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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Magnetic resonance imaging (MRI) was used in the diagnosis of various conditions giving rise to leg oedema, with special attention to the oedema after femoro-distal vascular reconstruction for obliterative atherosclerosis (n = 14). Patients with deep venous thrombosis (n = 6), chronic lymphoedema (n = 6) and closed muscular compartment syndrome (n = 2) were also investigated. Leg volume increase was measured according to the formula of a truncated cone. Interstitial fluid hydrostatic pressure (Pif) was recorded with the wick-in-needle technique. Spin echo series with 10 mm transverse slices were obtained with MRI. Following vascular reconstructions, leg volume increased 26% on the operated side. In the operated leg, no gradient in Pif was found between the posterior muscular compartment and the subcutaneous tissue. However, there was a significantly higher Pif in the subcutaneous tissue compared to the anterior muscular compartment (p less than 0.05). In the operated group, MRI revealed oedema around the entire circumference of the leg, mainly restricted to the subcutaneous tissue. In contrast, oedema of the leg muscles, particularly in the posterior compartments, was typical for patients having deep venous thrombosis. The group with chronic lymphoedema showed circumferential subcutaneous oedema alone or in combination with a fibrotic honeycomb pattern. Oedema of the affected muscular compartment was easily observed in patients who had a closed compartment syndrome. In conclusion, the use of MRI is promising in the investigation of conditions giving rise to leg oedema. It is likely that the formation of post-reconstructive oedema is taking place in the subcutaneous tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The use of MRI in the investigation of leg oedema. 157 51

A total of 58 popliteal aneurysms were found in 40 patients presenting between June 1982 and May 1989. Of these, 51 were caused by atherosclerosis, and there were five post-stenotic aneurysms associated with entrapment, one mycotic and one post-traumatic aneurysm. There were 18 patients with bilateral aneurysms, and two others had the first side repaired elsewhere before referral to this hospital. Aneurysms were found at other sites in 16 patients. Urgent treatment was needed for 32 patients (80%). Two required streptokinase treatment to clear arteries distally. Three needed fasciotomy for compartment syndrome. Two patients had above-knee amputation. Of 36 urgent operations, 13 had postoperative complications (36%). Four grafts were later revised successfully. At mean follow-up of 23 months (range 3-96 months), three patients had claudication secondary to preoperative distal arterial occlusion, and one patient had residual mild foot drop. These operative results contrast sharply with the low complication rate after elective operation for popliteal aneurysm. In these patients, 14 asymptomatic aneurysms were repaired uneventfully. Four patients who did not undergo elective operation later developed acute thrombosis (3) and rupture (1). This experience supports our policy that early elective treatment for popliteal artery aneurysm is the most appropriate choice.
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PMID:The management of popliteal aneurysm: the importance of early surgical repair. 175 77

Intramuscular pressure in the anterior tibial compartment and calf circumference were measured daily during six days following reconstructive surgery for lower limb atherosclerosis in 31 patients. Both intramuscular pressure and calf circumference were significantly increased in the operated extremity from the first postoperative day. Maximum intramuscular pressure was found on the second postoperative day. No patient developed a compartment syndrome. Calf circumference increased more slowly and reached maximum on the fifth postoperative day. Following successful reconstructive arterial surgery intramuscular pressure and calf circumference increased most in patients undergoing dissection of the groin and leg, probably reflecting intraoperative damage of lymphatic vessels. In four patients where the reconstructive arterial surgery failed intramuscular pressure and calf circumference remained unchanged postoperatively despite dissection of the groin and leg. Thus, the present study suggests that both impaired lymphatic drainage and increased capillary filtration contribute to the development of increased intramuscular pressure and calf circumference following reconstructive arterial surgery of the leg.
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PMID:Muscular compartment pressure following reconstructive arterial surgery of the lower limbs. 660 12

The primary function of the circulatory system is to transport oxygen, nutrients, and waste products. Hemodynamics of the vessels are governed by a variety of physical properties and laws that explain blood flow through the vascular system. Blood flow is affected by pressure differences, radius of the vessel, length, and viscosity (Poiseuille's Law). Flow is directly proportional to the difference in pressure and inversely proportional to resistance. Any disturbance in blood flow in the arterial and venous system disrupts the delivery of oxygen and nutrients and the elimination of waste products. Disturbances of blood flow can be due to compression of the blood vessel (edema, hematoma, compartment syndrome), structural changes within the vessel (atherosclerosis), vasospasm (Raynaud's syndrome), vasodilatation (sepsis, distributive problems), or blood clot (thrombus or embolus). Decrease in perfusion will promote compensatory mechanisms such as vasodilatation, development of collateral vessels, and anaerobic metabolism. If compensatory mechanisms are unable to meet the oxygen demand by the tissues, ischemia develops, and eventually, tissue death occurs.
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PMID:Peripheral vascular anatomy, physiology, and pathophysiology. 749 55

Leg pain in the athlete is common and has many different etiologies. The most common causes include muscle or tendon injury, medial tibial stress syndrome, stress fracture, and exertional compartment syndrome. Less common causes of leg pain include lumbosacral radiculopathy, lumbosacral spinal stenosis, focal nerve entrapment, vascular claudication from atherosclerosis, popliteal artery entrapment syndrome, and venous insufficiency. This article reviews the essential history and physical examination findings and the various causes of leg pain to help the clinician pinpoint the diagnosis and facilitate the athlete's return to sport participation.
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PMID:Differential diagnosis of leg pain in the athlete. 1286 3

A 55-year-old man was hospitalized for endovascular stent placement in both right common iliac and femoral arteries for relief of claudication symptoms due to peripheral vascular disease. Angiography demonstrated diffuse atherosclerosis of the infrarenal aorta and severe stenosis of the right common iliac and right femoral arteries. Physical examination showed diminished but palpable peripheral pulses. Uncomplicated stent placement was done in the right common iliac and right femoral arteries via a left femoral artery approach resulting in improved pedal pulses. Over the next 36 hours, the patient developed severe bilateral lower extremity pain followed by extensive livedo reticularis over lower extremities, elevated creatine kinase levels, myoglobinuria, and a rise in serum creatinine to 1.5 mg/dL (133 micromol/L). Pedal pulses continued to be palpable. This was followed by bilateral lower extremity compartment syndrome, requiring fasciotomies. Myoglobinuria cleared with hydration and creatinine kinase levels returned to normal; however, the patient ultimately developed gangrene of both lower extremities. Bilateral below the knee amputations were performed and histopathology showed wide spread cholesterol crystals in arterioles and small and medium sized arteries in skin and muscle of both lower extremities. This case emphasizes the potential for major complications of cholesterol embolism associated with even uncomplicated vascular procedures performed for treatment of peripheral vascular disease.
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PMID:Catastrophic cholesterol crystal embolization after endovascular stent placement for peripheral vascular disease. 1848 Jun 61

Compartment syndrome of the arm is a rare condition because of the large capacity of the arm compartment. Although several cases of compartment syndrome of the forearm associated with vascular access procedures have been reported, the literature contains few detailed reports of compartment syndrome of the arm caused by transcather angiography or angioplasty. This article presents 4 cases of compartment syndrome of the anterior arm caused by transcatheter angiography or angioplasty; all patients required surgical treatment and anticoagulation therapy. Following urgent fasciotomy and hemostasis, 1 patient experienced recurrent bleeding and another exhibited delayed complex regional pain syndrome of the forearm. The remaining 2 cases had good outcomes. Because all patients had been prescribed various oral anticoagulants, their compartment syndrome was considered a complication of thrombolytic therapy. In addition, because all patients had a history of multiple arterial diseases, atherosclerosis was considered to be severely advanced and the vessels to be easily damaged. Due to the authors' experiences with these 4 cases, they recommend that surgery be performed under general rather than local anesthesia and that the bleeding site be sutured or ligated. Compression of the bleeding point alone could allow heavy bleeding or recurrence of bleeding to occur because of the influence of anticoagulation therapy. Continuous bleeding of the arm may expand into the volar compartment of the forearm, leading to a condition similar to chronic compartment syndrome. Effective hemostasis, in addition to early decompressive fasciotomy, is essential in compartment syndrome caused by the catheter procedure.
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PMID:Compartment syndrome of the arm caused by transcatheter angiography or angioplasty. 2327 44

Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood-brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.
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PMID:The primary vascular dysregulation syndrome: implications for eye diseases. 2374 77

Acute limb ischemia (ALI) is caused by embolisms or progressive atherosclerosis. We report the case of a 68-year-old female who presented with acute total occlusion of left iliac artery due to remarkably massive ascites from pancreatic cancer. To our knowledge, no other case reports of ALI caused by acute compartment syndrome have been published. We treated our case successfully by draining the ascites fluid without any balloon angioplasty or stent implantation. The removal of extrinsic compression may be the best treatment for cases of this type.
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PMID:Acute limb ischemia due to abdominal compartment syndrome. 2378 12

Although most cases of vasculogenic intermittent claudication are caused by atherosclerosis, there is an important minority of cases that are due to nonatherosclerotic causes. Because of their rarity and younger population affected, often without traditional atherosclerotic risk factors, there is frequently a significant delay in diagnosis of nonatherosclerotic peripheral arterial diseases by several months to years in some cases. Here, we review the literature on nonatherosclerotic causes of lower extremity claudication, symptoms, management including surgical and endovascular interventions, and outcomes. Conditions included are popliteal artery entrapment syndrome, cystic adventitial disease, pseudoxanthoma elasticum, persistent sciatic artery, fibromuscular disease, giant cell arteritis, iliac endofibrosis, neurogenic claudication, and chronic exertional compartment syndrome.
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PMID:Basic data underlying decision making in nonatherosclerotic causes of intermittent claudication. 2527 47


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