Limb salvage using bypass to the perigeniculate arteries.

OBJECTIVE: To describe bypass to perigeniculate vessels for limb salvage. DESIGN: Retrospective cohort study. MATERIAL AND METHODS: Between 1995 and 2009, 47 bypass procedures to perigeniculate collateral arteries were performed in 46 patients (15 women, 31 men; median age, 68 years). All patients presented with critical ischaemia (tissue loss in 87.5%, rest pain in 12.5%). Mean ankle brachial index was 0.27 ± 0.17. The site of distal anastomosis was the descending genicular artery (DGA) in 23 bypasses (1 bilateral) and the medial sural artery (MSA) in 24. Proximal anastomosis was to the external iliac artery in 2 cases, common femoral artery in 23 cases, superficial femoral artery in 8 cases, deep femoral artery in 8 cases, above-knee poplitaeal artery in 2 cases, and previous graft in 4 cases. RESULTS: There were four deaths during the immediate postoperative period. Mean follow-up duration was 27 months. Ten patients required major amputation. Mean ankle brachial index post-operatively was 0.60 ± 0.21. At 3 years, primary patency was 74.7 ± 7%, secondary patency was 83.4 ± 8%, and the limb salvage and survival rates were 73.5 ± 7% and 77.4 ± 7%, respectively. CONCLUSION: Bypass to perigeniculate arteries is a viable treatment option for critical limb ischaemia in selected patients.

Galactomannoglucans of lichenized fungi of Cladonia spp.: significance as chemotypes.

The chemical structures of the glucans, galactoglucomannans and galactomannoglucans of two species of the Cladonia, section Cocciferae, Cladonia miniata and Cladonia salmonea, were determined and compared. alpha-D-Glucans of the nigeran type were isolated from both species, in common with all Cladonia spp., along with galactoglucomannans containing (1-->6)-linked main-chains of alpha-D-Manp units substituted by structurally different and typical side-chains. Isolated were previously unreported galactomannoglucans, with (1-->3)-linked main-chains of beta-D-Glcp units, substituted at O-2,6 by side-chains. These consisted of beta-D-Galf, 6-O-substituted beta-D-Galf and 2-O-, 4-O-, 6-O- and 2, 3-di-O-substituted alpha-D-Manp units. According to (13)C NMR spectroscopy, a similar galactomannoglucan was isolated from the Cladonia spp. Cladonia signata, Cladonia crispatula, Cladonia penicillata, Cladonia imperialis, Cladonia clathrata, Cladonia connexa, Cladonia substellata and Cladonia ibitipocae. Its presence could also contribute to the classic taxonomy of lichenized fungi.