ArticleCureus2026
Successful Cases of Combined Treatment for WIfI Clinical Stage 4 Chronic Limb-Threatening Ischemia Using Popliteal-to-Distal Bypass, Minor Amputation, Debridement, and Rheocarna Therapy in Hemodialysis Patients: A Case Series.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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15 authors.
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Abstract
Chronic limb-threatening ischemia (CLTI) is a severe form of lower extremity artery disease. CLTI is an umbrella term for conditions in which the lower limb is threatened by ischemia, tissue defects, neural disorders, or infection. In Japan, CLTI primarily affects patients with diabetes and those on hemodialysis. The severity of CLTI is assessed using the Wound, Ischemia, and foot Infection (WIfI) classification. CLTI needs multidisciplinary therapy. Rheocarna is a novel direct hemoperfusion device and can adsorb low-density lipoprotein (LDL) cholesterol and fibrinogen, thereby improving hemorheology. However, reports describing its use after distal bypass surgery are limited. In this report, we present three initial cases of successful combined treatment for WIfI clinical stage 4 CLTI in patients undergoing hemodialysis, including distal bypass, minor amputation, debridement, and Rheocarna therapy. Case 1 is a 67-year-old man with CLTI in the left foot. Endovascular therapy (EVT) failed to revascularize the anterior tibial artery (ATA). Necrosis of the left fifth toe progressed, and the ulcerative purulent wound tested positive for
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