Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.
Abstract Spondias tuberosa Arr., a fructiferous tree endemic to the northeast Brazilian tropical dry forest called Caatinga, accounts for numerous benefits for its ecosystem as well as for the dwellers of the Caatinga. The tree serves as feed for pollinators and dispersers as well as fodder for domestic ruminants, and is a source of additional income for local smallholders and their families. Despite its vantages, it is facing several man-made and natural threats, and it is suspected that S. tuberosa could become extinct. Literature review suggests that S. tuberosa suffers a reduced regeneration leading to population decrease. At this juncture S. tuberosa cannot be considered threatened according to the International Union for Conservation of Nature Red List Categories and Criteria, as it has not yet been assessed and hampered generative regeneration is not considered in the IUCN assessment. The combination of threats, however, may have already caused an extinction debt for S. tuberosa. Due to the observed decline in tree density, a thorough assessment of the S. tuberosa population is recommended, as well as a threat assessment throughout the entire Caatinga.
Resumo Spondias tuberosa Arr., é uma árvore frutífera endêmica da Caatinga, floresta seca tropical localizada no Nordeste do Brasil. A árvore traz diversos benefícios para o ecossistema e para a população local. Ela serve de alimento tanto para polinizadores e dispersores quanto para ruminantes domésticos e é fonte de renda extra para os agricultores familiares da região. Apesar de seus benefícios, esta árvore enfrenta várias ameaças naturais e antrópicas que podem levar a sua extinção. A revisão da literatura científica sugere que S. tuberosa sofre de reduzida capacidade de regeneração, o que leva à diminuição da população. Todavia, S. tuberosa não é considerada uma espécie ameaçada de extinção de acordo com as categorias e critérios da Lista Vermelha da União Internacional para a Conservação da Natureza, já que a espécie ainda não foi avaliada e capacidade regenerativa reduzida não é considerado critério pelo UICN. A combinação de ameaças, entretanto, pode já ter levado ao débito de extinção da S. tuberosa. Devido ao declínio observado da densidade das árvores, recomenda-se uma avaliação completa da população de S. tuberosa e uma avaliação de todas as ameaças sofridas pela árvore na Caatinga.