This was then compared to Clinical CTA and MRI measurements. UTE MRI was then also compared to intravascular optical coherence tomography (OCT) images in 10 amputated limb studies. Results 26 patients and 48 lesions were evaluated (27.1% femoropopliteal, 72.9% infrapopliteal). 32.6% of patients underwent DSA without pre-operative clinical cross-sectional imaging. Based on UTE MRI intimal sizing, incorrect sizing occurred in 43.8% of cases (90.5% undersizing) (figure 1). Based on EEL diameter, devices were undersized by >1mm in 60.4% of cases. Clinical MRA showed no significant difference from UTE MRI measurement (2.81mm vs 2.79mm, p=062, r=0.14) whereas clinical CTA significantly undersized when compared to UTE MRI ( 3.38mm vs 3.94mm, p=0.03, r=0.90). In 10 amputated limb arteries, the median difference diameter between UTE MRI and OCT was 0.18mm. Conclusion This study shows a high rate of incorrect sizing, mostly due to undersizing of devices. UTE MRI provides an accurate methodology of vessel sizing and its introduction into clinical practice could result in more accurate treatment decisions without the need for intravascular imaging such as IVUS.
Peripheral Arterial & CLTIEndovascular iliac preparation for renal transplantation using auto-expandable covered stenting
By: jennifer canonge
INTRODUCTION : Severe iliac calcifications may preclude standard renal transplantation (RT) because of hostile vascular access. For some patients, an aorto-femoral or ilio-femoral bypass is performed to permit the arterial anastomosis. But in this frail population, the complication rate is higher. We developed a technique of iliac endovascular preparation using auto-expandable covered stent as arterial landing zone for RT in patients with severe iliac calcifications. METHODS : All patients were discussed in multidisciplinary meetings. The technique was proposed to patients with severe iliac calcifications without clamping zone and without the possibility to perform in situ renal transplantation. The surgery was performed by a urologist and a vascular surgeon. Retrograde endoclamping was used at the proximal part of the stent. A metallic clamp was used at the distal part. After prosthotomy the arterial anastomosis was performed including both arterial wall and textile after cutting stent strutts with Potts Scissors. Angiographic control and angioplasty of the distal part of the stent (metallic clamping zone) were routinely performed . RESULTS : 5 patients were included in this preliminary case series. All grafts remained patent with no vascular complication or stenosis. One patient needed a compressive hematoma evacuation at day 11. No patient needed dialysis in follow-up. Mean follow-up was 16 months. One patient died during follow-up of a non-vascular and non-renal cause. DISCUSSION & CONCLUSION: This minimally invasive strategy avoids major bypass surgery and facilitates RT in patients previously considered ineligible. Although early outcomes are encouraging, strict patient selection and experienced surgical teams are essential. Larger studies are needed to validate long-term efficacy and safety.
Peripheral Arterial & CLTIUltrasound detection of below-the-knee medial arterial calcifications in asymptomatic patients is an early negative predictor of major adverse cardiovascular events
By: Giulia Baldazzi
Background: Medial arterial calcification (MAC) is a vascular disorder that affects the arterial media layer. It represents a predictor of major adverse limb events in patients affected by diabetes mellitus (DM). This single-center retrospective observational study investigates whether ultrasound (US) detection of MAC in below-the-knee (BTK) vessels represents a negative predictor of major adverse cardiovascular events (MACE) in asymptomatic patients. Methods: In 2019, 584 patients, referred to the Vascular Surgery Unit for lower limb US, were examined by the same operator, who assessed the presence of BTK MAC. The primary outcome was the rate of MACE during a 5-year follow-up period. The secondary outcomes included the development of peripheral arterial disease (PAD), the overall survival rates, lower limb revascularizations, and major amputations. Results: MAC in BTK vessels was highlighted in 239 patients (MAC+) who exhibited a younger age (p < 0.001), DM (p < 0.001), and chronic kidney disease (CKD) (p = 0.048). The 345 subjects without MAC (MAC−) showed prior myocardial infarction (p < 0.001), stroke (p = 0.034), and smoking habits (p < 0.001). After propensity score matching, the MAC+ group presented a higher risk of MACE (HR: 1.84; CI: 1.01–3.38; p = 0.047) during a median follow-up of 57 months. Age (HR: 1.06; CI: 1.01–1.12) and MAC (HR: 1.22; CI: 1.06–1.57) were independently associated with MACE. New diagnoses of PAD mainly occurred in the MAC− group (p < 0.001). No differences were observed in major amputations, revascularization procedures, or overall survival rates. Conclusions: Ultrasound detection of BTK MAC was associated with the presence of DM and CKD and with a 1.8-fold increased risk of developing a MACE within 5 years in asymptomatic patients.
Peripheral Arterial & CLTIAdjunctive Ozone Therapy in Limb-Threatening Chronic Ischemia: From Failed Wound Healing to Complete Ulcer Resolution
By: Daniel Gomez
Introduction: Chronic limb-threatening ischemia (CLTI) in elderly patients is challenging due to comorbidities and impaired wound healing. Ozone therapy, though not mainstream, is emerging as a potential adjunctive therapy in refractory cases. Case Description: We present the case of an 83-year-old active male, a retired golf instructor who exercised daily for 40–60 minutes. He developed a 1x1 cm ischemic ulcer on the lateral base of his left fifth toe. Initial treatment in a wound care clinic failed to show improvement. He was referred to vascular surgery, where ankle-brachial index was 0.27 and duplex ultrasound showed a femoropopliteal disease with popliteal artery occlusion. The patient underwent successful angioplasty of the popliteal artery and tibioperoneal trunk, resulting in single-vessel runoff through the peroneal artery to the ankle. Post-procedure ABI improved to 0.7 with adequate pain control. Despite two months of wound care management, the ulcer showed no signs of healing. Given the poor response, he was referred to integrative medicine, where he received both local and systemic ozone therapy. Remarkably, the ulcer began to improve as early as the third session. The healing process continued steadily, culminating in complete ulcer closure. Discussion: Ozone therapy has shown biological plausibility in enhancing tissue oxygenation, promoting microcirculation, and modulating inflammation. While evidence remains limited and mostly anecdotal, this case illustrates potential benefit when standard revascularization fails to yield wound healing. Conclusion: In selected patients with CLTI and refractory ulcers despite successful revascularization, ozone therapy may serve as a valuable therapy. This case supports further investigation into integrative strategies in vascular surgery.
Peripheral Arterial & CLTI„Pacemaker for the Legs“: Spinal Cord Stimulation (SCS) in patients with peripheral arterial disease (PAD) class III or chronic limb threateninng ischemia (CLTI) without possiblity of revascularization
By: Sarah Gleichauf
Aims: Critical limb ischaemia (CLI) manifests itself in the form of pain at rest, therapy-resistant ulcerations and gangrene, which usually leads to a significant loss of quality of life and, in most cases, requires major amputation. Interventional procedures such as percutaneous transluminal angioplasty (PTA) with/without stent implantation and surgical interventions have been shown to reduce morbidity. For patients without revascularisation options, spinal cord stimulation (SCS) is a treatment alternative. This prospective study records amputation rates and mortality in SCS patients. The secondary endpoints are pain reduction of up to 40%, improved microcirculation and quality of life. Methods: The prospective, single-centre cohort study has been approved by an ethics committee and will include 20 patients. Following this, a 12-month follow-up will be scheduled. The follow-up would involve the recording of standardised parameters such as VAS score, ankle-brachial index, TcPO2 measurements and PROMIS-29 questionnaire. The study endpoints are said to be explantations, major amputations and mortality. Abbott GmbH & Co. KG has kindly provided financial support. Results: A total of 17 patients were evaluated for the study, and 9 patients underwent successful SCS implantation. A total of five patients completed the 12-month follow-up, while four patients are still in the follow-up phase. One patient underwent a major amputation postoperatively. Two implantations were unsuccessful due to spinal rigidity and intraoperative dyspnoea, respectively. Four patients demonstrated an insufficient response to alprostadil, and two exhibited terminal tissue damage. The presentation of the interim results and the study design is now to be considered. Conclusions: SCS offers an innovative additive option for CLI through pain modulation, vasodilation and improved quality of life. The findings of the study indicate the existence of the possibility for its utilisation as an additive standard therapy. Early implantation has been shown to prevent tissue damage and significantly reduce the amputation rate. The selection criteria for patients remain to be elucidated; these issues will be defined in the prospective study.
Peripheral Arterial & CLTIMajor Reamputation after Initial Minor Amputation in Chronic Limb-Threatening Ischemia: a Portuguese Tertiary Care Center Study
By: Jose Miguel Vilas Boas
This retrospective single-center study evaluated reamputation rates and risk factors in patients with chronic limb-threatening ischemia who underwent initial minor amputation, finding a high 6-month major reamputation rate of 35.9%. Lower preoperative ankle-brachial index, higher white blood cell count, and the presence of chronic kidney disease were significantly associated with an increased risk of major reamputation. These findings highlight the importance of identifying high-risk patients early to guide initial amputation level decisions and potentially improve outcomes and quality of life.
Peripheral Arterial & CLTIFeasibility and Inter-Observer Reliability of Hand-Held Doppler Audio Interpretation in Lower-Limb Arterial Disease: A Multicentre Pilot Study
By: Daniel Curley
Background: Hand-held Doppler (HHD) assessment of lower-limb arterial signals is simple and inexpensive, but audio interpretation is subjective and variably taught. This multicentre pilot (Phase 1) evaluated inter-observer reliability of Doppler audio waveform interpretation across professional experience levels to inform standardisation and future diagnostic-accuracy work. Methods: Twenty-five anonymised continuous-wave Doppler audio clips (monophasic n=11, biphasic n=5, triphasic n=9) from lower-limb arteries were distributed in random order to 50 raters from 39 centres across six countries. No standardised teaching was provided. Raters classified each clip as triphasic, biphasic, or monophasic. Performance was summarised for the three-category model and a simplified binary model (monophasic vs non-monophasic). Inter-rater agreement was assessed using weighted Fleiss’ κ. Results: Correct identification was 65.9% for monophasic, 54.1% for biphasic, and 37.1% for triphasic waveforms. Collapsing to monophasic vs non-monophasic increased correct classification to 81.4% (biphasic) and 80.7% (triphasic). Vascular scientists performed best (62.0%→83.0%); junior groups improved from ~45–50% to ~70–75%. Agreement improved from κ≈0.45 (moderate) in the three-category model to κ≈0.65 (substantial) with the binary model. Conclusion: Inter-observer reliability of HHD audio interpretation was moderate across experience levels and improved substantially with a simplified binary framework (monophasic vs non-monophasic). These findings support feasibility for a Phase 2 multicentre diagnostic-accuracy study evaluating standardised HHD audio assessment alongside contemporary imaging pathways and predefined reference standards.
Peripheral Arterial & CLTIFoot Care Awareness in Tunisian Diabetic Patients With Peripheral Arterial Disease: A Call for Targeted Prevention
By: Ziadi Arwa
Diabetic foot lesions represent a major cause of morbidity and mortality, especially in resource-limited settings such as Tunisia. The presence of lower extremity peripheral arterial disease (PAD) further worsens patient outcomes. This cross-sectional study, conducted between July and December 2024, aimed to evaluate the level of knowledge regarding foot care among diabetic patients hospitalized in a vascular surgery department. A total of 30 patients with type 2 diabetes admitted to La Rabta Hospital were included. Data collection involved patient interviews, clinical examinations to assess podiatric risk, and lesion classification using the Wagner system. Knowledge and practices were evaluated through a 14-item questionnaire, with a score below 7 indicating insufficient knowledge. This study highlights gaps in patient awareness and underlines the need for targeted educational and preventive strategies to improve diabetic foot management.
Peripheral Arterial & CLTIOur experience with Hybrid procedures in concomitant Ilio-femoral disease.
By: Ayush Mohan
INTRODUCTION- Common femoral artery (CFA) is the gateway for inflow and outflow in peripheral artery disease (PAD).Atherosclerotic lesions in the common femoral artery(CFA) are now one of the remaining barriers to the use of endovascular repair as the first-line therapy. Current guidelines recommend either open surgical reconstruction (OR) or hybrid repair (HR) combining iliac stenting with femoral endarterectomy and bypass. However, there are currently no randomised trials comparing both treatment modalities for patients with concomitant iliac and CFA occlusive disease .Rabellino et al classified CFA atherosclerotic lesions. METHODOLOGY- This is retrospective observational study was conducted at the Christian medical college between December 2022 and June 2025. Patients who underwent hybrid procedures for concomitant ilio-femoral diseases were included with non- diseased tibial vessels. Post procedures incidence of major amputation , increase in ABPI and TP, Post op ICU stay and patency rates of native vessels at 6 months. RESULTS- The mean age of participants was 63.9 ± 14.5 years, with 83% males. Lesions were classified according to Rabellino classification with 60% being type iii and iv. In our study post procedure rate of major amputation was 2% , Mean increase in ABPI was .28±.04 and TP was 30±8, mean post op ICU stay was 1±.02 . Patency rates were more than 90 percent at 6 months. CONCLUSION- This study supports hybrid techniques for ilio-femoral concomitant lesions, Our study shows significant increase in ABPI and TP Post procedure. Lower rates of major amputation and increased rates of patency. However we will require a larger sample size to further investigate the role of hybrid procedures.
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