Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We attempted percutaneous transluminal angioplasty in 70 patients with obliterative atherosclerosis of the femoral, popliteal, and tibial arteries. Patients with limb threatening ischemia (rest pain, nonhealing ulcer, or gangrene) or lifestyle-limiting claudication were acceptable candidates. Stenoses less than 4 cm long or occlusions less than 10 cm long and less than 2 years old were considered favorable for angioplasty, but less desirable lesions were accepted for limb salvage. Patients with increased surgical risk, inadequate saphenous veins, poor runoff, or in whom temporizing was necessary or desirable, were offered angioplasty for revascularization as an alternative to surgical reconstruction. Technical success was achieved in 62 (88%) of 70 patients with five early failures for an overall initial success rate of 57 (81%) of 70. Complete relief of clinical symptoms was achieved in 53 patients (92%) and 54 had improved lower limb perfusion when measured noninvasively. Patency rate at 1 year was 89% +/- 5% and in 2 years 84% +/- 6% by life table analysis. Major complications occurred in eight (11.4%) of 70 procedures. We conclude that angioplasty of femoral, popliteal, and tibial vessels is an effective and safe alternative to traditional surgical bypass grafting for revascularization of the ischemic lower extremity. Early patency rates are comparable to saphenous vein grafts and considerably better than prosthetic reconstruction.
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PMID:Femoral, popliteal, and tibial arteries: percutaneous transluminal angioplasty. 677 70

Necrotic angiodermatitis, as defined and described by the School of Lyon and especially by D. Colomb, stays at the confines of dermatology and angiology. Its diagnosis is easy in front of such "cutaneous gangrene in superficial plates". In fact it is a microangiohistopathy, it appears like an infarction of the skin, due to atherosclerosis and so to senescence, it means a low flow of perfusion and perhaps relates to immunology.
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PMID:[Necrotic angiodermatitis]. 684

Forty patients with mesenteric vascular occlusion were observed over a ten-year period. The main clinical findings were abdominal tenderness (in 80% of the patients), abdominal pain (in 83%), guarding and rigidity (in 60%) and vomiting. At operation, twelve patients (30%) had massive gangrene of the small and large bowel, 10 (25%) of the small bowel alone, and six (15%) had subsequent gangrene of the small bowel. Atherosclerosis with thrombosis of the superior mesenteric artery was found in 70% of cases, and embolism in 17.5%. Mortality was 77.5%. Nine patients (22.5%) who underwent resection survived.
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PMID:Acute mesenteric vascular occlusion: a review of 40 cases. 722 44

The effect of TTC-909 (isocarbacyclin methyl ester (CAS 88931-51-5, TEI-9090) incorporated into lipid microspheres) on obstruction of the peripheral artery was studied in two different animal models. The first was a peripheral occlusion model induced by intra-arterial injection of sodium laurate in rats. The second was a tail gangrene model induced by subcutaneous injection of both ergotamine and epinephrine in rats. Intravenous bolus-administered TTC-909 at 1.0 microgram/kg resulted in the inhibition of both progression of lesions induced by sodium laurate and the extension of tail gangrene by ergotamine and epinephrine. Moreover, the inhibitory effect of TTC-909 was more potent than that of PGE1 (LM) (prostaglandin E1 incorporated into lipid microspheres). These findings suggested that TTC-909 may be clinically useful for the therapy of peripheral vascular disorders such as thromboangiitis obliterans (TAO) and atherosclerosis obliterans (ASO).
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PMID:Effect of isocarbacyclin methyl ester incorporated in lipid microspheres on experimental models of peripheral obstructive disease. 748 20

The syndrome of progressive ischemic gangrene (PIG) of the extremities was examined over 3.5 years in patients undergoing maintenance dialysis (MD) in Kuwait and was compared to that in a similar age group (> 40 years) in the general population. The incidence of PIG in MD patients was 15.4/1000 person years of observation (PYO) versus 0.086/1000 PYO in the general population. Patients with diabetes mellitus were found to be at particular risk. PIG developed in 41.4/1000 PYO of diabetic patients who received MD, compared to 7.1/1000 in nondiabetic patients on MD and 0.14/1000 in diabetics without renal disease. The clinical, biochemical, radiological, and histological findings in the 8 patients who developed PIG while on maintenance dialysis (MD) are presented. Two patients had severe hyperparathyroidism and their histological findings were consistent with systemic calciphylaxis. Histological examination, in the remaining patients, showed severe calcified atherosclerosis. Intimal hypertrophy was common especially in patients with long duration on dialysis. The three lesions produced a variable degree of luminal narrowing and were associated with arterial thrombosis. None of the patients showed evidence of iron deposition even in those with systemic calciphylaxis and excessive iron stores. Our study indicated a high incidence of PIG in patients undergoing MD, especially in those with diabetes mellitus. These findings constitute a cogent argument in favor of early parathyroidectomy in selected cases and concern with long-term consequences of atherosclerosis in this patient population.
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PMID:Progressive ischemic gangrene in dialysis patients: a clinicopathological correlation. 756 14

Five patients with a "blue or purple" toe syndrome due to atheromatous embolization probably precipitated by oral anticoagulant therapy are reported. In four, the symptoms started a few weeks after initiation of oral anticoagulants and in the fifth they were clearly aggravated by coumarinic drugs. Prior to anticoagulation, one patient had received a course of thrombolytic therapy and two had undergone an arterial catherization without embolic events. A diagnostic arteriography performed in four patients caused no new symptoms. All patients had advanced atherosclerosis. A shaggy aorta and/or pelvic arteries were found in four and in the fifth a highly stenotic femoral lesion appeared the source of peripheral embolization. Oral anticoagulants were interrupted in all five and four underwent reconstructive vascular surgery to eradicate the nidus of atheromatous emboli. One died postoperatively from multiple organ failure. The poor condition of the fifth patient precluded aorto-iliac surgery. No new episodes of embolization occurred and the symptoms disappeared, although one patient needed a toe amputation for a skin lesion that had proceeded to gangrene. The possible role of anticoagulant drugs in precipitating atheromatous embolization is discussed and the importance of recognizing the syndrome is emphasized.
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PMID:Atheromatous embolization precipitated by oral anticoagulants. 782 5

Peripheral obstructive arterial disease (POAD) of the lower limbs is the third main complication of atherosclerosis, after coronary artery disease and cerebrovascular disease. In 15-20% of cases POAD have an unfavourable evolution toward critical leg ischemia (CLI). This clinical condition is characterized by the onset of rest pain and/or trophic cutaneous lesions until gangrene appears. In some cases amputation is needed. The pathophysiological, clinical and therapeutic aspects of CLI were recently discussed in two Consensus Conferences held in Berlin in 1989 and in Rudesheim in 1991, with the elaboration of a final draft published on circulation. CLI appears when peripheral perfusion critically decreases due to macro and microcirculatory alterations. Atherosclerotic plaque is the primum movens, but often there are more plaques in sequence along the ilio-femoro-popliteal axis. The pathophysiological and clinical consequences are more severe if the stenosis is haemodynamically important, after a rapid progression of plaque growth or when thrombotic complications develop. The reduction in distal perfusion induces troubles in the microcirculation and an embalancement between the microvascular defense system (MDS) and the microvascular flow regulating system (MFRS) with endothelial dysfunction, platelet and leucocytes activation, worsening of blood viscosity due to the increase in fibrinogen levels and to the red cells deformability changes, activation of coagulation and impairment of fibrinolysis. So, a vicious circle appears with further worsening of distal perfusion and onset of trophic lesions. A further worsening of CLI can derive from local recurrent infections particularly frequent in diabetic patients.
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PMID:[The physiopathology of critical ischemia of the lower limbs]. 811 25

Various kinds of surgical technique have been utilized for vascular reconstruction for arteriosclerotic arterial occlusive disease (ASO). In general concept, application of thromboendarterectomy is limited to the segmental occlusive aortoiliac atherosclerosis and bypass surgery can be used for almost all types of arterial occlusion. Patency result after bypass surgery are well established and the five year patency rates reveal more than 90% in aortoiliac disease, 75-80% in femoropopliteal disease, and around 70% in crural reconstruction respectively. Despite of these recent advances of reconstructive vascular surgery, there have been augmented several controversies in surgical treatment of ASO. How to treat multisegmental lesion which is characterized by high incidence of ischemic ulcer or gangrene. What is the treatment of choice for high risk patient especially with ischemic heart disease. In Japan, aged patient over 80 have been increasing and they are frequently complicated with limb threatening ischemia and usually grouped into high risk patient. Endovascular intervention, which is developed under the basis of recent technology, is the one of the topics of treatment of peripheral vascular disease. Its long term results, however, are not sufficiently evaluated and how to select the proper reconstructive procedures including the endovascular intervention for high risk patient is remained to be controversy.
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PMID:[Surgical treatment of arteriosclerotic arterial occlusive disease]. 841 80

Epidemiologic studies have identified lipoprotein(a) (Lp(a)) as an independent risk factor for atherosclerosis, mainly for coronary heart disease. Atherosclerosis is the most common cause of death in diabetic patients, but there is little information available concerning the importance of Lp(a) in these patients. We compared the presence or absence of late diabetic complications with Lp(a) serum concentrations in 224 patients (82 IDDM, 142 NIDDM). Lp(a) distribution was skewed as described for non-diabetic patients. Despite highly significant differences for total cholesterol, total triglycerides, HDL-cholesterol, VLDL-cholesterol and VLDL-triglycerides (P < 0.001) and for LDL-cholesterol (P < 0.01) Lp(a) concentrations were similar in NIDDM and IDDM (mean: 27 vs. 30, median: 12 vs. 21 mg/dl, P = 0.10). Diabetic polyneuropathy, autonomic neuropathy, nephropathy, peripheral occlusive disease, diabetic gangrene and coronary heart disease were not associated with raised Lp(a) values. Non-insulin-dependent patients with retinopathy exhibited higher Lp(a) concentrations in serum than those without this complication. This significant association was lost when duration of diabetes was taken into account by logistic regression. We conclude, that other risk factors surpass the significance of Lp(a) in diabetic patients.
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PMID:Lipoprotein(a) in diabetes mellitus. 845 77

Atherosclerosis, the principal cause of heart attack, stroke and gangrene of the extremities, is responsible for 50% of all mortality in the USA, Europe and Japan. The lesions result from an excessive, inflammatory-fibroproliferative response to various forms of insult to the endothelium and smooth muscle of the artery wall. A large number of growth factors, cytokines and vasoregulatory molecules participate in this process. Our ability to control the expression of genes encoding these molecules and to target specific cell types provides opportunities to develop new diagnostic and therapeutic agents to induce the regression of the lesions and, possibly, to prevent their formation.
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PMID:The pathogenesis of atherosclerosis: a perspective for the 1990s. 847 18


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