Web dedicada a la investigación de tópicos en angiología, cirugia endovascular y terapia celular avanzada.
PROTOCOLO DEL SERVICIO CTCV - TERAPIA CELULAR EN ISQUEMIA CRÍTICA
El 24 de Setiembre del 2014 mediante un trabajo protocolizado se da inicio en el Perú a una alternativa novedosa que viene dando resultados alentadores pero poco establecidos y estudiados a nivel del rescate del miembro inferior en isquemia crítica en riesgo de amputación. Pacientes que no tienen otra chance más que la probable amputación por la isquemia crónica de miembros inferiores, donde la cirugia de revascularización o el manejo mínimamente invasivo mediante la cirugia endovascular ya no es una opción, se da inicio al gran reto que es la terapia celular protocolizada en insuficiencia arterial periférica crónica crítica (llámese así al dolor en reposo o la presencia de úlcera o necrosis asociada).
El trabajo desarrollado en el Hospital Nacional Edgardo Rebagliati Martins por los cirujanos cardiovasculares Félix Tipacti Rodriguez y Manolo Briceño Alvarado, bajo el apoyo del jefe de departamento de cirugia de tórax y cardiovascular, el Dr. Alfonso Rivasplata Arrivasplata, el Jefe de Servicio de cirugia vascular, el Dr. Jorge Achata Arenas y el Jefe de Banco de órganos y tejidos del referido nosocomio el Dr. Ausberto Chunga Chunga, permiten dar una esperanza para evitar amputaciones y muertes asociadas. el trabajo dará sus primeros resultados a los 6 meses, 12 meses y 24 meses de seguimiento.
AUTOR: CARDIOVASCULAR - REBAGLIATI
PROTOCOLO DEL SERVICIO CTCV - TERAPIA CELULAR EN ISQUEMIA CRÍTICA.pdf by Manolo Briceño Alvarado
MANEJO DE HERIDAS EN INSUFICIENCIA ARTERIAL PERIFÉRICA
Ann Vasc Surg. 2010 Nov;24(8):1110-6. doi: 10.1016/j.avsg.2010.07.012.
Management of lower extremity wounds in patients with peripheral arterial disease: a stratified conservative approach.
Chiriano J, Bianchi C, Teruya TH, Mills B, Bishop V, Abou-Zamzam AM Jr.
Abstract
BACKGROUND:
Traditional wound care algorithms include aggressive detection of peripheral arterial disease (PAD) and treatment with revascularization for all patients with PAD and lower extremity wounds. Not every patient with PAD and a wound meets Transatlantic Inter-Society Consensus (TASCII) criteria for critical limb ischemia. We hypothesize that a conservative approach to selected patients with PAD and lower extremity wounds may be safe, provide acceptable limb salvage, and that failure of this approach does not translate into increased limb loss.
METHODS:
Veterans referred with PAD and nonhealing ulcers/wounds were prospectively enrolled into our Prevention of Amputation Care Team program. Patients were stratified according to management strategies which included revascularization, primary amputation, palliative limb care, and aggressive local care without revascularization (conservative group). Patients were assigned to conservative management group on the basis of transcutaneous oxygen measurement (TcpO2) and ankle-brachial index (ABI). Healing rates, need for "late" revascularization, major amputation rates, and survival of this conservative group were analyzed in terms of ABI and ankle pressures.
RESULTS:
Between January 2006 and March 2009, a total of 190 lower extremity wounds in 178 patients with PAD were analyzed. Forty-nine patients with 52 wounds (27.9%) were deemed candidates for conservative treatment. During mean follow-up of 14.5 months, complete wound healing was documented in 33 patients (35 wounds: 67%). Mean time to complete wound healing was 4.5 months. Predictors of healing included mean ABI (0.62 vs. 0.42 [p <>70 mm Hg (p = 0.025). Sixteen patients (17 wounds: 33%) were not healed at the time of analysis. Of these, three patients (four wounds: 8%) showed active healing and 13 (13 wounds: 25%) failed conservative management. Nine patients (9 wounds: 17%) underwent late revascularization. There was one case of amputation (2%) and six cases of mortalities (12.2%). There was no increase in the rates of limb loss and mortality in patients who failed conservative management and underwent "late" revascularization.
CONCLUSIONS:
Conservative management of lower extremity nonhealing wounds in selected patients with PAD is successful in over two-thirds of the patients. The failure of conservative management does not increase mortality or amputation rates. When the TcPO2 is >30 mm Hg, the ABI and the TASC II definition of critical limb ischemia predict wound healing and should be key factors in considering conservative therapy.