Seminars in Vascular Surgery最新文献

{"title":"The role of flaps in preventing lower extremity amputations","authors":"John M. Felder,&nbsp;Emmanuel Nageeb,&nbsp;Ingrid Rocha,&nbsp;Ryan Qasawa,&nbsp;Syena Moltaji,&nbsp;Yuma Fuse","doi":"10.1053/j.semvascsurg.2025.01.013","DOIUrl":"10.1053/j.semvascsurg.2025.01.013","url":null,"abstract":"<div><div>The increasing prevalence of chronic limb-threatening ischemia and diabetes mellitus has led to a surge in lower extremity amputations, driven by the combination of peripheral arterial disease and extensive wounds. Although revascularization often addresses ischemia, severe wounds pose a significant risk of amputation. Flaps, which involve the transfer of vascularized tissue, can provide immediate closure of complex wounds, particularly those involving bone or tendon exposure, where skin grafts are insufficient. Flap reconstruction of wounds can prevent amputation in cases when revascularization alone would not, but these complex efforts require close collaboration between vascular and plastic surgeons. Despite their potential to prevent amputations, flaps are underused in vascular surgery due to limited availability and expertise, particularly in complex cases involving diabetes and peripheral vascular disease. There are also socioeconomic and reimbursement challenges that limit interest on the part of plastic surgeons. This article explores the principles, techniques, and challenges of flap reconstruction in lower extremity limb salvage, emphasizing the need for multidisciplinary care.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 64-73"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best practice offloading treatments for diabetic foot ulcer healing, remission, and better plans for the healing-remission transition","authors":"Peter A. Lazzarini ,&nbsp;Jaap J. van Netten","doi":"10.1053/j.semvascsurg.2025.01.012","DOIUrl":"10.1053/j.semvascsurg.2025.01.012","url":null,"abstract":"<div><div>Diabetes-related foot disease is arguably the world's least known major health problem and causes a disease burden larger than most well-known diseases, such as stroke and breast cancer. This burden is driven by people developing more severe stages of foot disease, such as foot ulcers and infections, and with that worsening quality of life. To reduce this burden, we need treatments that prevent more severe stages of foot disease and improve quality of life. Best practice offloading treatments have been found to be arguably the most effective existing treatments to heal and prevent diabetes-related foot ulcers and infections, but can worsen quality of life. Furthermore, high re-ulceration rates still occur with best practice offloading treatments after healing. This may be because of the gap in guideline recommendations on the transition from ulcer healing to ulcer remission when it comes to offloading treatments. In this paper, we review why we need offloading treatments and what are the best offloading treatments recommended by the latest international guidelines for healing and remission. Further, we propose plans for future best practice offloading treatments for the transition from healing-to-remission to help reduce re-ulceration rates and improve longer-term ulcer remission. These plans could be the catalyst for better transitioning patients from first ulcer presentation through healing and into long-term remission, and in turn delivering better quality of life, and lower diabetes-related foot disease burdens on patients, nations, and the globe in future.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 110-120"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fundamentals of wound care for amputation prevention","authors":"Beatriz Moschiar Almeida ,&nbsp;Robyn Evans ,&nbsp;Ahmed Kayssi","doi":"10.1053/j.semvascsurg.2025.01.001","DOIUrl":"10.1053/j.semvascsurg.2025.01.001","url":null,"abstract":"<div><div>The initial skin breakdown and subsequent healing processes are complex and influenced by various parameters, including systemic factors, infectious bioburden, and perfusion. Vascular wounds comprise inadequate inflow (due to peripheral artery disease), microvascular damage (result of diabetes mellitus), or vasoconstriction. Normal healing of acute wounds occurs in a sequence of defined stages; however, if a dysregulated inflammatory state ensues, it is classified as chronic. Both chronic and vascular wounds carry an increased risk of amputation. Therefore, holistic wound care is crucial in preventing limb loss. This review outlines a systematic approach to wound assessment and examines the latest recommendations for managing vascular wounds, focusing on strategies for preventing amputations.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 54-63"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic foot infections: Questions for an infectious disease consultant","authors":"Varidhi Nauriyal ,&nbsp;Karin Byers","doi":"10.1053/j.semvascsurg.2025.01.009","DOIUrl":"10.1053/j.semvascsurg.2025.01.009","url":null,"abstract":"<div><div>Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 85-93"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of physical therapy in managing peripheral artery disease and diabetes","authors":"Stephanie L. Woelfel ,&nbsp;Deborah M. Wendland","doi":"10.1053/j.semvascsurg.2025.01.006","DOIUrl":"10.1053/j.semvascsurg.2025.01.006","url":null,"abstract":"<div><div>Peripheral artery disease and diabetes mellitus impact millions of adults in the United States and their combined effects are severe, resulting in loss of limb and loss of life. A strong multidisciplinary team is required to comprehensively care for this complicated patient population. As movement specialists, physical therapists are essential members of this team. Many of these patients will benefit from an individualized exercise and mobility prescription for not only disease and wound management but also for safe return to activity once any associated wounds have closed. Specialized care and loading guidance are necessary, especially for the closed but still healing skin. The purpose of this review is to highlight the role of physical therapists as team members in caring for patients with vascular compromise and/or diabetes mellitus. Furthermore, the value added for patient care and outcomes will be emphasized.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 101-109"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In the know with toe and flow","authors":"Ahmed Kayssi ,&nbsp;Samantha Minc ,&nbsp;David G. Armstrong","doi":"10.1053/j.semvascsurg.2025.01.010","DOIUrl":"10.1053/j.semvascsurg.2025.01.010","url":null,"abstract":"","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of limb preservation interventions with primary care providers caring for US Indigenous patients with diabetes and peripheral artery disease","authors":"Juell Homco ,&nbsp;Thane Gehring ,&nbsp;W. Landon Jackson ,&nbsp;Wato Nsa ,&nbsp;Madison Whitekiller ,&nbsp;Shari Clifton ,&nbsp;Peter R. Nelson ,&nbsp;Blake Lesselroth ,&nbsp;Kelly Kempe","doi":"10.1053/j.semvascsurg.2025.01.003","DOIUrl":"10.1053/j.semvascsurg.2025.01.003","url":null,"abstract":"<div><div>Amputation disparities due to diabetes and peripheral artery disease occur among vulnerable and historically mistreated populations. In Oklahoma, some of the highest amputation rates occur in Indigenous residents. Knowing that primary care providers are often the first to tackle prevention and assess at-risk limbs, we sought to understand the historical efforts made by primary care providers in this high-risk population. This scoping review evaluates the literature to summarize prior amputation prevention interventions and their characteristics, including the outcome metrics used among Indigenous populations in the United States. We searched MEDLINE using a combination of Medical Subject Headings and keywords related to amputation, limb preservation, limb salvage, and American Indian and Indigenous health inequities or disparities and ethnicity. We conducted our final search on October 4, 2024, including articles in English and those that focused on primary care practice-based interventions. We excluded case reports, trauma- or oncologic-related amputations, or articles describing interventions not conducted in the United States. We identified 404 articles and 3 fit the review criteria. All interventions were analyses of programs to improve diabetes care. All interventions occurred between 1986 and 2001 and were multilevel in structure. Intervention strategies used included expanded infrastructure, provider and patient education, implementation of clinical workflow and provider metrics, community awareness projects, foot-care expertise and footwear, and field visits. No interventions specifically targeted peripheral artery disease. This scoping review identifies a significant contemporary gap in amputation reduction interventions among Indigenous populations in the United States and highlights multiple areas where interventions may be needed to combat ongoing amputation disparities for a high-risk population.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 32-40"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes-Related Extremity Amputation Depression and Distress (DREADD): A Multimethod Study","authors":"Levi M. Brooks ,&nbsp;Bradley M. Brooks ,&nbsp;Allison S. Arp ,&nbsp;Cyaandi R. Dove ,&nbsp;Lee C. Rogers ,&nbsp;Rosemay Michel ,&nbsp;Valentina Clinton ,&nbsp;Jonathan Labovitz ,&nbsp;Brandon M. Brooks ,&nbsp;David G. Armstrong","doi":"10.1053/j.semvascsurg.2025.01.002","DOIUrl":"10.1053/j.semvascsurg.2025.01.002","url":null,"abstract":"<div><div>Of the roughly 38 million people diagnosed with type 2 diabetes mellitus in the United States, up to 34% will develop a diabetic foot ulcer at some point, up to 75% of those who develop an ulcer will experience recurrent ulcers, and approximately 18% of patients with a diabetic foot ulcer will undergo lower-limb amputation. The aim of this study was to determine whether depressive symptoms change after a minor, nontraumatic amputation. We conducted a multimethod study consisting of semi-structured interviews (n = 12) and a retrospective cohort (n = 20) of patients with type 2 diabetes mellitus who underwent a nontraumatic, minor amputation of a single toe (partial or total) or partial ray resection. Patient Health Questionnaire-9 (PHQ-9) scores were noted before and after surgery within 30 days of each other. The Wilcoxon matched pairs signed rank test was used to determine differences in the PHQ-9 scores before amputation and after amputation. Of the 20 patients in the retrospective cohort, 90% (18 of 20) had higher PHQ-9 scores within 30 days of amputation. Mean PHQ-9 scores were 3.65 and 12.35 before and after amputation, respectively (a difference of 8.7; <em>P</em> = .0001). Diabetes-related extremity amputation depression and distress is a potentially dangerous complication of diabetes mellitus. Nontraumatic amputations can be a traumatic experience for patients. Surgeons should screen their patients with type 2 diabetes mellitus before and after any (minor or major) nontraumatic amputation and make the appropriate referral, if necessary. Sufficient evidence exists in the literature to warrant the inclusion of psychiatrists and other mental health clinicians in multidisciplinary limb preservation teams.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 94-100"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous approach to deep vein arterialization for the “no-option” chronic limb-threatening ischemia patient","authors":"Jayne R. Rice,&nbsp;Brett C. Chatman,&nbsp;Elizabeth A. Genovese","doi":"10.1053/j.semvascsurg.2025.01.005","DOIUrl":"10.1053/j.semvascsurg.2025.01.005","url":null,"abstract":"<div><div>Chronic limb-threatening ischemia is an advanced stage of peripheral artery disease characterized by rest pain or tissue loss. Treatment of patients classified as ``no-option'' CLTI remains particularly challenging, as historically their primary treatment has been limited to major amputation. Venous arterialization has emerged as a promising alternative in this difficult-to-treat population. Advances in optimized technology and endovascular techniques, particularly deep venous arterialization, have had encouraging outcomes for long-term limb salvage. Successful limb preservation relies on proper patient selection, a compliant patient, and a robust multidisciplinary clinical team to support the complex processes of deep venous arterialization maturation and wound healing. This review will discuss the historical background of venous arterialization, patient selection criteria, and surgical techniques for percutaneous deep venous arterialization, and postoperative management after the index procedure, including wound care, surveillance, and reintervention strategies for successful limb salvage.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 41-53"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutional toe & flow programs: How and why the teams work","authors":"Ahmed A. Naiem,&nbsp;Ryan T. Callahan,&nbsp;Alexander M. Reyzelman,&nbsp;Michael S. Conte","doi":"10.1053/j.semvascsurg.2025.01.008","DOIUrl":"10.1053/j.semvascsurg.2025.01.008","url":null,"abstract":"<div><div>Diabetic foot ulcers with or without concomitant chronic limb-threatening ischemia put patients at exceedingly high risk of limb loss and death. The toe &amp; flow model is a multidisciplinary team-based model captained by a podiatrist or orthopedic foot and ankle specialist and a vascular specialist, which streamlines treatment for patients with diabetic foot ulcer and chronic limb-threatening ischemia. This model creates a functional ecosystem around it by integrating other medical professionals and community partners. It provides a high standard of care first via community education and engagement. It eliminates barriers to access between it and the community by establishing clear referral pathways. This model uses the best available evidence to create treatment pathways governing the patient trajectory through different stage of disease. Once acute treatment is provided, it aims to consolidate success and disease remission through aggressive surveillance and collaboration with the community. An important aspect of this model is that it collects and reports its outcomes and serves as an educational hub within its region. It ultimately aims to develop national policies and allocate resources to continue to improve. This review sheds light on successes associated with institutional toe &amp; flow programs.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 3-10"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}