Revascularisation of the wound-related artery is associated with

Revascularisation of the wound-related artery is associated with higher limb salvage rates than revascularisation of the arteries running to other angiosomes [146] and [147]. Even in the case of surgical revascularisation by means of a bypass, Neville has shown that a direct bypass on the wound-related artery leads to higher

limb salvage rates [134]. If tibial artery treatment is technically Bioactive Compound Library ic50 impossible, angioplasty of the distal perforating branches of the peroneal artery is a successful practicable option. Neither complete nor wound-related artery revascularisation should be pursued uncritically, but both should be personalised on the basis of a realistic technical strategy, the type of tissue lesions and their orthopaedic surgical treatment and the patient’s general clinical condition. [148] • The main aim of revascularisation is to reopen all occluded arteries. There are

currently no unequivocal criteria that define with certainty Selleck BLZ945 the most appropriate follow-up methods for patients who have undergone revascularisation because of ischaemic DF. This is probably due to the heterogeneity of patients with CLI: these may be relatively young with a good life expectancy and be suitable for the application of severe follow-up criteria that consider vascular, tissue and general aspects. However, there are also patients characterised by a ‘terminal’ Glutamate dehydrogenase picture of widespread atherosclerotic disease, who therefore have a very limited life expectancy in whom the follow-up should be less invasive. Generally, the follow-up should be clinical, oximetric and/or ultrasonographic, and the examinations should take place 1, 3, 6 and 12 months after treatment, and every 12 months thereafter. However, just as the treatment of DF needing a multidisciplinary approach, we believe that the follow-up

of revascularised patients should also be global, multidisciplinary and personalised, and take into account the following key elements. The criteria indicating the purely haemodynamic success of revascularisation are primary and secondary patency, that is, the capacity of the revascularisation procedure to guarantee the continued patency of the treated vessel or bypass [41]. In the case of a bypass, the follow-up should include Doppler ultrasonography in order to detect any restenosis (generally of the anastomosis) or the upstream or downstream progression of bypass disease; the treatment of such obstructions is fundamental as it prolongs the life of the bypass itself [149].

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