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

175 by-pass operations were performed for femoro-popliteal atherosclerosis during the period January 1967-April 1975. 154 were femoro-popliteal vein by-pass grafts. The material in addition includes 12 distal tibial arterial by-pass grafts, 6 homologous vein grafts, 2 Sparks prosthesis and 1 dacron graft. In the femoro-popliteal vein by-pass group 51% were operated for rest-pain or distal gangrene, while 49% had intermittent claudication. The 4 year patency rate in the two groups was 54% and 66% resepctively and was more favourable when the distal anastomosis was placed above than below the knee. However, the latter group had more severe ischaemic symptoms and the difference is probably in part due to case selection. The results were also more favourable when the proximal anastomosis was placed on the common femoral artery. The operative mortality was 38%. Vein by-pass to the lower leg arteries had a 2 year patency of only 34%. Semi-closed endarterectomy is preferred to homologous vein, Sparks prosthesis or dacron grafts where no sufficient vein for grafting exists. It is concluded that saphenous vein by-pass is the method of choice in patients where femoro-popliteal reconstruction is indicated.
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PMID:By-pass grafting for femoro-popliteal atherosclerosis. 14 81

It appears that the classical concept of atherosclerosis cannot be applied indiscriminately to all cases and that it is essentially valid for the aorta and its large branches of predominantly elastic structure. When more peripheral arterial trunks are considered, those of muscular type, the lesions are in great part characterized by a dystrophic fibrosis of the media, associated with a diffuse intimal thickening and with stratified fibro-hyaline plaques narrowing the lumen; the latter are responsible for the circulatory insufficiency and gangrene. Comparative analysis of 50 surgical specimens allow us to conclude that those fibro-hyaline plaques represent progressively stratified parietal thrombi that are populated by myocytes, at the contact of which ultrastructural investigation reveals important phenomena of elastogenesis and elastolysis. Most probably, the myocytes originate from the media, through fenestration within the inner elastic membrane. These facts have more than just a purely speculative interest: they express the great plasticity of the arterial walls and their capacity of adaptation to new hemodynamic and biologic conditions. It is interesting to note that this lesion constantly presents signs of metabolic activity and structural remodeling despite its long standing caracter.
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PMID:[Anatomic pathological aspects of chronic obliterating arteriopathies of the extremities (author's transl)]. 22 62

Present methods of management of juvenile-onset diabetes mellitus do not prevent serious and debilitating complications affecting multiple organ systems. In an effort to reverse advanced forms of these complications, segmental transplantation of the pancreas has been performed on 10 patients, seven of whom simultaneously or subsequently received renal transplants. Long periods of normoglycemia (two to four and one-half years) were achieved in two patients who also maintained transplant kidney function. The course of these two patients is described to illustrate the possible value and limitations of the procedure. These patients had normal blood glucose levels, exhibited repeated normal intravenous glucose tolerance curves, and had repeated normal endogenous insulin levels. Their courses were characterized by (1) absence of problems related to pancreatic exocrine secretions into the bladder; (2) stable eye changes despite some episodes of hemorrhage from preexisting retinopathy; (3) vascular complications, including stroke and gangrene of extremities necessitating amputation despite successful femoropopliteal bypass grafting; (4) peripheral neuropathy; and (5) repeated infections. Both patients succumbed to vascular complications. Thus, pancreatic transplantation can maintain blood glucose and insulin at normal levels for extended periods of time. However, it does not reverse such complications as advanced retinopathy or atherosclerosis. Since the procedure may have value in preventing progression of these complications, it should be evaluated in patients with less advanced complications of diabetes.
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PMID:Long-term effects of pancreatic transplant function in patients with advanced juvenile-onset diabetes. 40 Jan 24

One hundred and thirty-one reconstructions to the popliteal (n = 80), tibial (n = 26), and peroneal (n = 25) arteries were performed using glutaraldehyde (GA)-tanned human umbilical cord veins. Cumulative patency rates to 20 months, calculated by the standard life-table method were 84.8%, 74.0%, and 49.6% for popliteal, tibial, and peroneal reconstructions, respectively. The latter included many of the early cases with extremely advanced obliterative atherosclerosis and gangrene. These results are equivalent and even superior to those obtained with saphenous veins, particularly when the cases are analyzed in distinct clinical and pathological categories. The quality of the runoff was the major determinant in obtaining long-term patency and limb function. The primary factor accounting for graft closure was progression of the atherosclerotic process in the distal circulation. No failures could be attributed directly to the graft. This clinical experience confirmed previous data showing the unique properties of the GA-tanned umbilical vein. It is anticipated that longer-term follow-up will continue to show the superior qualities of this new vascular substitute.
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PMID:Evaluation of glutaraldehyde-tanned human umbilical cord vein as a vascular prosthesis for bypass to the popliteal, tibial, and peroneal arteries. 41 13

Smoking is the most prevalent 'risk factor' causing atherosclerosis. The association is strongest for disease in arteries to the legs. Continued smoking worsens claudication, increases the risk of progression to gangrene, and decreases long-term patency rates of arterial reconstructions.
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PMID:Relationship of smoking to peripheral arterial disease. 48 64

216 limbs in 180 patients were operated upon for aorto-iliac atherosclerosis during the period of 1967 to 1974. 45% were operated on for rest-pain or gangrene, while 55% had intermittent claudication. Four year patency following semi-closed end-arterectomy was 85% whereas 83% and 74% 4 year patencies were observed after open endarterectomy and synthetic by-pass grafting. However, synthetic by-pass grafts were used in patients with the most extensive atherosclerosis. Femoro-femoral and axillo-femoral subcutaneous by-pass grafts may be useful alternatives when contraindication exists against direct reconstruction of the aorta or the iliac arteries. The operative mortality was 6.7%. Eleven patients were reoperated for bleeding and 10 for early reocclusion. A good result was obtained in 14 of these cases. The indications for the different operative techniques are discussed. It is concluded that both prosthetic by-pass grafting and endarterectomy have a definite place in the treatment of aorto-iliac atherosclerosis.
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PMID:Surgical treatment of aorto-iliac atherosclerosis. 85 53

303 limbs in 270 patients were operated by endarterectomy for femoro-popliteal atherosclerosis from January 1967 to April 1975. 236 reconstructions were carried out as semi-closed endarterectomy. Sixty-seven open endarterectomies were performed during the same period. In the 2 groups 37% and 33% respectively of the patients were treated for rest-pain and distal gangrene. The remaining patients had intermittent claudication as the main symptom. The operative mortality of the two groups were 2.5% and 4.5% respectively. Although the early results were encouraging, the long-term patency following semi-closed endarterectomy was significantly lower than after saphenous vein by-pass. Open endarterectomies had the same 5-year patency as vein by-pass grafts. This may at least partly be due to case selection, since open endarterectomy was mainly used for short obstructions in limbs with good run-off. Even if fair results may be obtained when semi-closed endarterectomy is performed between 2 arteriotomies above the knee in limbs with good run off, we recommend this method only to be used in cases with insufficient vein for by-pass grafting and sometimes for the treatment of short obstructions of the superficial femoral artery. Since the choice of operative method often has to be done during operation, familiarity with both methods is necessary.
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PMID:Endarterectomy for femoro-popliteal atherosclerosis. 85 54

Fourty-five reconstructions of the profunda femoris artery were performed in 41 patients during the period from 1972 to 1974. 78% were operated upon for pain at rest or distal gangrene. Three patients died postoperatively and in 5 cases the reconstruction failed to save the limb. In 1 additional case the operation probably lowered the amputation level to below knee. There was only 1 late occlusion. In the present material profundaplasty alone or combined with iliac reconstruction could relieve rest pain and save limbs when no other possibilities except amputation existed. However, when significant obstruction of the profounda femoris artery is demonsrated by angiography, profundaplasty should probably be perferred to femoro-popliteal reconstruction in most cases since it represents a minor operation with encouraging long-term results. Lateral angiograms of the deep femoral artery should supplement conventional angiography or lower limb atherosclerosis.
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PMID:The place of profundaplasty in surgical treatment of lower limb atherosclerosis. 89 87

Controversy exists as to whether regression occurs in atherosclerotic plaques in response to serum cholesterol reduction. In the present study, using sequential observation of canine atherosclerosis, we attempted regression in hypothyroid dogs. Animals with established lesions prior to a regression attempt were placed on a 0.05% cholesterol diet and observed up to 60 months. Weighted average cholesterols ranged from 235 to 587 mg/100 ml during the regression attempt. A control fed for the entire period of the experiment, 75 months, had an average weighted cholesterol of 435 mg/100 ml. We failed to obtain regression of atherosclerotic plaques in spite of reduction of serum cholesterol from high to moderate levels. The lesions in the experimental animals contained less lipid and more collagen and calcium than occurred in the control. Complicated plaques with aneurysm formation, stenosis of the distal aorta, and gangrene of the tail were also noted.
Atherosclerosis 1977 Jul
PMID:Failure of regression of atherosclerosis in dogs with moderate cholesterolemia. 90 27

Thirty-one aneurysms of the popliteal artery in 23 patients have been studied. Twenty-nine aneurysms were secondary to atherosclerosis, while one was secondary to trauma and one was associated with a coagulopathy. The lesions were bilateral in eight patients and were associated with extra-popliteal aneurysms in ten patients; the abdominal aorta was the most frequent extrapopliteal site. All except two of the 23 patients were over 50 years of age, and many exhibited atherosclerosis and related symptoms in other vessels. Ischemic rest pain was the most common presenting symptom in patients with popliteal aneurysm, but three of the patients were asymptomatic. The most common physical sign was a palpable popliteal mass in 25 patients, with impending gangrene distal to the aneurysm in four. Thrombosis occurred in 11 of the aneurysms, embolism in three, and rupture in two. Amputation was eventually necessary in five patients with thrombosis and in one patient with embolism. Of 16 patients presenting with a complication of popliteal aneurysm, six patients eventually required amputation. All popliteal aneurysms should be treated surgically and arterial continuity restored unless contraindicated by the over-all condition of the patient. The saphenous vein represents the optimal replacement material available at this time, but fabric grafts can be used successfully.
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PMID:Aneurysms of the popliteal artery. 111 29


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