char = A;code = 65 char = l;code = 108 char = w;code = 119 char = a;code = 97 char = y;code = 121 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = a;code = 97 char = c;code = 99 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = s;code = 115 char = p;code = 112 char = e;code = 101 char = c;code = 99 char = i;code = 105 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = c;code = 99 char = r;code = 114 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = b;code = 98 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = c;code = 99 char = h;code = 104 char = e;code = 101 char = m;code = 109 char = i;code = 105 char = a;code = 97 char = .;code = 46 result sql = Always contact a vascular interventional specialist before amputating a patient with critical limb ischemia.
Always contact a vascular interventional specialist before amputating a patient with critical limb ischemia.char = P;code = 80 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = v;code = 118 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = r;code = 114 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = b;code = 98 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = c;code = 99 char = h;code = 104 char = e;code = 101 char = m;code = 109 char = i;code = 105 char = a;code = 97 char = ;code = 32 char = (;code = 40 char = C;code = 67 char = L;code = 76 char = I;code = 73 char = );code = 41 char = ;code = 32 char = d;code = 100 char = u;code = 117 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = l;code = 108 char = o;code = 111 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = t;code = 116 char = i;code = 105 char = b;code = 98 char = i;code = 105 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = a;code = 97 char = r;code = 114 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = c;code = 99 char = l;code = 108 char = u;code = 117 char = s;code = 115 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = i;code = 105 char = d;code = 100 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = r;code = 114 char = g;code = 103 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = i;code = 105 char = z;code = 122 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = f;code = 102 char = r;code = 114 char = e;code = 101 char = q;code = 113 char = u;code = 117 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = e;code = 101 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = u;code = 117 char = p;code = 112 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = l;code = 108 char = o;code = 111 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = b;code = 98 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = S;code = 83 char = u;code = 117 char = b;code = 98 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = g;code = 103 char = i;code = 105 char = o;code = 111 char = p;code = 112 char = l;code = 108 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = (;code = 40 char = S;code = 83 char = A;code = 65 char = );code = 41 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = r;code = 114 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = m;code = 109 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = n;code = 110 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = b;code = 98 char = ;code = 32 char = s;code = 115 char = a;code = 97 char = l;code = 108 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = v;code = 118 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = m;code = 109 char = i;code = 105 char = s;code = 115 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = p;code = 112 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = b;code = 98 char = j;code = 106 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = u;code = 117 char = d;code = 100 char = y;code = 121 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = u;code = 117 char = l;code = 108 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = S;code = 83 char = A;code = 65 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = C;code = 67 char = L;code = 76 char = I;code = 73 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = u;code = 117 char = s;code = 115 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = b;code = 98 char = y;code = 121 char = ;code = 32 char = l;code = 108 char = o;code = 111 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = t;code = 116 char = i;code = 105 char = b;code = 98 char = i;code = 105 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = c;code = 99 char = l;code = 108 char = u;code = 117 char = s;code = 115 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = o;code = 111 char = ;code = 32 char = h;code = 104 char = a;code = 97 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = r;code = 114 char = g;code = 103 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = o;code = 111 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = i;code = 105 char = z;code = 122 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = c;code = 99 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = W;code = 87 char = e;code = 101 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = t;code = 116 char = r;code = 114 char = o;code = 111 char = s;code = 115 char = p;code = 112 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = v;code = 118 char = i;code = 105 char = e;code = 101 char = w;code = 119 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = e;code = 101 char = c;code = 99 char = u;code = 117 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = C;code = 67 char = L;code = 76 char = I;code = 73 char = ;code = 32 char = d;code = 100 char = u;code = 117 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = l;code = 108 char = o;code = 111 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = t;code = 116 char = i;code = 105 char = b;code = 98 char = i;code = 105 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = o;code = 111 char = c;code = 99 char = c;code = 99 char = l;code = 108 char = u;code = 117 char = s;code = 115 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = o;code = 111 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = c;code = 99 char = h;code = 104 char = e;code = 101 char = d;code = 100 char = u;code = 117 char = l;code = 108 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = c;code = 99 char = a;code = 97 char = u;code = 117 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = y;code = 121 char = ;code = 32 char = h;code = 104 char = a;code = 97 char = d;code = 100 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = r;code = 114 char = g;code = 103 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = o;code = 111 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = s;code = 115 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = i;code = 105 char = z;code = 122 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = o;code = 111 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = b;code = 98 char = y;code = 121 char = ;code = 32 char = S;code = 83 char = A;code = 65 char = .;code = 46 char = ;code = 32 char = A;code = 65 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = t;code = 116 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = 2;code = 50 char = 6;code = 54 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = 2;code = 50 char = 5;code = 53 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = (;code = 40 char = 1;code = 49 char = 4;code = 52 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = ;;code = 59 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = ,;code = 44 char = ;code = 32 char = 7;code = 55 char = 0;code = 48 char = ;code = 32 char = +;code = 43 char = /;code = 47 char = -;code = 45 char = ;code = 32 char = 1;code = 49 char = 5;code = 53 char = ;code = 32 char = [;code = 91 char = S;code = 83 char = D;code = 68 char = ];code = 93 char = ;code = 32 char = y;code = 121 char = e;code = 101 char = a;code = 97 char = r;code = 114 char = s;code = 115 char = );code = 41 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = e;code = 101 char = c;code = 99 char = h;code = 104 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = c;code = 99 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = 8;code = 56 char = 8;code = 56 char = %;code = 37 char = ;code = 32 char = (;code = 40 char = 2;code = 50 char = 3;code = 51 char = /;code = 47 char = 2;code = 50 char = 6;code = 54 char = );code = 41 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = u;code = 117 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = p;code = 112 char = l;code = 108 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = i;code = 105 char = c;code = 99 char = h;code = 104 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = .;code = 46 char = ;code = 32 char = F;code = 70 char = i;code = 105 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ,;code = 44 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = 1;code = 49 char = 0;code = 48 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = 2;code = 50 char = 6;code = 54 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = b;code = 98 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = e;code = 101 char = d;code = 100 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = ;code = 32 char = A;code = 65 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = j;code = 106 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = e;code = 101 char = d;code = 100 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = 1;code = 49 char = 0;code = 48 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = b;code = 98 char = s;code = 115 char = ;code = 32 char = (;code = 40 char = 7;code = 55 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = l;code = 108 char = o;code = 111 char = w;code = 119 char = -;code = 45 char = k;code = 107 char = n;code = 110 char = e;code = 101 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = 3;code = 51 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = -;code = 45 char = k;code = 107 char = n;code = 110 char = e;code = 101 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = );code = 41 char = .;code = 46 char = ;code = 32 char = H;code = 72 char = a;code = 97 char = l;code = 108 char = f;code = 102 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = j;code = 106 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = o;code = 111 char = k;code = 107 char = ;code = 32 char = p;code = 112 char = l;code = 108 char = a;code = 97 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = 3;code = 51 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = h;code = 104 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = .;code = 46 char = ;code = 32 char = C;code = 67 char = u;code = 117 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = r;code = 114 char = e;code = 101 char = e;code = 101 char = d;code = 100 char = o;code = 111 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = j;code = 106 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = 1;code = 49 char = 2;code = 50 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = h;code = 104 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = 5;code = 53 char = 9;code = 57 char = %;code = 37 char = ;code = 32 char = (;code = 40 char = S;code = 83 char = E;code = 69 char = ;code = 32 char = =;code = 61 char = ;code = 32 char = 1;code = 49 char = 1;code = 49 char = %;code = 37 char = );code = 41 char = .;code = 46 char = ;code = 32 char = I;code = 73 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = i;code = 105 char = x;code = 120 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = b;code = 98 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = l;code = 108 char = i;code = 105 char = m;code = 109 char = i;code = 105 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = S;code = 83 char = e;code = 101 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = (;code = 40 char = 2;code = 50 char = 8;code = 56 char = %;code = 37 char = );code = 41 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = d;code = 100 char = u;code = 117 char = r;code = 114 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = l;code = 108 char = l;code = 108 char = o;code = 111 char = w;code = 119 char = -;code = 45 char = u;code = 117 char = p;code = 112 char = .;code = 46 char = ;code = 32 char = I;code = 73 char = n;code = 110 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = c;code = 99 char = l;code = 108 char = u;code = 117 char = s;code = 115 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ,;code = 44 char = ;code = 32 char = S;code = 83 char = A;code = 65 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = i;code = 105 char = b;code = 98 char = i;code = 105 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = a;code = 97 char = r;code = 114 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = i;code = 105 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = e;code = 101 char = m;code = 109 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = b;code = 98 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = j;code = 106 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = C;code = 67 char = L;code = 76 char = I;code = 73 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = o;code = 111 char = ;code = 32 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = a;code = 97 char = c;code = 99 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = d;code = 100 char = u;code = 117 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = l;code = 108 char = a;code = 97 char = c;code = 99 char = k;code = 107 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = r;code = 114 char = g;code = 103 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = o;code = 111 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 result sql = Patients with severe critical limb ischemia (CLI) due to long tibial artery occlusions are often poor candidates for surgical revascularization and frequently end up with a lower limb amputation. Subintimal angioplasty (SA) offers a minimally invasive alternative for limb salvage in this severely compromised patient population. The objective of this study was to evaluate the results of SA in patients with CLI caused by long tibial occlusions who have no surgical options for revascularization and are facing amputation. We retrospectively reviewed all consecutive patients with CLI due to long tibial occlusions who were scheduled for amputation because they had no surgical options for revascularization and who were treated by SA. A total of 26 procedures in 25 patients (14 males; mean age, 70 +/- 15 [SD] years) were evaluated. Technical success rate was 88% (23/26). There were four complications, which were treated conservatively. Finally, in 10 of 26 limbs, no amputation was needed. A major amputation was needed in 10 limbs (7 below-knee amputations and 3 above-knee amputations). Half of the major amputations took place within 3 months after the procedure. Cumulative freedom of major amputation after 12 months was 59% (SE = 11%). In six limbs, amputation was limited to a minor amputation. Seven patients (28%) died during follow-up. In conclusion, SA of the tibial arteries seem to be a valuable treatment option to prevent major amputation in patients with CLI who are facing amputation due to lack of surgical options.
Publication: Cardiovasc Intervent Radiol 2010 Jun ;33(3)::469-74. :doi: 10.1007/s00270-009-9687-3.
Publication Date: 2010 Jun
Study Author(s): Met, Rosemarie;Koelemay, Mark J W;Bipat, Shandra;Legemate, Dink A;van Lienden, Krijn P;Reekers, Jim A;
Institution: Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
[email protected]
Shortcut link to this study:
Patients with severe critical limb ischemia (CLI) due to long tibial artery occlusions are often poor candidates for surgical revascularization and frequently end up with a lower limb amputation. Subintimal angioplasty (SA) offers a minimally invasive alternative for limb salvage in this severely compromised patient population. The objective of this study was to evaluate the results of SA in patients with CLI caused by long tibial occlusions who have no surgical options for revascularization and are facing amputation. We retrospectively reviewed all consecutive patients with CLI due to long tibial occlusions who were scheduled for amputation because they had no surgical options for revascularization and who were treated by SA. A total of 26 procedures in 25 patients (14 males; mean age, 70 +/- 15 [SD] years) were evaluated. Technical success rate was 88% (23/26). There were four complications, which were treated conservatively. Finally, in 10 of 26 limbs, no amputation was needed. A major amputation was needed in 10 limbs (7 below-knee amputations and 3 above-knee amputations). Half of the major amputations took place within 3 months after the procedure. Cumulative freedom of major amputation after 12 months was 59% (SE = 11%). In six limbs, amputation was limited to a minor amputation. Seven patients (28%) died during follow-up. In conclusion, SA of the tibial arteries seem to be a valuable treatment option to prevent major amputation in patients with CLI who are facing amputation due to lack of surgical options.
PMID: 19688364