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AIRS CLINIC 610 SOUTH FAIRMONT LODI, CA 209 224 5236 CLI FIGHTERS# AMPUTATION PREVENTION AIRS CLINIC 610 S FAIRMONT AVE LODI, CA Ultrasound-Guided Tibial Pedal Arterial Access: The Truth About Critical Limb Ischemia CLI and Amputation Growing Alternative Strategy in the Treatment Of Complex Peripheral Artery Disease EDITORIAL Critical Limb Ischemia or CLI, describes late stage changes of peripheral vascular disease. CLI may have several presentations to include: Leg pain at rest, nonhealing ulcers or gangrenous changes in the soft tissue of the legs and feet. Changes commonly seen in diabetics. Hoart Stroke Aasociation Worth an Arm and a Leg: The Critical Importance of Limb Ischemia Javier A. Valle, MD, MScs; Stephen W. Waldo, MD CLI has a mortality rate of over 24% in a year and 60% in 5 years. To put this in perspective, when the top 22 cancers are evaluated only five have a higher 5 year death rate. These are the number of cancer deaths seen every 5 years-Lung cancer 192,00o, Pancreatic cancer 51,000, Colorectal 49,000, Liver cancer 35,000 but CLI kills 58,000 in the same time. However, this does not capture the suffering associated with limb amputation. Many more patients will die each year from CLI than from many cancers considered to be the most lethal like: esophageal, brain, stomach, and ovarian, to name but a few. Critical Limb Ischemia: A Threat to Life and Limb Below-the-Knee Retrograde Access for Peripheral Jounal of Endovasculls Therapy 1-8 O The Author(s)2018 Reprints and permissions sagepub.com/journakPerminionsnav DO 1Q1177/1526602818765248 Interventions: A Systematic Review www.jevtorg SSAGE Limb amputation still continues to be an early consideration in many hospitals and clinics. 30% of patients present with rest pain and pain with walking but no evidence of actual tissue loss. Yet many of these patients will never have a diagnostic evaluation, and when compared to revascularization amputation doubles the Original Studies Tibia-Pedal Arterial Minimally Invasive Retrograde Revascularization in Patients with Advanced Peripheral Vascular Disease: The TAMI Technique, Original Case Series risk of death over the following year. J.A. Mustapha," MD, Fadi Saab, MD, Theresa McGoff, BsN, Carmen Heaney, BSN, Larry Diaz-Sandoval, Mo, Matthew Sevensma, Do, and Barbara Karenko, DO Even in patients with gangrene or tissue loss, many health care providers still see amputation as a first line treatment, however endovascular therapy doubles survival when compared to amputation. B.aekground: A tibial -pedal access method Is needed lor patients with advanced peripheral artery disease (PAD) unable to tolerate common femoral artery (CFA) access and intervention due to body habitus or comorbidities. This is the fir11t case series DO NOT CONSIDER AMPUTATION WITHOUT FIRST BEING EVALUATED FOR REVASCULARIZATION OR BYPASS SURGERY Endovascular therapy for CLI must include a certain skill set as described by Dr. Mustapha and Dr. Saab, two internationally recognized CLI experts. This must include the ability to accurately interpret diagnostic imaging, manipulate an array of specialized equipment and a mastery of specialized techniques like pedal retrograde access, intravascular ultrasound and ultrasound directed Tibio-Pedal techniques. This diverse tool box allows the experienced operator the ability to target complex lesions and avoid major amputation. The two images above show the use of intravascular ultrasound and accurate measurement of therapy. The two sets of images to the left show two cases of retrograde revascularization. Both patients had been considered for below knee amputation, both patients had severe limb ischemia and greater than 2 months later both patients have avoided major amputation. The majority of facts quoted in this article are derived from the literature cited above. Call clinic for references AIRS CLINIC 610 SOUTH FAIRMONT LODI, CA 209 224 5236 CLI FIGHTERS# AMPUTATION PREVENTION AIRS CLINIC 610 S FAIRMONT AVE LODI, CA Ultrasound-Guided Tibial Pedal Arterial Access: The Truth About Critical Limb Ischemia CLI and Amputation Growing Alternative Strategy in the Treatment Of Complex Peripheral Artery Disease EDITORIAL Critical Limb Ischemia or CLI, describes late stage changes of peripheral vascular disease. CLI may have several presentations to include: Leg pain at rest, nonhealing ulcers or gangrenous changes in the soft tissue of the legs and feet. Changes commonly seen in diabetics. Hoart Stroke Aasociation Worth an Arm and a Leg: The Critical Importance of Limb Ischemia Javier A. Valle, MD, MScs; Stephen W. Waldo, MD CLI has a mortality rate of over 24% in a year and 60% in 5 years. To put this in perspective, when the top 22 cancers are evaluated only five have a higher 5 year death rate. These are the number of cancer deaths seen every 5 years-Lung cancer 192,00o, Pancreatic cancer 51,000, Colorectal 49,000, Liver cancer 35,000 but CLI kills 58,000 in the same time. However, this does not capture the suffering associated with limb amputation. Many more patients will die each year from CLI than from many cancers considered to be the most lethal like: esophageal, brain, stomach, and ovarian, to name but a few. Critical Limb Ischemia: A Threat to Life and Limb Below-the-Knee Retrograde Access for Peripheral Jounal of Endovasculls Therapy 1-8 O The Author(s)2018 Reprints and permissions sagepub.com/journakPerminionsnav DO 1Q1177/1526602818765248 Interventions: A Systematic Review www.jevtorg SSAGE Limb amputation still continues to be an early consideration in many hospitals and clinics. 30% of patients present with rest pain and pain with walking but no evidence of actual tissue loss. Yet many of these patients will never have a diagnostic evaluation, and when compared to revascularization amputation doubles the Original Studies Tibia-Pedal Arterial Minimally Invasive Retrograde Revascularization in Patients with Advanced Peripheral Vascular Disease: The TAMI Technique, Original Case Series risk of death over the following year. J.A. Mustapha," MD, Fadi Saab, MD, Theresa McGoff, BsN, Carmen Heaney, BSN, Larry Diaz-Sandoval, Mo, Matthew Sevensma, Do, and Barbara Karenko, DO Even in patients with gangrene or tissue loss, many health care providers still see amputation as a first line treatment, however endovascular therapy doubles survival when compared to amputation. B.aekground: A tibial -pedal access method Is needed lor patients with advanced peripheral artery disease (PAD) unable to tolerate common femoral artery (CFA) access and intervention due to body habitus or comorbidities. This is the fir11t case series DO NOT CONSIDER AMPUTATION WITHOUT FIRST BEING EVALUATED FOR REVASCULARIZATION OR BYPASS SURGERY Endovascular therapy for CLI must include a certain skill set as described by Dr. Mustapha and Dr. Saab, two internationally recognized CLI experts. This must include the ability to accurately interpret diagnostic imaging, manipulate an array of specialized equipment and a mastery of specialized techniques like pedal retrograde access, intravascular ultrasound and ultrasound directed Tibio-Pedal techniques. This diverse tool box allows the experienced operator the ability to target complex lesions and avoid major amputation. The two images above show the use of intravascular ultrasound and accurate measurement of therapy. The two sets of images to the left show two cases of retrograde revascularization. Both patients had been considered for below knee amputation, both patients had severe limb ischemia and greater than 2 months later both patients have avoided major amputation. The majority of facts quoted in this article are derived from the literature cited above. Call clinic for references