• The effects of normalizing hyperhomocysteinemia on clinical and operative outcomes in patients with critical limb ischemia.

      Waters, Peadar S; Fennessey, Paul J; Hynes, Niamh; Heneghan, Helen M; Tawfick, Wael; Sultan, Sherif; Western Vascular Institute, University College Hospital Galway, Ireland. (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2012-12)
      To assess the outcome of patients with medically treated hyperhomocysteinemia (HHC) requiring intervention for critical limb ischemia (CLI).
    • Homocysteine, the cholesterol of the 21st century. Impact of hyperhomocysteinemia on patency and amputation-free survival after intervention for critical limb ischemia.

      Heneghan, Helen M; Sultan, Sherif; Western Vascular Institute, Department of Vascular & Endovascular Surgery, University College Hospital, Galway, Ireland. (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2008-08)
      To assess the prevalence of hyperhomocysteinemia and determine any correlation to the clinical and technical outcome of peripheral arterial revascularization for critical limb ischemia (CLI).
    • Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.

      Sultan, Sherif; Esan, Olubunmi; Fahy, Anne; Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland. sherifsultan@esatclear.ie (Vascular, 2008)
      Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.
    • Sequential compression biomechanical device in patients with critical limb ischemia and nonreconstructible peripheral vascular disease.

      Sultan, Sherif; Hamada, Nader; Soylu, Esraa; Fahy, Anne; Hynes, Niamh; Tawfick, Wael; Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway, Ireland. sherif.sultan@hse.ie (Journal of vascular surgery, 2011-08)
      Critical limb ischemia (CLI) patients who are unsuitable for intervention face the dire prospect of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. This study assessed the outcome of SCBD in severe CLI patients who otherwise would face an amputation. Primary end points were limb salvage and 30-day mortality. Secondary end points were hemodynamic outcomes (increase in popliteal artery flow and toe pressure), ulcer healing, quality-adjusted time without symptoms of disease or toxicity of treatment (Q-TwiST), and cost-effectiveness.
    • Ten-year technical and clinical outcomes in TransAtlantic Inter-Society Consensus II infrainguinal C/D lesions using duplex ultrasound arterial mapping as the sole imaging modality for critical lower limb ischemia.

      Sultan, Sherif; Tawfick, Wael; Hynes, Niamh; Western Vascular Institute, Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Ireland. sherif.sultan@hse.ie (2013-04)
      The aim of this study was to evaluate duplex ultrasound arterial mapping (DUAM) as the sole imaging modality when planning for bypass surgery (BS) and endovascular revascularization (EvR) in patients with critical limb ischemia for TransAtlantic Inter-Society Consensus (TASC) II C/D infrainguinal lesions.